§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 observations, a review of the facility's planned cycle menus, and resident and staff interview it was determined that the facility failed follow written planned menus for four of seven residents sampled. (Resident 14, 55, 87, and 56).
Findings included:
Review of the facility policy titled "Menu Substitutions" last reviewed by the facility January 2024, revealed that menu substitutions/changes shall be made to the planned menu in an emergency situation only and not for the convenience of the facility.
At the time of the survey ending on January 30, 2025, the facility census was 86 residents.
On January 30, 2025, at 9:50 AM resident 14 reported the menu changes occurred frequently, and staff only notified him when they are picking up his breakfast tray. He stated that they run out of food and blame the truck for not supplying food to the facility.
Interview with Resident 14 on January 30, 2025, at 10:00 AM revealed that the "always available menu is not consistently available- it's now changed to "IF available" (always available menu is called the alternate entrmenu which includes egg salad sandwich, turkey sandwich, hamburger, grilled cheese sandwich and meatball hoagie). He reported that the facility is consistently running out of the "always available" food items.
He stated that when ordering from the '"always available" menu, if the kitchen runs out of an item, they will serve him whatever they have left. He provided an example of ordering a hamburger and was served a tuna fish sandwich instead, without any explanation or confirmation that he was agreeable to the substitution. He continued "they run out of food, and they blame the truck for not supplying".
Interview with Resident 55 on January 30, 2025, at 11:00 AM reported residents do not receive weekly menus in their rooms. She stated she would like to have a copy of the menu so she could decide based on the options presented in front of her. She reported that she frequently orders a toasted cheese sandwich and "sometimes they just give you whatever is available, not what I ordered. It happens at least once a week".
Interview with Resident 87 on January 30, 2025, at 11:15 AM stated that "the kitchen gives me the wrong order when they run out of stuff".
Interview with Resident 56 on January 30, 2025, at 11:35 AM stated that her food orders were frequently incorrect. She provided an example of ordering a grilled cheese sandwich but receiving a hamburger stating, "That's all they have cause the truck never came". She continued, "I don't get my coffee. They say the ran out of coffee cause the truck didn't come"
Review of Resident Council Meeting Minutes (January 14, 2025):
The minutes documented the alternate menu was not always available, and basic food supplies such as sugar, butter, milk, tea, ketchup, and coffee were frequently out of stock. It was noted that the facility was experiencing food supply shortages, but there was no documented evidence that these concerns were addressed by the facility. The facility frequently runs out of bread
At the time of the survey ending January 30, 2025, there was no documented evidence that the facility addressed the concerns voiced during the food committee meeting regarding food supply shortages.
Review of the facility's Week 3 lunch menu for Thursday January 30, 2025, revealed that the planned menu included maple glazed ham, macaroni and cheese, Prince Edward vegetable blend, wheat dinner roll and choice of dessert.
However, an observation of the lunch meal on Thursday January 30, 2025, at 12:34 PM revealed chicken and dumplings were severed in place of the ham and macaroni and cheese, and mixed vegetables was served in place of the planned Prince Edward vegetable blend.
Interview with the dietary manager at this time confirmed substitutions for the lunch meal were made. The dietary manager noted the facility maintains a substitution log and frequently substitutions are made due to not having the food items needed based on the planned menu.
Review of the facility's meal substitution records revealed multiple instances due to unavailable ingredients affecting a variety of planned menu items.
Review of the facility's Substitution Record for November 2024 revealed that planned menu items such as baked potatoes, BBQ beef, spinach, mixed vegetables, California blend vegetables, coleslaw, rice, and potato chips all required substitutions due to the items/ingredients to prepare the food items not being available in the facility.
Review of the facility's Substitution Record for December 2024 revealed that planned menu items such as taco coup, stuffed shells, chicken casserole, tossed salad, hot dogs, and Prince Edward vegetable blend all required substitutions due to the items/ingredients to prepare the food items not being available in the facility.
Review of the facility's Substitution Record for January 2025 revealed that planned menu items such as ham salad, peaches, pears, hot dogs, French toast, bacon, fruit cocktail, egg salad, taco soup, fish, maple ham, Prince Edward vegetable blend, and macaroni and cheese all required substitutions due to the items/ingredients to prepare the food items not being available in the facility.
An interview with the Nursing Home Administrator (NHA) and the Dietary Manager on January 30, 2025, at approximately 1:20 PM confirmed that the facility was unable to consistently follow the written planned menus due to supply shortages. The Dietary Manager stated that menu items were ordered timely, but the food service supplier was not delivering the food order in its entirety. The NHA confirmed that the facility's food service supplier is not providing the facility with their full order upon delivery.
The facility to follow written planned menus as required which resulted in unapproved meal substitutions, lack of access to resident-preferred menu options, and inconsistent meal service.
28 Pa. Code 211.6(a) Dietary Services
| | Plan of Correction - To be completed: 02/28/2025
F 803
The facility follows the written planned menus.
Residents 14,55,27 and 56 were not harmed from the deficient practice, nor were the remaining residents.
On 1/30/2025 a substitution was made as the food items on the menu did not arrive with the weekly order nor the makeup order the following day. All substitutions are approved by the dietician; all will be audited for appropriate ness.
'The dietary department may 'run out of an item', or an item may not have come in.' The dietary department is in weekly contact with the vendor regarding missed items and will purchase locally any items that we do not have available for the next meal. Audits will be conducted weekly x 6 weeks of items needed to be purchased locally. Menu changes will be posted next to all menus, as soon as a change needed is known.
The Food service director has in-serviced staff on food substitutions, accurate ordering and inventory
Surveys will be conducted with Residents weekly x 8 weeks to assure they are getting the food items as per menus
Audits will be conducted weekly 6 weeks, by dietician/FSS on any changes on the menu as well as shopping needs.
Eight residents attended the recent food committee on 2/10/2025, with little concerns
Results of audits will be reviewed monthly at the Facility's QAPI meeting x 3 months
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