Failure to Honor Resident Dietary Preferences and Assist With Menu Selection
Penalty
Summary
The deficiency involves the facility’s failure to honor and manage residents’ dietary preferences and menu choices in accordance with its own policies and physician/dietary orders. For one resident with Alzheimer’s disease and severe cognitive impairment, records showed orders for a regular mechanical soft diet with thin liquids and ice cream at lunch and dinner, along with a low BMI and moderate assistance needed for eating. Despite this, there was no documentation of updated dietary preferences, no evidence of family involvement in nutrition assessments, and no changes to the nutrition care plan over several months. The resident’s son reported that, due to her cognitive impairment, she could not remember to request alternative food items and that the family had not been asked to update preferences or informed they could complete weekly menus. Another resident, admitted with a fracture, anxiety disorder, morbid obesity, and intact cognition but dependent for all ADLs, had a physician order for a regular diet with thin liquids. The nutrition assessment and care plan noted a regular diet, set-up assistance, and some meal refusals, but did not document specific dietary preferences. This resident reported telling staff on the first day that chicken was disliked and being told the kitchen would be informed, yet continued to receive chicken. The resident also stated that daily menus were provided but staff did not consistently assist with filling them out. Review of the diet ticket confirmed a regular diet with no listed preferences or chicken dislike, and the RD acknowledged the absence of documented preferences and uncertainty about whether staff consistently passed out and assisted with daily menus. A third resident with unspecified dementia and a regular diet order had a care plan intervention to review food likes, dislikes, and meal preferences as needed. During a breakfast observation, the resident received a tray containing items such as a hard-boiled egg, oatmeal, hash brown, and a pastry, while the ticket listed cereal, hard-boiled egg, blueberry muffin, hash brown, milk, coffee, and juice. The resident appeared upset and stated only frosted flakes, coffee, and milk had been requested. A CNA confirmed the tray was incorrect and commented that dietary staff frequently made errors with residents’ orders. After the correct items were brought, the resident expressed ongoing dissatisfaction and confusion about why meals were always wrong. The RD later acknowledged awareness of this concern and stated that dietary staff were having difficulty knowing what each resident wanted. Review of facility policies showed that diets were to be determined in accordance with residents’ informed choices, preferences, treatment goals, and wishes, and regularly reviewed by the dietitian, nursing staff, and physician.
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