Failure to Provide Ordered Protein Portions and Menu Items for Pureed and Special Diets
Penalty
Summary
Menus failed to meet residents’ nutritional needs when staff did not follow prescribed portion sizes and menu items for pureed diets and special diet orders. During a noon meal service, staff used a blue scoop that provided a 2‑oz portion to plate pureed beef brisket for residents on pureed diets, despite the menu spreadsheet specifying a #6 scoop (5⅓‑oz portion) for protein. The dietary manager confirmed that residents on pureed diets received less than half of the required protein portion. For a resident with dysphagia and dementia on a regular diet with blenderized (pureed) texture and thin liquids, observation of tray plating showed no pureed bread being placed on the tray, and subsequent inspection of the resident’s plate confirmed there was no bread present, even though the menu spreadsheet required a pureed bread serving for that meal. A resident with diabetes mellitus type II, cardiomegaly, morbid obesity, and intact cognition had a care plan identifying risk for impaired skin integrity and a dietary note recommending double protein meals at lunch and dinner due to a high BMI. The physician’s diet order in the record listed a no concentrated sweets diet with regular texture and thin consistency, and the dietitian ordered double protein meals, which were correctly printed as “double protein” on the meal tickets. However, the resident reported not receiving the proper diet, and observation of a lunch tray showed two sweet potatoes, two dinner rolls, approximately one cup of shredded meat, mixed vegetables, cranberry juice, a cookie, and brown sugar, rather than the 16‑oz meat portion that would constitute double protein based on the 8‑oz single meat portion listed on the portion size spreadsheet. The dietary manager and dietitian confirmed that staff had been providing double portions instead of double protein and that the medical record diet order had not been updated to reflect the double protein order.
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