Insufficient Dietary Staffing Resulting in Late and Cold Meals
Penalty
Summary
The facility failed to provide sufficient dietary staff to safely and effectively carry out food and nutrition services, resulting in late and cold meals and incomplete tray service. Facility meal schedules showed designated serving times for both the main dining room and cart service, but Food Committee meeting notes from two separate months documented ongoing concerns about condiments not being on carts, lack of notice about menu changes, posted menus not being followed, missing items from trays, meals being late, food being cold, and running out of food before meal service was complete. The interim Dietary Manager reported that the Certified Dietary Manager had left the facility without notice, she had stepped into the role temporarily despite having allowed her CDM certification to lapse, and that the facility only had a Registered Dietitian on-site one day per week. She specifically stated there was not enough staff for the kitchen to run efficiently. Multiple residents reported that their meals were consistently cold, that meals delivered to rooms were late and cold, and that staff refused to reheat food in a microwave. During a confidential group interview, all participating residents confirmed that meals were consistently late and cold. Surveyor observations showed that on one observed day, tray line assembly was still occurring after the scheduled lunch start time, dining room residents did not begin receiving meals until later than scheduled, and cart delivery of trays to resident rooms did not begin until well after dining room service started. The acting Dietary Manager acknowledged that lunch was running about 30 minutes behind due to insufficient staff to prepare the meal on time, and staffing for that meal period consisted of one cook, one cook in training, and one dietary aide. The Nursing Home Administrator confirmed that the facility failed to provide sufficient dietary staff to perform essential kitchen duties.
Plan Of Correction
The facility will provide sufficient dietary staff to perform essential kitchen duties. On the assessment of the kitchen function, it was found that the facility was using an older menu which did not match the food ordering guide. Creating the need for frequent menu changes. The menu and order guide have now been reconciled, which will decrease the need for menu changes. The Tray Line will be moved from the dining room into the kitchen to improve time management, meal preparation and accuracy of meal including condiments needed. Education will be provided by the Administrator/Designee on the need for accuracy and time management for meal production. The Administrator will audit the kitchen meal production and accuracy weekly for four weeks and monthly for two results will be presented to the QAPI committee for review and recommendations
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