Health inspection·October 5, 2023

F 0806 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure each resident receives and the facility provides food that accommodates resident allergies, intolerances, and preferences, as well as appealing options. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to provide food that accommodated resident ' s preferences for one of four sampled residents (Resident 1). This failure had the potential to result in inadequate food intake, weight loss, and emotional distress. Findings: During a review of Resident 1's admission Record, the admission Record indicated Resident 1 was admitted to the facility on [DATE] with diagnoses that included fracture of the right second metatarsal bone (long bone of the second toe), anemia (lower than normal amount of healthy red blood cells), and chronic migraine. During a review of Resident 1's Minimum Data Set (MDS, a resident assessment instrument used to identify resident care problems to be addressed in an individualized care plan.) dated 9/6/23, the MDS indicated a Brief Interview for Mental Status (BIMS, a scoring system used to determine the resident's cognitive status in regard to attention, orientation, and ability to register and recall information) score of 15 (a BIMS score of 13-15 is an indication of intact cognitive status). During an interview on 10/5/23 at 10 a.m. with Resident 1, Resident 1 expressed frustration over getting food items that were not her preferences. Resident 1 stated telling Certified Dietary Manager (CDM) what food items Resident 1 could not have because of her multiple medical conditions. Resident 1 stated everybody in the facility knew she could not have onions, bell peppers, pineapples, anything spicy, anything that had breading, food that had vinegar, and fried foods. Resident 1 stated being frustrated, agitated, and angry about food served. During an interview on 10/5/23 at 10:33 a.m. with CDM, CDM stated Resident 1 was screened for any food preferences within 48 hours after admission to the facility. CDM stated Resident 1's dietary preferences included baked or grilled plain fish or white chicken only and no peppers. CDM stated, the past days, CDM did random meal tray checks before the Certified Nursing Assistants (CNAs) served the trays and caught the kitchen staff two times of not following what was written on the meal ticket. During a review of Resident 1's Dietary Profile/Malnutrition Risk Tool dated 8/31/23, the Dietary Profile/Malnutrition Risk Tool indicated Resident 1's food groups included meat and milk/dairy. Food Preferences was left blank with no responses. Page 1 of 2 555113 555113 10/05/2023 Lake Park Healthcare Center 1850 Alice Street Oakland, CA 94612

F 0806 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few During a concurrent observation and interview on 10/5/23 at 11:43 a.m. with Resident 1, the lunch tray for Resident 1 was observed. There was a cup of sliced mixed fruits; a bowl of vegetable salad with a light brown dressing in a separate small plastic cup; a cup of hot water; a packet of green tea; and a plate of rice, plain chicken breast, and snow peas. The small bowl of vegetable salad had shredded red bell pepper and onions. Resident 1 stated the tray was typical of what Resident 1 had been served since being admitted to the facility. Resident 1 also stated she did not know what dressing came with the salad. The meal ticket that came with the lunch tray indicated Resident 1's dislikes included onions and bell peppers. The meal ticket also indicated olive oil and lemon juice only for salad dressing. During an interview on 10/5/23 at 12:15 p.m. with Pantry Staff (PS), PS stated she made the Asian salad from shredded cabbage, carrots, almonds, red onions, green and red bell peppers, and fried noodles. PS stated she did not follow a recipe for it and made the salad from memory. PS also stated there were three kinds of vegetable salads that were served alternately that included Asian salad, which was served during lunch time; mixed green salad from shredded carrots, cucumber, cherry tomatoes, and salad dressing; and Caesar salad from romaine lettuce, parmesan cheese and croutons. During an interview on 10/5/23 at 12:18 p.m. with Dietary Services Director (DSD), DSD stated the kitchen staff were used to following recipes from the old food service company even after a new company took over. DSD stated kitchen staff did not want to follow the new recipes from this new company, they just made food from memory. DSD stated PS chopped up vegetables, tossed them all in one big bowl, divided in smaller portions and served to the residents. DSD stated Resident 1's salad was served with toasted sesame dressing and not olive oil and lemon juice as indicated in the meal ticket. DSD stated the facility did not have written policy and procedure to address residents' food preferences. 555113 Page 2 of 2