Failure to Follow Meal Tickets, Preferences, and Substitutions for Multiple Residents
Penalty
Summary
The deficiency involves the facility’s failure to ensure its system for individualized meal service, including use of meal tickets, honoring resident preferences, and providing listed substitutions, was consistently followed. For one resident with severe protein-calorie malnutrition, weight loss, and chronic pain, the care plan and medical orders called for a regular, mechanical soft diet with thin liquids. During a meal observation, this resident was served green beans, which were documented as a dislike and were not listed on the meal ticket. The resident reported that the meal tray frequently contained incorrect items. Another resident with severe protein-calorie malnutrition, adult failure to thrive, and muscle weakness was on a consistent carbohydrate, mechanical soft diet with thin liquids. Observation showed this resident received a lunch tray with pasta, spinach, pie, and applesauce, despite the meal ticket specifying a mechanical soft chicken salad sandwich on white bread, sautéed spinach, three boiled eggs, a mechanical soft peanut butter and jelly sandwich, unsweetened applesauce, and tomato soup. The meal ticket also directed staff to offer chicken salad, tuna salad, or grilled cheese if the resident did not accept the meal. The tray did not include the ordered sandwiches, boiled eggs, or tomato soup, and the listed substitutions were not provided when the resident stated they did not eat pasta and requested tuna fish. A third resident, cognitively intact and at risk for malnutrition, had medical orders and a care plan for a regular diet with regular texture and thin liquids. During one observation, the resident’s tray contained apple juice, which was not on the meal ticket, and the resident stated the meal usually did not match the ticket. In a subsequent observation, the meal ticket listed salad, salad dressing, and cranberry juice, but the tray again contained apple juice and lacked the salad, dressing, and cranberry juice. Staff interviews confirmed that dietary and nursing staff were responsible for checking meal tickets, ensuring accuracy of trays, and not serving items listed as dislikes, and that items identified as dislikes should be removed if present on the tray.
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