Deficiency in Menu Planning and Approval
Penalty
Summary
The facility failed to properly design, approve, and follow its Winter five-week cycle menu and modifications, as evidenced by a review of facility policies, documents, observations, and staff interviews. The facility's 'Menu Planning' policy required that menus be completed at least two weeks in advance and approved by the registered dietitian (RD). However, the Winter cycle menu extension sheets did not provide guidance for regular and therapeutic diets as outlined in the facility's template, and they lacked portion sizes and food consistency guidance for Mechanical soft and Puree diets. This created the potential for dietary staff to serve inaccurate portion sizes and food consistencies. The facility's documents, such as the 'SLP Mech Soft Recommendations' and 'Puree Serving Guidelines,' lacked documented evidence of review and approval by the facility's RD. These documents provided conflicting recommendations for portion sizes, which could lead to inappropriate servings for residents on puree diets. Additionally, the 'Small, Regular and Large Portion Sizes' document also lacked RD approval. The Mechanical Soft/Puree menu extension sheets included items like rice pilaf and pineapple, which were not permitted for these diets according to the SLP's recommendations. Interviews with staff, including the Food Service Director (FSD) and a cook, confirmed the discrepancies in the menu extension sheets and the lack of RD approval. The facility also failed to pre-plan menu modifications, such as substituting chef salad for residents on a renal diet, without RD review and approval. These failures in menu planning and approval created the potential for conflicting guidance, which may result in residents receiving inappropriate and inaccurate portion sizes and food product consistency for their prescribed therapeutic diets.
Plan Of Correction
The RD reviewed the current menu cycle for the remainder of this season. Menus, extensions, and diet consistencies were updated and signed by the RD and reviewed with the CDM. Extension sheets include portion sizes for all diets and combined guidance for Mechanical soft and Puree diets consistencies. For subsequent seasons, the RD will review and sign the menu, extensions, and consistencies. RD provided education to the CDM on menus, extensions, and diet consistency. The CDM will provide education to the dietary line staff on how to follow the menu, recipe, extensions, and portion size for each meal respectively. The RD/designee will complete audits of three meals a week for four weeks to ensure that the meal is prepared and served per the menu and with appropriate portion control. Audits will be taken to QAPI for review and discussion.