F-Tag 800 states: “The facility must provide each resident with a nourishing, palatable, well-balanced diet that meets his or her daily nutritional and special dietary needs, taking into consideration the preferences of each resident.”

The facility must present residents with a nutritional meal that meets individual dietary requirements. The purpose is to maintain the resident’s weight or to increase/reduce their weight to retain a healthy lifestyle. Residents have the right to make choices regarding their diet.

Compliance auditors look for the following items:

  • Does the Plan of Care reflect specific requirements for the resident’s diet?
  • Do the residents have a choice of alternate meals?
  • Do the alternate meals meet the nutritional requirements for the resident?
  • Does the documentation in the meal plan reflect what the resident is given to eat each meal?
  • Are the residents served the correct portion sizes to meet the established nutritional plan?
  • Are the dietary staff following a recipe?
  • Is the food prepared, served and presented in an appetizing manner?
  • Is food served at the proper temperatures?
  • Does the facility take into consideration the resident’s concerns about food frequency, quality, variety, timeliness, etc.?

The interpretive guidelines in Appendix PP states: “Also, cite this Tag if there are overall systems issues relating to how the facility manages and executes its food and nutritional services.” This comment expands the scope of the deficiency to include all programs, procedures, and practices within the dining department.

The following are F-Tag 800 violations taken from annual state surveys and complaint surveys from 11/28/17–1/26/18.

  • The facility was completing a one-month menu rotation, with two seasonal menus. The residents voiced concerns about the repetitive menu, the facility was aware but did not make any changes.
  • Portions sizes for one resident were too small and did not reflect the expectations from the care plan.
  • French fries were not stored on the steam table and were served to the residents’ cold.
  • Dining Employee did not follow the recipe for pureed food, added ingredient and did not cool properly.
  • The facility lacked a written policy for resident food preferences. CNAs were expected to know the resident’s likes/dislikes and allergies. The meal tickets lacked personal information.
  • Portion sizes do not match the serving sizes to meet a nutritional meal. Residents had voiced concerns and the facility did not follow-up.
  • Resident did not have preferences documented and was served the same meals consistently which the resident would not eat.
  • The facility failed to act on resident’s request to re-evaluate diet texture.
  • Cold food held at elevated temperatures. Hot food dropping 86˚F from the hot hold to resident service. Infection control concerns with glove usage and failure to wash hands when replacing gloves. Leftovers not cooled properly. Vegetables cooked in water reducing nutritional value.
  • Facility served foods that were not to be eaten with resident’s medication. Lack of communication between departments.
  • Pureed meal did not match recipe. Facility failed to provide meat on two meal service trays.
  • Failure to ensure resident received correct diet per physician orders.
  • Resident was served food daily that she did not like or eat. Dining Department was notified, but there were no changes made.
  • Cold and hot hold temperatures were outside of required temperatures. Improper sanitizing of equipment in 3-compartment sink.
  • Failure to provide food trays in a timely manner.

Note, deficiencies vary in subject matter, and could easily fall under other deficiencies in the regulations.