§483.60(c) Menus and nutritional adequacy. Menus must-
§483.60(c)(1) Meet the nutritional needs of residents in accordance with established national guidelines.;
§483.60(c)(2) Be prepared in advance;
§483.60(c)(3) Be followed;
§483.60(c)(4) Reflect, based on a facility's reasonable efforts, the religious, cultural and ethnic needs of the resident population, as well as input received from residents and resident groups;
§483.60(c)(5) Be updated periodically;
§483.60(c)(6) Be reviewed by the facility's dietitian or other clinically qualified nutrition professional for nutritional adequacy; and
§483.60(c)(7) Nothing in this paragraph should be construed to limit the resident's right to make personal dietary choices.
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Observations:
Based on review of facility documentation, and interviews with staff and residents, it was determined that the facility did not follow menus that meet the nutritional needs of residents in accordance with established national guideline and that menus were prepared in advance and followed.
Findings include:
Review of Wyndmoor Hills Rehab and Nursing Emergency Operations Program and Plan Manual revealed, Operations Chief: Provide reassurance to residents and visitors Provide increased hydration and implement cooling and warming measures, as indicated Consider temporarily gathering residents in an area where lighting and temperatures can be maintained within an acceptable range (Main Dining Room) Ensure generator is running properly Initiate Disaster menus or alternative meals/snacks
Emergency and Disaster Supplies-3 day, non-perishable supply (100 beds) ( 9 meals) Fruit: to be served twice per day, 1/2 cup per serving=28 #10 cans or 5 cases. 25 portions per #12 can Vegetables: to be served twice a day, 1/2 cup per serving = 28 #10 cans or 5 cases. 25 portions per #10 cans Protein: ready to eat, canned or cooked. No frozen supply is to be considered due to possible lack of cooking methods. 5 ounces per day = 94 lbs. Cottage cheese, cheese, bologna, hot dogs, chicken breasts are acceptable. Thaw and serve items are okay, For meat, if can of chili con carne weighs 4#, it will yield 2#. 2 day, perishable supply...Use these figures only if the order is received twice a week or less. Milk: maintain 2 day supply at all times. In addition, dry fat milk should be available. Bread: 40 loaves-check the type of bread used Maintain 2 day supply at all times Three day supply of paper products, includes plates, napkins, flatware, glasses, straws, paper trays, bowls, etc
Disaster Plan-Emergency Menu 1 Breakfast: 1/2 c cranberry juice 3/4 c dry cereal 1 sl cheese on 1 slice bread, toasted 1 cup of milk-coffee Dinner-noon meal 3 oz beef/cubes/gravy (canned) 1/2 c mashed potatoes (instant) 1/2 cup carrots (canned) 1 slice of bread-1 margarine 1/2 c applesauce coffee Supper-evening meal 1/2 c vegetable soup (canned) chicken sandwich-2 oz chicken (canned), 2 sl bread, 1 t salad dressing 1/2 c pudding, prepared 1/2 c milk
Disaster Plan-cold menu (Emergency) Breakfast: 1/2 c apple juice 3/4 c dry cereal 1 T peanut butter on 1 slice of bread 1 c milk Dinner- Noon Meal: Tuna sandwich-2 oz tuna on 2 sl bread 1/2 c bean salad 1/2 c canned peaches, sliced or 1 peach half 2 vanilla wafers 1/2 c milk Supper Evening meal 1/2 c tomato juice Peanut butter-jelly sandwich (2 tsp peanut butter, 1 tbsp jelly on 2 sliced bread) 1 sl pineapple salad (lettuce if available) 1/2 c pudding 1/2 c milk
Review of facility documentation revealed that the facility experienced a power outage on December 31, 2023 at 12:15 p.m. that interrupted the facility operations. The lunch tray line commences at 12:15 p.m. Peanut butter and jelly sandwiches were prepared, individual cups of fruit, applesauce, pudding and individual bags of chips were provided for lunch. The generator activated and the facility ran on generator until power was restored at 5:30 p.m. The lights and electricity in the kitchen of Wyndmoor Hills are maintained by the generator in the adjacent personal care building of Wyndmoor. The generator for the (Adjacent Assistive Living Facility) did not activate. Therefore, Wyndmoor Hills' kitchen remained inoperable. An interview on January 8, 2024 with Employee E1 (Nursing Home Administrator) and E3 (Food Service Director) revealed, " A decision was made to order pizza for residents. Residents on renal diet would receive chicken wings. Jars of baby food were purchased at a local grocery market for two residents on a pureed diet. Additional quantities of water and juice were purchased. Employee E3 stated, "Our residents are on liberalized diets."
