Failure to Follow Consistent Carbohydrate Diet Extensions for Diabetic Residents
Penalty
Summary
The facility failed to ensure that residents on physician-ordered consistent carbohydrate diets received foods in the appropriate form and nutritive content as specified by the therapeutic diet extensions. Facility policy titled "Consistency Alterations and Therapeutic Menus" stated that the regular/liberalized menu would be extended for therapeutic diets, including consistent carbohydrate diets, to provide diets as ordered by the physician/APP. The facility’s diet extension sheet for a specific lunch meal indicated that residents on a regular/liberalized diet should receive a slice of angel food cake, while residents on a consistent carbohydrate diet should receive a slice of diet angel food cake. However, during observation of the tray line meal service, multiple residents on consistent carbohydrate diets for diabetes were served regular angel food cake instead of the diet version. Review of physician orders showed that six observed residents, as well as numerous additional residents, were ordered consistent carbohydrate diets for diabetes. Despite these orders and the diet extension sheet, the Dietary Manager confirmed that the same angel food cake was served across all diet orders, without differentiation for the consistent carbohydrate diet. Review of the nutrition facts and ingredients label for the angel food cake served revealed it contained 28 grams of total carbohydrates and 20 grams of sugar, with sugar listed as the primary ingredient and no sugar substitutes present. The Nursing Home Administrator stated that he would expect therapeutic diets to be provided as ordered and for extension sheets to be followed for therapeutic diet alterations.
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