Failure to Provide Ordered Double Protein Portions for Two Residents
Penalty
Summary
The deficiency involves the facility’s failure to follow physician and RD diet orders for double portions or double protein portions for two residents. One resident was admitted with hypothyroidism and a history of unintentional weight loss and had a physician order for a regular diet with double portions for weight management. The RD documented that the resident had a good appetite, usually ate 75–100% of meals, and that adding double portions to all meals helped stabilize the resident’s weight. The care plan directed staff to provide the diet as ordered and monitor intake, and the MDS showed the resident was cognitively intact and had no recent weight gain or loss. During a lunch observation, the resident’s meal ticket indicated a regular diet with double portions, but the tray contained only two chicken tenders, one serving of mashed potatoes, one serving of cabbage, and one dinner roll. The resident reported he was supposed to receive double portions and stated he had only received double portions approximately twice since admission, adding that he could eat four chicken tenders. The Dietary District Manager confirmed that double portions meant two servings of protein and that the resident should have received four chicken tenders. The Dietary Manager and Dietary Aide #1 both acknowledged that, given the physician order for double portions, the resident should have received four chicken tenders and that the aide, who was responsible for checking tray accuracy, had overlooked the missing double portion. A second resident, admitted with diabetes and adult failure to thrive, had a nutrition care plan noting nutritional risk related to multiple comorbidities, abnormal nutrition-related labs, and the need for a texture-modified diet. Interventions included RD evaluation and serving the diet as ordered. The MDS showed moderate cognitive impairment, dependence on staff for eating, a mechanically altered diet, and nutrition/hydration interventions for skin problems. The RD progress note documented a current order for a mechanical soft diet with double protein portions and end-of-life skin failure at multiple sites, and the physician’s order specified a mechanical soft diet with double protein portions. Observation of this resident’s lunch tray showed a chicken salad sandwich, potato salad, chopped broccoli salad, and mandarin oranges; the sandwich appeared uniformly thin with bread edges touching, indicating it did not contain a double protein portion. The RD later stated that double protein meant double meat in sandwiches, and the Dietary Manager explained that double protein portions should be plated using a #8 scoop so that the meat would be visibly thicker and prevent the bread from fully meeting, confirming that the observed sandwich did not meet the ordered double protein portion.
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