|§483.60 Food and nutrition services.|
The facility must provide each resident with a nourishing, palatable, well-balanced diet that meets his or her daily nutritional and special dietary needs, taking into consideration the preferences of each resident.
Based on a review of clinical records, grievances lodged with the facility, observations, staff, and resident interviews, it was determined the facility failed to ensure effective management and execution of the duties and responsibilities of the facility's food and nutrition department to provide consistent planned meals and professional dietary and nutritional services to meet the nutritional needs of each resident.
A review of grievance dated November 18, 2021, indicated that Resident 4 had complaints about dietary services. The grievance noted that the resident was crying a visibly upset. The resident voiced concerns that she was not receiving food items of her choice.
An observation of the kitchen on December 9, 2021, at 8:50 AM revealed that the facility failed to maintain acceptable practices for the storage and service of food to prevent the potential for contamination and microbial growth in food, which increased the risk of food-borne illness.
Refrigerator fan cover was removed and laying on the top shelf next to food. Further an accumulation of dust and debris was noted on the refrigerator fan.
Two containers of cottage cheese and one container of mayonnaise were noted with standing water on the lids and black dust and debris located on the lids.
Boxes of food were placed directly on the floor in the in the refrigerator and dust noted on the boxes.
One container of beef base was opened and not dated as to when staff opened the container. Further a brown sticky substance was noted on the bottom of the beef base container.
A box of defrosting fish open to air was noted to be on a metal sheet pan. The box of fish was lying in a large amount of liquid that was accumulated on the sheet pan.
A box of pasteurized eggs was noted with a broken egg lying in the box.
The tray line cooler contained milk purchased by staff for residents from a local grocery store had expired on December 5, 2021.
Two containers of thicken lemon flavored water opened on November 4, 2021. Per the manufacturing instructions the water is to be discarded seven days after opening.
One tray of defrosted vanilla and strawberry nutritional health shakes and one tray of defrosted apple cranberry nutritional drinks were noted in the cooler. Manufacturing instructions indicated discard 14 days after defrosting. No dates were noted when the drinks were defrosted.
Three bags of white rolls and 14 bags of hot dog rolls purchased by staff for residents from a local grocery store had expired on December 3, 2021.
An interview with the certified dietary manager on December 9, 2021, at approximately 9:00 AM revealed that Employee 1 had purchased food because sufficient food items were not available at the facility. He was unaware that the products that had been purchased at the local grocery store were expired, and that all food should be checked for expiration.
An interview with Employee 1 on December 9, 2021, at 10:50 AM revealed had to go to the local grocery store to by food and cleaning supplies because the the facility was running out of food and supplies. The employee stated that the facility had not yet secured food service vendors to provide delivery service to the facility and she purchased all the bread products and milk from the local grocery store in November 2021. Employee 1 also stated that she went to the local grocery store to buy the following because the facility's supply was low or depleted:
November 21, 2021, multiple buns
November 22, 2021, Dawn dish soap
November 23, 2021, oregano, and lemon juice
November 24, 2021 bread
December 1, 2021 Lactaid milk.
A review of meal cart delivery times for December 9, 2021, revealed that lunch meal carts were to be delivered to the floor at the following times: North Hall 11:15 AM, Spruce 400 Hall at 11:30 AM, Spruce 200 Hall at 11:45 AM.
An observation of the lunch meal tray line service on December 9, 2021, at 11:00 AM revealed that Employee 2 cook began tray line by removing plates and plate warmers, assembling the plates and stacking them five high, touching each plate on which food was to be served and also decreasing the temperature of the plate warmers designed to maintain acceptable food temperature on service to the residents.
The dietary staff working the tray line were not communicating with each other to assure accuracy of resident meal service. Observation revealed that on multiple instances Employee 2 would plate the residents' food incorrectly. Employee 2 would have to stop, to correct her mistake, and replate the food causing a delay in tray line meal service.
Observations of the lunch meal service on December 9, 2021, review of clinical records, and interviews with staff it was determined that the facility failed to provide nutritional supplementation prescribed to maintain residents' nutritional status for two of eight residents reviewed (Resident 6, 7, and 8).
