Menus and Recipes Not Followed: A resident reported that orange juice and milk were not consistently served and that potatoes were sometimes too hard to eat. During meal observations, residents were served items that did not match the posted menu, including a cold tuna sandwich instead of a tuna melt and missing listed sides such as coleslaw and mandarin oranges. The DON and RD stated the kitchen was selecting only one of the listed menu items in some meal categories and that the tuna melt recipe required toasted bread and heating until the cheese melted, which was not done.
Puree Diet Menu Not Followed: The facility failed to follow the posted menu for residents on a puree diet. A cook pureed only two menu items for the noon meal and did not puree the dessert, instead serving applesauce to a resident. The DON/DM stated all menu items, including desserts, should be pureed, and a resident on a puree diet said she usually received applesauce, pudding, or ice cream for dessert.
Posted menu items were not followed for three residents when desserts listed as frosted or iced were served plain instead. During a Resident Council meeting and meal observations, the residents reported and staff confirmed that a banana cupcake and yellow cake were served without frosting or icing, despite the menu specifying frosted banana cupcake and yellow cake with chocolate icing. The DM acknowledged the mismatch, and the Administrator stated kitchen staff should follow the established menu.
Failure to Serve Full Portions of Altered Diets: Surveyors found the facility did not follow the menu or serve complete portion sizes for altered-texture meals. Residents on pureed and mechanical soft diets, including residents with dx such as dementia, dysphagia, malnutrition, GERD, and CVA history, were served partial scoops of entrées and sides instead of the full menu portions listed. The Administrator stated the menu should be followed and full scoops of mechanically altered diets should be served.
Failure to Follow Planned Meal Menu: Staff did not follow the pre-planned menu, with lunch items substituted because ingredients were unavailable or not prepared in time. A cook stated the evening shift does not follow the menu and prepares foods based on what is available, and several residents said they were not served what their tray cards listed or notified of the planned meals.
Menu Not Followed as Planned: A resident council complaint and staff interviews showed the facility did not serve the planned lunch menu on multiple days. Meals were substituted when ingredients were unavailable, including chicken patties instead of chicken breast supreme, meatballs without the planned sauce, and rosemary potatoes instead of company potatoes. Staff stated deliveries were late, items were not ordered in time, and available foods were used to feed the census.
Failure to follow planned menu portions and diet extensions led to under-portioned meals for multiple residents. During tray line observation, a dietary aide served fish that weighed less than the ordered 3 oz portion, pudding was portioned with a smaller scoop than required, and ham portions also fell short of the recipe amount. Residents and staff reported the servings were too small, and the RD stated the kitchen should follow the menu spreadsheets and standardized recipes to ensure adequate calories and protein.
Incorrect meal portions were served when cooks plated Italian beef sandwiches without weighing the meat or following the recipe portion size. Staff were unsure of the required amount, the recipe was not available at the time, and a test plate of beef measured only 1.9 oz instead of the expected 3 oz. The RD confirmed the sandwiches had less beef than the recipe picture and that meat should have been weighed before serving.
Pureed pork portions were not served in the amounts listed on the approved menu for two residents on pureed diets. A cook initially plated smaller portions than the planned 2-#10 scoop serving, and the FSD reviewed the menu and directed a larger portion for the third plate. The facility’s spreadsheet, recipe, and policy all specified the same serving size.
Menu Not Followed and Posted Meal Items Did Not Match Served Food: A resident was served fish sticks and other items that did not match the meal ticket, and other residents in the dining room received the same substituted foods. The posted lunch menu also did not match the facility’s written menu, and the Dietary Mgr stated several items were unavailable because they were not ordered or were forgotten, while fish sticks were routinely used instead of the planned fish entrée.
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