Menu Substitution Deficiency in LTC Facility
Penalty
Summary
The facility failed to ensure that menus were followed as written, resulting in food items being omitted or substituted without informing the residents. This deficiency was observed during the Dining Observation task for five residents. The facility's policy requires that any menu substitutions be documented, including the reason for the substitution, and that these changes be visible to residents. However, the survey found that items such as milk, salad, and tartar sauce were crossed out on tray tickets without appropriate substitutions or notifications to the residents. Several residents with varying degrees of cognitive impairment were affected by these omissions. For instance, one resident with severe cognitive impairment was served a dinner tray missing milk, which was crossed out on the tray ticket. Another resident, also with severe cognitive impairment, was served a tray missing assorted juice, which was similarly crossed out. These omissions were not documented in the menu substitution log, and the residents were not informed of the changes. Interviews with staff revealed inconsistencies in the handling of menu substitutions. Certified Nursing Assistants and Dietary Aides indicated that items were crossed out when unavailable, but there was no consistent process for substituting or notifying residents. The Director of Food Service and the Registered Dietitian were not always consulted on these changes, which is contrary to the facility's policy. This lack of communication and documentation led to the deficiency noted in the survey.
Plan Of Correction
Plan of Correction: Approved January 16, 2025 Element 1 F803 Corrective Actions for Residents Identified: The Registered Dietitian reviewed menus for residents #97, #156, #212, #252, and #271 to ensure they met their nutritional needs as per national guidelines (e.g., Dietary Guidelines for Americans, RDA). The Registered Dietitian interviewed residents or resident representatives #252, #271, and #212 to review and discuss their meal preferences. Meal tickets were adjusted to reflect their preferences. Residents #97 and #156 were discharged, and no changes were required. Dietary staff immediately received training on following planned menus and compliance with meal tickets. Element 2 All residents have the potential to be affected by this practice. All residents were immediately audited to ensure all dietary preferences were being met. All meal tickets were reviewed to ensure that what was printed on the resident's meal ticket was being served; no issues were identified. Element 3 Systemic Changes: Policy and Procedure for Resident food Preferences were reviewed, and no revisions were required. All menus will be reviewed and approved quarterly by a licensed RD to ensure nutritional adequacy and compliance with guidelines. Monthly Food Committee meetings will be scheduled to ensure menus reflect resident preferences while maintaining nutritional needs. Food purchasing, inventory management, and meal preparation will be implemented to ensure timely adherence to planned menus. Dietary staff will be in-serviced regarding menu preference, menu item substitution, and adherence to meal tickets on the tray line. The new process was implemented to notify residents of any menu substitution by posting changes in each nursing unit. This new process will be discussed at the next resident council meeting on (MONTH) 21, 2025. An audit tool was developed to monitor compliance. Element 4 Monitoring of Corrective Actions: 10 resident trays will be audited daily for 30 days to confirm that meals served match planned menus, resident preferences, and nutritional standards are being met. Documentation will be maintained of all menu changes, resident-specific adjustments, and training sessions. The RD will conduct quarterly audits x 2 quarters to monitor menu compliance and resident preferences, including nutritional analysis. The audit results will be shared with the administrator monthly. QAPI Integration will include menu compliance as a standing agenda in QAPI Meetings for 2 quarters. The Audit results, including resident feedback and RD recommendations, will be reviewed during QAPI meetings to identify and implement further improvements for 2 quarterly meetings. QAPI Committee will make sure to figure out if further action is required. Element 5 Completion Date: (MONTH) 12, 2025 Persons Responsible: Registered Dietitian, Food Service Director, and Food Service Supervisor.