Failure to Provide Nutritionally Adequate Menus and Consistent Meal Options
Penalty
Summary
The facility failed to ensure that its menus met the nutritional needs of residents, as required by regulations and the facility's own dietary manual. The Registered Dietitian (RD) did not consistently review and approve the four-week cycle menus for nutritional adequacy, and there was a lack of documentation confirming that all menu cycles were reviewed. The Food Service Director (FSD) and RD were unable to confirm the process for menu development and review, and the FSD did not have access to the diet manual. The menus provided only one meal option for lunch and dinner, and the Always Available list was not consistently accessible to residents. Several menu items and alternates, such as hot dogs and grilled cheese, did not provide the required minimum of 3 oz. (21 gms) of protein per meal, with some meals providing as little as 6 gms of protein. The FSD and RD acknowledged that these protein amounts were inadequate, and invoices and nutritional information confirmed that multiple meals throughout the cycle did not meet protein requirements. Residents reported limited food choices, poor food quality, and inconsistent availability of menu items and alternates, including bread and buns for sandwiches. During interviews and group meetings, residents expressed dissatisfaction with the lack of variety and the nutritional inadequacy of certain meals, such as fish patties, chicken patties, burgers, and meatballs. One resident specifically requested breakfast meat daily but did not consistently receive it, and when alternate items were requested, they were not always available or nutritionally equivalent. Observations confirmed that residents sometimes received substitutes, such as hot dogs or sandwiches, that did not meet protein requirements, and that bread products were sometimes unavailable, leading to substitutions like serving hot dogs on regular bread instead of buns. The facility's documentation, including food purchase invoices and nutritional labels, supported the findings that several menu items did not meet the required protein content. The RD and FSD acknowledged that some prepared products used did not meet protein requirements, and that recipes provided for review did not always match the products actually served. The dietary manual specified that regular diet portion sizes for protein at lunch and dinner should be 3 oz., but this standard was not consistently met. The deficiency was further corroborated by resident council feedback and direct observations by surveyors.