F0801

F

Failure to Employ Qualified Dietary Leadership in Absence of Full-Time Dietitian

Canonsburg, Pennsylvania Survey Completed on 04-10-2026

Penalty

No penalty information released

Summary

The deficiency involves the facility’s failure to employ a full-time qualified dietitian or a qualified director of food and nutrition services for a 25-day period, as required by federal regulations. Surveyors reviewed the job description for the Dietary Manager position, which outlined responsibilities such as managing daily dietary operations, working closely with a registered dietitian to implement meal plans, maintaining food safety standards, supervising dietary staff, and overseeing food quality and inventory. During this time, the facility did not have a full-time dietitian on staff, and the registered dietitian functioned only as a consultant, present at the facility one day per week.

Employee file review and staff interviews showed that the individual serving as interim Dietary Manager, identified as Employee E12, did not meet the qualification requirements for the role. E12 had been hired as a Graduate Nurse while awaiting RN licensure and later signed the Dietary Manager job description, but she reported that her Certified Dietary Manager (CDM) license had lapsed after a previous employer closed and she changed career paths. The Nursing Home Administrator confirmed that there was no full-time dietitian employed, that the RD was only a consultant without a facility job description, and that the facility did not employ a qualified dietary manager in the absence of a full-time dietitian during the identified period.

Plan Of Correction

The facility will employ a full-time qualified Dietary Manager.

The interim Dietary Manager will be taking CDM renewal on 05/08/2026

The Administrator educated the governing body for the requirement for the Dietary Manager have a CDM certification

The Administrator will audit compliance of the requirement that the Dietary Manager maintains a CDM certification.