Failure to Serve Palatable and Appropriately Tempered Food
Penalty
Summary
The facility failed to provide appetizing food at palatable and safe temperatures for three out of five residents reviewed for food and nutrition services. Residents with complex medical conditions, including end stage renal disease, pressure ulcers, and muscle wasting, reported that the food was consistently cold, unappetizing, and sometimes arrived late. One resident with a pureed diet and mechanical soft preferences, as ordered by a Speech Language Pathologist, also expressed ongoing dissatisfaction with food quality. Grievances and resident council meeting minutes documented repeated concerns about cold food. Direct observation during meal service revealed that hot food items, such as gravy, were not maintained at appropriate temperatures, with a measured temperature of 105°F, below the facility's policy preference of 120°F or greater for palatability. The gravy was left on the counter without a method to keep it warm, and staff acknowledged this lapse. Facility policy and staff interviews confirmed the expectation that food should be served at acceptable temperatures, but this standard was not met during the survey period.