§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 observation, review of the minutes from Resident Council Meetings, scheduled facility mealtimes, and select facility policy, and resident and staff interviews it was determined that the facility failed to ensure the provision of a nourishing (satisfying to the resident) evening snack when greater than 14 hours elapsed from the supper meal to breakfast the next day for residents including eight residents of 25 sampled (Resident 7, 10, 57, 61, 64, 78, 90 and 104).
Findings include:
Review of the facility's policy titled "Snacks Policy", last reviewed October 2, 2023, indicated that a variety of snacks are available on the units throughout the day. Residents able to consume oral feedings will be offered a nutritious bedtime snack.
Review of the facility's scheduled meal times revealed 15 hours between the evening meal and the next day's breakfast meal.
Review of Resident Council Meeting minutes dated from February 21, 2024, March 28, 2024, and April 24, 2024, revealed that a meeting topic of snacks was discussed during these meetings. When asked if the residents were being offered a snack after dinner in the evening, most residents responded no, and some that they did not want a snack.
During a tour of the facility, observations on April 30, 2024, at 7:24 PM revealed on the fourth floor, Hallway D (resident rooms 428 - 434) snacks were not observed to have been provided to the residents that evening.
During an interview with Resident 57 on April 30, 2024, at 7:29 PM the resident stated that the resident does not receive bedtime snacks nor is a snack offered in the evening.
During an interview with Resident 104 on April 30, 2024, at 7:33 PM the resident stated that if you want a snack you have to ask the staff, because they do not just automatically bring one or offer one.
During an interview with Employee 6, nurse aide, on April 30, 2024, at 7:34 PM Employee 6 stated that if the resident snacks came up from dietary, they would be in the nurse's station. Residents receive snacks from dietary or from the pantry on the floor if requested.
Observations at that time revealed no evidence of snacks being delivered to the fourth floor.
During an interview with Resident 61 on April 30, 2024, at 9:00 AM the resident stated that the resident has never been offered a bedtime snack.
During an interview with Resident 7 on April 30, 2024, at 9:23 AM the resident stated the resident had never been offered a snack in the evening.
During an interview with Resident 78 on April 30, 2024, at 9:50 AM the resident stated that they have to ask for a snack before bedtime if they want one.
During a group interview with five alert and oriented residents on May 2, 2024, at 10:00 AM, three of the five residents (Residents 64, 10, and 90) in attendance stated that snacks are not routinely offered to them in the evenings. The residents stated they would like to receive an evening/bedtime snack. Resident 10 reported that when he has requested a snack, one is provided for him.
Interview with the foodservice director (FSD) on May 3, 2024, at 12:30 PM confirmed that there was greater than 14 hours between supper and breakfast the next day. The FSD confirmed that bedtime snacks were to be offered to residents.
28 Pa. Code 211.12 (d)(3)(5) Nursing Services
| | Plan of Correction - To be completed: 06/11/2024
1. Resident 7, 10, 57, 61, 64, 78, 90, and 104 will be offered a nourishing snack at bedtime.
2. An audit will be conducted to ensure all residents are offered a nourishing snack at bedtime and staff document appropriately.
3. The Nursing Staff and Dietary Department will be re-educated on Snack and Oral Supplement policy to ensure residents are offered a nourishing snack at bedtime and document appropriately.
4. Audits will be conducted weekly by AIT/Designee to ensure residents are offered a nourishing snack at bedtime. The results of these audits will be reviewed in monthly Quality Assurance Meetings and will continue until substantial compliance has been obtained.
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