Unapproved Menu Substitution Without RD Notification
Penalty
Summary
The facility failed to follow its menu and substitution policy when a planned dessert item was changed without required approval from the Registered Dietician (RD). On the winter menu for a specific lunch date, the written menu indicated that chicken jambalaya, seasoned zucchini with parsley garnish, garlic bread, apple crisp, and milk were to be served. During observation of a resident’s lunch tray in the hallway, the tray instead contained macaroni and cheese, zucchini, and a large piece of cake. Review of the facility’s substitution list for that date showed that apple crisp had been replaced with apple cake due to the apple crisp being out of stock, and the section for RD initials was left blank. In an interview, the Certified Dietary Manager (CDM) stated that apple cake was substituted for apple crisp because not all ingredients for the apple crisp were available and acknowledged that the RD should have been called to approve the substitution but was not. In a separate interview, the RD confirmed she had not been made aware of the substitution and stated she should have been notified prior to the change. Review of the facility’s “Menus” policy and procedure indicated that foods served should adhere to the written menu and that any substitutions must be reviewed by both the dietary manager and the dietitian for appropriateness per the diet order and recorded on the substitution list. The failure to obtain RD review and approval for the dessert substitution was identified as having the potential to place residents at risk of inadequate nutrition.
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