Failure to Provide Ordered Breakfast Beverages and Honor Resident Preferences
Penalty
Summary
The deficiency involves the facility’s failure to provide beverages according to residents’ diet orders and stated preferences, specifically related to breakfast juice service. Multiple residents had care plans identifying potential for altered nutrition and interventions that included providing diets as ordered and honoring food and beverage preferences. Physician orders and dietary tickets specified that these residents were to receive orange juice or other beverages at breakfast, but observations on the breakfast meal service showed that these ordered beverages were not provided. For one resident with a fracture, muscle weakness, and osteoarthritis, the care plan called for honoring preferences and the physician ordered a regular diet with thin liquids and double entrees, including eight ounces of orange juice at breakfast; the breakfast tray did not include orange juice, and the resident reported that portion sizes, especially at breakfast, were not correct. Another resident with anxiety disorder, schizoaffective disorder, and osteoarthritis, who was dependent on staff for eating, was ordered a regular pureed diet with thin liquids and was supposed to receive orange juice and coffee at breakfast, but neither beverage was on the tray. A resident with anorexia, vascular dementia, and major depressive disorder, whose care plan included nutrient-dense foods and honoring preferences, was ordered a regular diet with fortified cereal and eggs and was supposed to receive orange juice at breakfast, but did not receive it. Additional residents were similarly affected. A resident with multiple sclerosis, COPD, and schizophrenia, who had intact cognition and required supervision for eating, was supposed to receive eight ounces of orange juice at breakfast but did not. A resident with metabolic encephalopathy, diabetes mellitus, and severe protein-calorie malnutrition, whose care plan included nutrient-dense foods and honoring preferences, was supposed to receive four ounces of orange juice at breakfast but did not. Another resident with chronic atrial fibrillation, COPD, and nicotine dependence, with intact cognition and needing supervision for ADLs, was also supposed to receive four ounces of orange juice at breakfast but did not. Staff interviews revealed that two new employees on the tray line ran out of orange juice and did not substitute another type of juice, and facility documentation showed that residents not on fluid restriction were expected to receive four ounces of juice at breakfast as part of their average daily fluid intake.
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