Failure to Provide Ordered Double Meal Portions per Resident Preference
Penalty
Summary
The deficiency involves the facility’s failure to honor a resident’s meal preference for larger portions despite a physician’s order and the resident’s repeated requests. During an initial interview, Resident J reported that he had asked for more food with his meals for quite some time but continued to receive regular, small portions and felt hungry between meals. Observation of his lunch tray showed that he did not receive double portions when compared to a regular tray, and his meal ticket did not document any order for double portions. Record review showed that Resident J had COPD, unspecified dementia with moderate cognitive deficit, required set-up assistance with eating, and was care planned as being at risk for malnutrition, with interventions including meals as ordered by the physician. A physician’s order dated 1/26/26 directed that he receive a regular diet with double portions per his request. Interviews and documentation revealed confusion and lack of clarity in the dietary system for indicating portion sizes and special meal preferences. The Dietary Manager initially stated that the resident’s ticket showed “4 HLF,” which she said meant double portions, while regular tickets showed “2 HLF,” but the observed lunch tray did not reflect double portions, and the resident choice meal tickets did not show any deviation in portion size. Two dietary staff members reported they did not know what “2 HLF” and “4 HLF” meant and indicated that double portions should be explicitly written on the ticket. The Registered Dietician confirmed there was an issue with meal tickets not clearly indicating portion sizes or special resident choice meals, and that the resident’s ticket did not indicate double portions. The facility’s Resident Rights policy stated that residents’ individuality and input through self-determination would be respected, but Resident J’s expressed preference and physician-ordered double portions were not implemented as ordered.
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