§483.60(f) Frequency of Meals
§483.60(f)(1) Each resident must receive and the facility must provide at least three meals daily, at regular times comparable to normal mealtimes in the community or in accordance with resident needs, preferences, requests, and plan of care.
§483.60(f)(2)There must be no more than 14 hours between a substantial evening meal and breakfast the following day, except when a nourishing snack is served at bedtime, up to 16 hours may elapse between a substantial evening meal and breakfast the following day if a resident group agrees to this meal span.
§483.60(f)(3) Suitable, nourishing alternative meals and snacks must be provided to residents who want to eat at non-traditional times or outside of scheduled meal service times, consistent with the resident plan of care.
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Observations:
Based on review of facility policy, resident and staff interviews, it was determined that the facility has failed to provide a nutritious snack at bedtime for nine out of nine residents reviewed (Residents 1, 2, 3, 4, 5, 6, 7, 8, and 9).
Findings include:
The current facility policy entitled "Offering/Serving Bedtime Snacks" last reviewed September 2026, revealed it is the practice of the facility to offer and serve residents with a nourishing snack in accordance with their needs, preferences, and requests at bedtime daily. The nursing staff offers bedtime snacks to all residents on a daily basis. All diabetic or special diet bedtime snacks are labeled and dated; each label contains the resident's name and room number. Dietary staff deliver bedtime snacks to each nurses' station, and the charge nurse is made aware of the delivery of the snacks. Nursing staff delivers and serves snacks to residents and intake of bedtime snacks is documented in the medical record.
Interview with Employee 1 (dietary manager) on September 17, 2026, at 9:40 AM revealed that the evening dietary aides are responsible for stocking the pantries with snacks. She stated was not sure of the facilities process for ensuring all residents are offered a snack in the evening.
Interviews conducted with Residents 1, 2, 3, 4, 5, 6, 7, 8, and 9 on September 17, 2026, from 9:45 AM to 10:20 AM revealed that they are not offered snacks at bedtime.
The above information was reviewed in a meeting with the Director of Nursing, and Employee 2 (assistant director of nursing) on September 17, 2026, at 2:30 PM.
28 Pa. Code 201.14(a) Responsibility of licensee
| | Plan of Correction - To be completed: 10/02/2026
0809
1. Residents 1,2,3,4,5,6,7,8 and 9 have had their snack preferences reviewed updated with the Dietary Manager.
2. Residents will receive nutritious HS snacks according to preferences during the times designated by facility policy.
3. The facility policy on offering/serving bedtime snacks has been reviewed for assurance that dependent residents are provided with a nutritious snack at bedtime.
4. The dietary manager/designee will audit snack pass 1 x per week for 8 weeks to assure that HS snacks are delivered timely by dietary to nursing then timely to residents. The audit will be submitted to the QA team for review.
5. 10/2/2026
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