Interview with Employees E1 and E3 continued, "On January 2, 2024 at 8:00 a.m., it was determined that a sump pump to the (Adjacent Assistive Living Facility) malfunctioned, causing sewage to travel across a connecting tunnel and into Wyndmoor Hills kitchen hall and food prep areas. The Montgomery County Health Department shut down kitchen operations. The facility was required to shop vac the sewage, wash floors and sanitize with bleach. Breakfast of dry cereal, milk and juice was prepared at a different location. Peanut butter and jelly sandwiches, fruit cups, and individual bags of chips and cookies were provided at lunch. We had used our emergency food supply and thrown out the chili. A dietary plan was developed for dinner and is listed below. However, the Montgomery County Health Department returned to Wyndmoor Hills and reopened the kitchen on January 2, 2024 at 3:35 p.m. so we were able to prepare dinner for the residents."
Wyndmoor Dietary Plan January 2, 2024
Meals for Wyndmoor Hills will be provided by an alternate nursing home located in Philadelphia County which has food service site with the appropriate licenses to provide food for Wyndmoor Cenetr who is under Montgomery County.
Each meal will be delivered in the appropriate containers via the facility van and delivered through the front door of the facility. After arrival, food will be transported to the appropriate floor via the elevator and served from the (Adjacent Assistive Living Facility) kitchen. Meals will be served with all disposable items. Temperature checks will accurate the time of preparation, on delivery and then at time of service. This process will occur during the four-hour time span as required and all remaining items will be disposed of as required after the time span has lapsed. The van will be sanitized as appropriate after each use to ensure that cross contamination does not occur.
Supplements, snacks, and cold items will be housed in the facility designated refrigerators to maintain appropriate temps. Refrigerators are being housed in a sanitized area. The meals and food will be monitored by the administrative staff and a Registered Dietician is on site.
This plan will remain in place until emergency work has been completed.
Interview on January 4, 2024 at 11:30 a.m. with Employee E3, Food Service Director, revealed, "No, we don't have a three day emergency food supply. We used the food on December 31, 2023 and January 2, 2024. We had peanut butter and jelly sandwiches, fruit cups, pudding, applesauce, jello and individualized bags of chips. I threw out the chili because it was close to the expiration date. We will replenish our 3 day emergency food supply on Friday (January 5, 2024) when our food order arrives. We have a liberalized diet plan so that people with soft diets could eat pizza. We bought chicken wings for those on renal diets. And we purchased baby food for those who are on a pureed diet." All receipts for purchased food items are attached to this report.
Further interview revealed, "We didn't implement the plan with the [contracted nursing home] because we were cleared to open the kitchen in enough time to prepare dinner. Breakfast and lunch on January 2, 2024 were prepared in [a personal care] kitchen."
There were no food items observed necessary to meet the needs of residents with modified diet requirements such as allergies, low salt, ground or pureed planned menu. The facility did not develop and implement a three day emergency food menu. The facility did not stock an emergency food pantry.
28 Pa. Code 201.14 Responsibility of Licensee
28 Pa. Code 201.18(b) (3) Management
| | Plan of Correction - To be completed: 02/13/2024
1. No specific residents were cited by this F-Tag 2. A food delivery which included emergency food supply was received on 01/05/2024 3. An additional delivery of emergency food was delivered on 01-09-2024 and. The Food Service Director and NHA were inserviced by the Vice President of Culinary regarding the emergency food supply policy and procedure 4. An audit will be conducted by the NHA/designee to ensure there is a 3 day emergency food supply for weekly x4 and monthly x3. The results of the audits will be reported to the QAPI Committee monthly x3. QAPI Committee will make review the audits and make any additional recommendations.
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