Failure to Follow Ordered Diets and Fortified Nutrition at Breakfast
Penalty
Summary
The deficiency involves the facility’s failure to provide ordered diets and nutritional interventions as prescribed for three residents, despite identified risks for altered nutrition. One resident with a history of upper right tibia fracture, muscle weakness, and osteoarthritis had physician orders for a regular diet with regular texture, thin liquids, and double entrees at all meals, including eggs, grits, and meat at breakfast due to risk for malnutrition. His care plan directed staff to provide the ordered diet and honor preferences. He reported that portion sizes, especially at breakfast, were not correct. Observation of his breakfast tray showed he did not receive double portions and received no meat, which was confirmed by a CNA and later verified by the DON against the physician’s orders. A second resident with anorexia, vascular dementia, and major depressive disorder had orders for a regular diet with regular texture, thin liquids, and fortified cereal and fortified eggs at breakfast, with a care plan addressing potential alteration in nutrition and interventions to provide the ordered diet, honor preferences, and offer nutrient-dense foods. Observation of this resident’s breakfast showed that fortified cereal was not provided, which was confirmed by a CNA and verified by the DON against the physician’s orders. A third resident with chronic atrial fibrillation, COPD, and nicotine dependence had orders for a no added salt, mechanical soft diet with thin liquids and fortified cereal and fortified eggs at breakfast, with a care plan to provide the ordered diet and honor preferences. Observation of this resident’s breakfast tray showed that fortified cereal was not provided, which was confirmed by the Corporate Dietary Manager. The Dietary Manager reported that two new employees on the trayline being trained must have missed the fortified cereals. The facility’s “Food First Program” policy stated that honoring resident food and beverage preferences and incorporating them into the diet is an effective intervention when managing nutritional status.
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