Resident 6's was not provided his Glucerna supplement at the lunch meal as ordered.
Resident 7's was not provided her Ensure Clear supplement at the lunch meal as ordered.
Resident 8's was not provided her Glucerna supplement at the lunch meal as ordered.
Resident 5 was not provided adaptive eating equipment for hot liquids when observed at the lunch meal on December 9, 2021.
Resident 1 was not served fruit salad as she indicated as her preference for this lunch meal.
Resident 2 received gray on her food, but her meal preferences indicated no gravy.
Resident 3 was served peaches at this lunch meal although the resident's tray card indicated that the resident was allergic to peaches.
The facility ran out of rolls at the lunch meal on December 9, 2021, and had to substitute sliced white bread.
The certified dietary manager dropped a loaf of bread on the floor and picked it up and the dietary staff served it the residents' meal trays.
Employee 3 dietary aide used her hands to grab bread from the loaf and place it on the residents' trays without performing hand hygiene or changing gloves prior to completing the task.
Due to the multiple plating errors, the Spruce 400 Hall lunch cart left the kitchen at 11:20 AM, 20 minutes late. The Spruce 200 Hall lunch cart left the kitchen at 12:15 PM, 30 minutes late.
Interview with Resident 4 on December 9, 2021, at approximately 2:00 PM revealed that the resident stated she frequently receives foods that she does not like although her preferences are identified. She stated the facility serves her the wrong food items and does not follow her food preferences. Resident 4 also stated that food is often delivered late.
Interview with Resident 1 on December 9, 2021, at approximately 2:01 PM revealed that the resident stated that she is occasionally served the wrong foods that she does not like, although her preferences were identified. Resident 1 also stated that meals are delivered late on occasion, such as they were at the lunch meal on December 9, 2021. Resident 1 also stated that meals are delivered late and not according to the scheduled time.
An interview with the Nursing Home Administrator on December 9, 2021, at approximately 3:00 PM confirmed the facility failed to ensure that facility staff support the nutritional well-being of the residents while respecting an individual's right to make choices about his or her diet and that issues remain in the overall systems in managing and executing its food and nutrition services.
Refer F692, F806, F810, and F812
28 Pa. Code 211.6 (a)(b)(c)(d) Dietary services
28 Pa. Code 201.29 (j) Resident rights
| ||Plan of Correction - To be completed: 01/11/2022|
1. R4 was seen by dietician to review preferences; Refrigerator fan was cleaned and cover was stored appropriately. Container of cottage cheese and mayonnaise was discarded. Boxes of food located on floor cleared of any dust and properly stored . Opened can of beef base was discarded; Box of defrosting fish was discarded. Broken egg discarded; Milk discarded based on expiration dates. Thickened lemon water discarded based on manufacture instructions; items (defrosted health shake and nutritional drinks) were discarded based on manufacture instructions; Rolls with expired dates were discarded. E1 was educated on reviewing expiry dates of products prior to purchase if utilizing outside local vendor. E2 cook was educated on accuracy in serving plates and sanitation during process; R6,7, 8 were served supplements based on orders; R5 was provided required adaptive eating equipment; R1, R2 and R3 was provided food based on their preferences and indications; CDM and E3 was educated on infection control practices in the kitchen; R4 and R1 was seen by dietician to review preferences and verify meals delivered timely and based on preferences.
2. The Dietary Staff shall be educated by the FSD/designee on the importance of verifying that food sent out on the meal tray is food that is listed on the resident's preference list, and meal ticket. Education shall also include storage and service of food to prevent potential of contamination and microbial growth in food, and timeliness of food served.
3. Dietary service department staff will be re-educated by then CDM on supporting the well being of residents by reviewing resident choices/preferences, maintaining sanitation requirements in the kitchen and acceptable practices for storage and service of food to prevent contamination.
Food committee to meet weekly x 1 month to discuss any concerns and problem solve issues identified.
4. FSD/designee will complete audits of kitchen, meal trays daily x 1 week, weekly x4 then monthly x2 or until 100 % compliance is achieved. Findings will be reviewed in QAPI committee.
5. Date of compliance 01/11/2022