§483.60(d) Food and drink
Each resident receives and the facility provides-
§483.60(d)(1) Food prepared by methods that conserve nutritive value, flavor, and appearance;
§483.60(d)(2) Food and drink that is palatable, attractive, and at a safe and appetizing temperature.
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Observations:
Based on observation, review of facility policy, test tray results, and interviews with staff and residents, the facility failed to serve meals that were palatable and maintained at a safe and appetizing temperature for 6 of 10 residents sampled (Residents 2, 3, 5, 6, 7, and 8).
Findings include:
According to the federal regulatory guidance at 483.60(i)-(2) Food safety requirements - the definition of "Danger Zone," found under the Definitions section, is food temperatures above 41 degrees Fahrenheit and below 135 degrees Fahrenheit that allow rapid growth of pathogenic microorganisms that can cause foodborne illness.
On April 1, 2025, at 8:20 a.m., an observation was made of a breakfast cart on the second floor, positioned directly across from the elevator with no staff present to distribute trays. Upon re-observation at 8:45 a.m., the cart remained in the same location, and staff were just beginning to pass trays at that time.
A test tray evaluation was conducted on the last tray from the same cart at 8:48 a.m. The regular diet meal included waffles, ham, hot cereal, and coffee. Food temperatures were as follows:
Waffles: 100.389.2cereal: 115.3156waffles were soggy and mushy, the ham was cold, and the cereal was not palatable, all due to being served below the required 135minimum. These temperatures fall within the "Danger Zone," defined as above 41and below 135which allows the rapid growth of harmful bacteria.
An interview with Resident 2, a cognitively intact resident, on April 1, 2025, at 9:30 a.m., revealed the facility's food was served cold most times and that the food was not palatable.
An interview with Resident 3, a cognitively intact resident, on April 1, 2025, at 9:40 a.m., revealed the facility's food was often served cold and the food was not palatable.
An interview with Resident 5, a cognitively intact resident, on April 1, 2025, at 9:50 a.m., revealed the facility's food was often served cold.
An interview with Resident 6, a cognitively intact resident, on April 1, 2025, at 10:00 a.m., revealed the facility's food was often served cold and not palatable.
An interview with Resident 7, a cognitively intact resident, on April 1, 2025, at 10:40 a.m., reported food was cold due to delays in tray passing, as carts often remained in hallways.
An interview with Resident 8, a cognitively intact resident, on April 1, 2025, at 10:45 a.m., revealed the facility's food was often served cold and she stated, " it has been getting worse lately".
An interview with the Nursing Home Administrator on April 1, 2025, at approximately 12:20 p.m. confirmed that food must be palatable and served at safe and appetizing temperatures. The dietary manager acknowledged the test tray results did not meet regulatory or facility standards.
The facility failed to maintain appropriate food temperatures which resulted in meals that were not safe, appetizing, or palatable, affecting resident satisfaction and increasing the risk of foodborne illness.
28 Pa. Code 201.18 (e)(3) Management
| | Plan of Correction - To be completed: 04/29/2025
The facility cannot retroactively r the cited deficiency.
Meals that are being served are palatable, attractive, and at a safe and appetizing temperature.
The Dietary Manager/Designee will re-educate the dietary staff on the facility's Test Tray and Point of Service Food Temperatures policy. The ADON/designee will re-educate nursing staff on timely pass of resident meal trays to help to ensure safe temperature of meals.
The Dietary Manager/designee will audit all three meals weekly x 4, then monthly x 3 to ensure acceptable temperatures are served and that they are palatable and attractive on the tray line. Any variations will be corrected immediately and/or offered as training to staff to ensure compliance. The Dietary Manager/designee will audit all three meals weekly x 4, then monthly x 3 on the units to ensure that trays are being served timely and what is being served is palatable, attractive, and that the temperatures are in an acceptable range. Any variations will be corrected immediately and/or offered as training to staff to ensure compliance. The results of these audits will be discussed at the facility QAPI meeting monthly for further review and recommendations.
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