§483.60(a) Staffing
The facility must employ sufficient staff with the appropriate competencies and skills sets to carry out the functions of the food and nutrition service, taking into consideration resident assessments, individual plans of care and the number, acuity and diagnoses of the facility's resident population in accordance with the facility assessment required at §483.71.
This includes:
§483.60(a)(1) A qualified dietitian or other clinically qualified nutrition professional either full-time, part-time, or on a consultant basis. A qualified dietitian or other clinically qualified nutrition professional is one who-
(i) Holds a bachelor's or higher degree granted by a regionally accredited college or university in the United States (or an equivalent foreign degree) with completion of the academic requirements of a program in nutrition or dietetics accredited by an appropriate national accreditation organization recognized for this purpose.
(ii) Has completed at least 900 hours of supervised dietetics practice under the supervision of a registered dietitian or nutrition professional.
(iii) Is licensed or certified as a dietitian or nutrition professional by the State in which the services are performed. In a State that does not provide for licensure or certification, the individual will be deemed to have met this requirement if he or she is recognized as a "registered dietitian" by the Commission on Dietetic Registration or its successor organization, or meets the requirements of paragraphs (a)(1)(i) and (ii) of this section.
(iv) For dietitians hired or contracted with prior to November 28, 2016, meets these requirements no later than 5 years after November 28, 2016 or as required by state law.
§483.60(a)(2) If a qualified dietitian or other clinically qualified nutrition professional is not employed full-time, the facility must designate a person to serve as the director of food and nutrition services.
(i) The director of food and nutrition services must at a minimum meet one of the following qualifications-
(A) A certified dietary manager; or
(B) A certified food service manager; or
(C) Has similar national certification for food service management and safety from a national certifying body; or
D) Has an associate's or higher degree in food service management or in hospitality, if the course study includes food service or restaurant management, from an accredited institution of higher learning; or
(E) Has 2 or more years of experience in the position of director of food and nutrition services in a nursing facility setting and has completed a course of study in food safety and management, by no later than October 1, 2023, that includes topics integral to managing dietary operations including, but not limited to, foodborne illness, sanitation procedures, and food purchasing/receiving; and
(ii) In States that have established standards for food service managers or dietary managers, meets State requirements for food service managers or dietary managers, and
(iii) Receives frequently scheduled consultations from a qualified dietitian or other clinically qualified nutrition professional.
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Observations:
Based on staff interviews and observations, it was determined that the facility failed to employ staff with the appropriate competencies and skills to carry out the daily functions of the food and nutrition services department.
Finding include:
During an interview on 3/27/25, at 8:33 a.m., the Nursing Home Administrator (NHA) confirmed that the facility currently did not have a Dietary Manager and a Dietary Manager from South Hills facility has been ordering the facility food. The NHA stated that the remote Dietician who covers the facility is there a weekly. The Regional Dietician will be coming in the facility but this will be her second visit since the last Dietary Manager quit. The NHA stated that he has cooked evening meals and the Maintenance Director has been helping when able. The NHA stated that if an immediate food item is needed he goes to Walmart. The previous Dietary Manager was terminated on 2/18/25, per facility staffing records.
During an observation on 3/27/25, at 8:43 a.m., staff in the kitchen indicated they did not have a Dietary Manager and that a Dietary Manager from another facility was ordering food and came in "occasionally". A list of needed food items is on a "whiteboard" for her to order foods needed.
During a phone interview on 3/27/25, the South Hills Dietary Manager stated that she orders the facility food every two weeks and asks staff to keep a list of needed items.
During an interview on 3/27/25, at 8:33 a.m., the Nursing Home Administrator confirmed that the facility did not possess the qualifications of a Certified Dietary Manager as required.
28 Pa. Code: 211.6(c)(d) Dietary services.
| | Plan of Correction - To be completed: 05/14/2025
A qualified Dietary Manager has been hired and has accepted the full-time position effective 5/5/25. The facility continues to employ a qualified dietitian to oversee the nutritional needs of residents, ensuring that dietary requirements are consistently met. The Regional Director of Food Services has been assigned to manage the Dietary Department on an interim basis, maintaining seamless dietary services during the recruitment process for a permanent director. An assessment of current dietary staffing qualifications has been conducted to ensure compliance with regulatory standards and to address any gaps affecting resident meal services. Feedback from residents and families has been requested to address any meal service concerns promptly. The facility will maintain a proactive recruitment strategy to identify and attract qualified candidates to ensure that any future vacancies in the Dietary Manager position are promptly addressed to prevent lapses in compliance. The interim director, in collaboration with the Quality Assurance Performance Improvement (QAPI) committee, will conduct weekly audits of meal service quality for the next 4 weeks. Audit findings will be presented to the QAPI committee monthly to assess the effectiveness of corrective actions and implement further adjustments as necessary.
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