Unapproved Menu Substitutions and Failure to Follow Dietitian-Approved Recipes
Penalty
Summary
The deficiency involves the facility’s failure to ensure that menus and recipes were followed and that meal substitutions were approved by the Registered Dietitian (RD) to meet residents’ nutritional needs. Facility records showed that a cook changed the menu and did not prepare ground beef stew according to the recipe, instead serving canned beef stew. Resident council later complained that hamburger patties were used to make sandwiches in place of corned beef, and this complaint was confirmed. The Dietary Manager also made substitutions to the menu without consulting the RD and made unauthorized food purchases, including frozen pepperoni pizzas when the facility lacked pizza crust to prepare the planned menu item. Interviews with staff revealed that menu substitutions occurred due to last-minute changes, missing items from food deliveries, or ordering errors by the Dietary Manager, and that the RD was not consistently notified when these substitutions occurred. The Social Services Director reported that menu substitutions happened about every other week and that she did not believe the RD was always informed. The Dietary Manager acknowledged that when ingredients were missing or not ordered, the kitchen would “switch it up,” including using frozen pizza instead of making pizza per the approved menu and recipe, and serving canned beef ravioli instead of following a soup recipe. The RD reported concerns that the Dietary Manager was not ordering the correct amount of food, was purchasing other products, and was not informing her regularly of menu substitutions, despite prior meetings to clarify expectations for RD notification. The RD specifically cited the frozen pizza substitution as problematic due to residents with weight loss goals and fluid retention, and noted that simply removing pepperoni from the pizza for a resident on a no added salt (NAS) diet was not ideal. Review of facility documents showed that on the date pepperoni pizza was on the menu, there were residents on NAS, consistent carbohydrate, and small portion diets, and the facility’s own menu policy required RD review and approval of menus and documentation of deviations from posted menus, including reasons for substitutions, which was not consistently followed.
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