Failure to Follow Dietitian-Approved Menus and Serving Sizes for Resident Meals
Penalty
Summary
The deficiency involves dietary staff failing to follow dietitian-approved menus and prescribed serving sizes for residents’ meals. During a lunchtime observation in the kitchen, a cook reported that most residents requested smaller portions and stated she typically served about four ounces of meat and two ounces of vegetables or side dishes, without referencing the dietitian-approved menu to verify correct serving sizes for each prescribed diet. In the dining room, the same cook was observed using a four-ounce scoop for peas and two-ounce scoops for pureed peas, stewed tomatoes, and mashed potatoes, but only serving one two-ounce scoop of these items instead of the menu-required four ounces. She also served smaller chicken legs to female residents and larger bone-in chicken breasts to male residents, and provided one resident with one scoop of peas (about four ounces), one scoop of mashed potatoes (about two ounces), one scoop of gravy (about two ounces), one slice of bread, and one small chicken leg, despite the resident’s laminated diet card not indicating any request for small portions. Review of the dietary extension menus showed that the menu for the observed day required three ounces of protein, a half-cup (four ounces) of mashed potatoes, and a half-cup of stewed tomatoes or peas, including a half-cup of pureed peas for residents on pureed diets, and that there was no designated small portions diet. A diet orders report indicated that seven residents had requested small portions and two residents were on pureed diets. The dietary manager stated that staff were expected to use a menu book and a binder labeled “Cold Orders” that contained menus and serving sizes for each diet, and that all dietary staff should know how to access and use these diet menu spreadsheets. On a separate observation day, a newly hired dietary aide was seen using a two-ounce scoop for mashed potatoes and ground beef and serving only one scoop of each to residents, after being helped with hot-holding table setup by the same cook. Review of the provider’s menu for that day showed that residents should have received a half-cup (about four ounces) of mashed potatoes and three ounces of roast beef or ground beef for mechanical soft diets, which was not followed.
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