Failure to Honor Resident Representative’s Diet Preferences and Fully Evaluate Diet Needs
Penalty
Summary
The deficiency involves the facility’s failure to honor a resident representative’s request to change a resident’s diet from full liquid to a soft/mechanical consistency, despite evidence the resident could tolerate soft foods and that the liquid diet was not ordered for swallowing concerns. Surveyors observed the resident being fed full liquid meals, including broth, yogurt, supplements, pudding, and juice, which she took via spoon and straw without difficulty. A CNA who frequently assisted with meals reported the resident ate well and did not exhibit choking, coughing, or other eating concerns. The resident’s diagnoses included Alzheimer’s disease, dementia, COPD, acute kidney failure, and issues concerning food and fluid intake, and a prior hospital nutrition note documented that the full liquid diet was intended to promote nutritional intake due to hypernatremia and poor intake, not because of dysphagia. The resident’s POA reported that before a recent hospitalization for dehydration and malnutrition, the resident had been on soft foods and that the family had continued to feed her soft items such as mashed potatoes and cottage cheese without any swallowing difficulty. The POA stated the family had repeatedly requested a change from a liquid diet to a mechanical soft diet but were told by the facility that the diet order would not be changed. In a care plan meeting, the family reported being able to feed the resident cottage cheese, pudding, and yogurt in the hospital without problems, and were informed by the Administrator that a legal waiver would be needed if the family chose to feed foods outside the liquid diet ordered from the hospital. Interviews with facility staff showed that the facility continued the full liquid diet order from the hospital and did not ensure a timely, thorough evaluation of the resident’s swallowing capabilities upon readmission. The Therapy Department Manager and DON stated that because the resident could not follow commands, she did not meet criteria for a diet change and that a swallow study could not be performed, and it was unclear why physical therapy was involved in decisions about swallow testing. The DON also stated that the facility had to follow the physician’s full liquid diet order and referenced multiple meetings with the family about their desire for a soft diet and the family’s refusal to sign a waiver. A subsequent swallow study by Speech Therapy, observed by surveyors, confirmed the resident had previously been on a soft mechanical diet and that the hospital’s liquid diet was for nutritional reasons, after which Speech Therapy initiated a pureed diet; however, the deficiency centers on the period when the facility did not act on the family’s requests or fully evaluate the resident’s diet needs in accordance with her rights to self-determination as outlined in the facility’s Resident Rights policy.
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