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.
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.
Failure to follow the planned menu and provide substitutions when food service was disrupted. Residents reported not receiving coffee, hot food, or requested alternatives, and one resident with multiple diagnoses including dysphagia and cognitive issues was observed with a tray of items the resident said would not be eaten. The DON and dietary staff stated the kitchen was closed after the health permit was suspended, leaving only cold items and limited drinks available.
Dietary staff did not follow the planned menu or resident preferences when a cook served eggs, toast, and oatmeal instead of the breakfast egg and sausage casserole listed on the menu. The dietary manager confirmed sausage products were available in the freezer and stated the cook should have followed the menu to provide enough protein and nutrients. A resident reported receiving toast, a boiled egg, and oatmeal for breakfast and said he did not get meat with every meal. The RD stated substitutions must match the menu’s nutritional value and calorie intake.
The facility failed to follow its approved menus, standardized recipes, and portion guidelines, resulting in residents receiving undersized protein portions and frequent omissions of planned foods and condiments. During a lunch observation, a protein entree of chicken sausage jambalaya was served in bowls that were mostly rice with minimal sausage, chicken, and beans; when the protein was weighed, it totaled less than 1 oz instead of the 2 oz specified on the recipe and diet spreadsheet. Multiple residents reported very small entree portions, frequent substitutions or omissions from the planned menu, and repeated shortages of items such as juice, butter, cheese, ham, and condiments including sugar, salt, pepper, ketchup, mustard, and mayonnaise, with one resident saving sugar packets to share with another. CNAs and dietary staff confirmed that the facility often ran out of condiments and some food items, that menus were not always followed, and that certain salad components were only provided if they happened to be in stock, contrary to the facility’s written menu planning and standardized recipe requirements.
Surveyors found that staff failed to follow the written menu and did not prepare or serve the planned dinner rolls at a lunch meal for all residents receiving food from the kitchen. The cook reported not realizing dinner rolls were on the menu, and the dietary manager confirmed the rolls remained in the freezer and were not baked. Several residents, including individuals with CHF, type 2 DM, dementia, prior CVA with hemiplegia, dysphagia, osteomyelitis, paraplegia, and other chronic conditions, reported they did not receive a dinner roll and would have wanted one. Facility policy requires use of standardized cycle menus, planned and revised by the RD and dietary manager, to provide nourishing meals that meet residents’ nutritional needs and preferences.
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