Failure to Follow Dietitian-Approved Menus and Maintain Menu Item Availability
Penalty
Summary
The facility failed to ensure that the registered dietitian-approved dietary menus were followed and that menu items were not depleted during meal service, potentially affecting 99 residents who received meals. Observations revealed that the lunch menu for a specific day was not followed as written: the approved menu called for Chinese pepper steak, fried rice, oriental blend vegetables, iced mandarin orange cake, and beverages, but substitutions and omissions occurred. For example, two different types of cake were served due to running out of the specified mandarin orange cake, and carrot cake was substituted for residents on certain floors. Additionally, the serving size of pepper steak was not consistent with the production sheet, as a four-ounce scoop was used instead of the required six-ounce portion. Further observations and interviews indicated that menu modifications and substitutions were made without consultation or approval from the registered dietitian. For pureed diets, seasoned cream of rice was not provided as a modification for fried rice; instead, pureed wheat bread was given, a change that had not been discussed with the dietitian. The food service director also confirmed that baked chicken was routinely substituted for beef in mechanical soft and pureed diets due to concerns about meat texture, but these substitutions were not documented on the substitution log or menu, and no standardized recipes were followed for these changes. Additionally, when the facility ran out of fried rice, white rice was served instead, and pudding was substituted for pureed dessert when the specified cake was unavailable. Interviews with dietary staff revealed that recipes were not consistently used or followed, and some staff were unaware of the required ingredients for menu items, such as eggs in fried rice. The registered dietitian confirmed that she had not been conducting test trays and had recently reminded staff that modified diets must match the menu. Facility policy required the use of standardized recipes, but this was not adhered to, as evidenced by the lack of recipe use and undocumented substitutions. One resident on a pureed diet was observed receiving a meal that did not match the approved menu, but no swallowing concerns were noted at the time.