Welcome

A Surveyor’s Perspective

of the Dining Experience

1-1October 20, 2014

Angela Williams

Nurse Consultant

CMS Region IV

Objectives

• Lesson objectives

– Identifying benefits of the dining experience

– Understanding of the survey process for the

1-2October 20, 2014

– Understanding of the survey process for the

dining observation

– Knowledge of common F tags associated with

dining

• Why is the dining experience so important?

1-3October 20, 2014

experience so important?

Background

Food and dining requirements are core

components of quality of life and quality

of care in nursing homes and provides:

– Increased meal consumption

1-4October 20, 2014

– Increased meal consumption

– Decreased weight loss

– Decreased supplement use

Statistics

• 50-70% of residents leave 25% or more of

their food uneaten at most meals

• 60-80% of residents have a physician’s

order to receive a nutritional supplement

1-5October 20, 2014

order to receive a nutritional supplement

• The prevalence of protein energy under-

nutrition for residents is estimated from

23-85%

o Resident Choice and preferences

o Maintenance of eating abilities

o Provide assistance to dependent residents

o Meal Service with respect and dignity

Survey Process

1-6October 20, 2014

o Meal Service with respect and dignity

o Safe and sanitary meal service

o Adequacy of the dining area

Survey Process

• Meal times

• Dining locations

• All dining rooms will be observed

1-7October 20, 2014

• A second observation will be conducted IF

concerns are identified

F371

• Dietary Sanitation

– Preventing eating surfaces from coming in

contact with staff’s clothing

1-8October 20, 2014

– Handling cups/glasses on the outside of the

container

– Handling knives, forks and spoons

– Does staff use proper hand hygiene

F441

• Infection Control

– Determine whether staff have open areas on their skin,

signs of infection, or other indications of illness.

1-9October 20, 2014

F241

• Dignity

– Provide meals to all residents at a table at the

same time

– Provide napkins and non-disposable cutlery and

1-10October 20, 2014

– Provide napkins and non-disposable cutlery and

dishware (including cups and glasses)

– Consider residents’ desires when using clothing

protectors

F241

– Wait for residents at a table to finish their meal

before scraping food off of plates

– Sitting next to the residents while assisting them

to eat, rather than standing

1-11October 20, 2014

– Talk with residents for whom they are providing

assistance rather than conducting social

conversations with other staff who are assisting

other residents

F241

– Allow residents the time needed to complete

eating their meal

– Speak with residents politely and respectfully

and communicate personal information in a

way that maintains confidentiality

1-12October 20, 2014

way that maintains confidentiality

– Respond to residents’ requests in a timely

manner

– Remove beverages from containers

F252

• Homelike Environment

– Meals served on trays in a dining room

– Medication administration practices that

interfere with the quality of the dining

1-13October 20, 2014

interfere with the quality of the dining

experience

F242

• Choices

– Where to eat?

– Refuse meal?

– Substitutes offered?

1-14October 20, 2014

– Substitutes offered?

– Did the resident choose when to eat?

– Were food preferences honored?

F312

• Provision of Assistance, Assistive Devices and Positioning

– Provision of cueing, prompting or assisting

– How assistance is provided to residents who eat in their room

1-15October 20, 2014

in their room

– How staff identify and provide any special dietary requirements or adaptation of utensils

– Staff availability during the dining process

– Provision of assistive devices

– Proper positioning to maximize eating ability (wheel chairs fit under tables, etc)

– Assistance provided to resident’s dependent on

1-16October 20, 2014

– Assistance provided to resident’s dependent on staff

F364

• Food Quality

– Mechanically altered diets, such as puree, were

prepared and served as separate items

1-17October 20, 2014

– Food placement, colors and textures were in

keeping with the residents needs

– Resident interviews regarding the food

F364

Test Tray Procedures:

• Send the meal to the unit that is the

greatest distance from the kitchen

1-18October 20, 2014

greatest distance from the kitchen

• Check the food temperature and

palatability of the test meal close to the

time the last resident on the unit is served

and begins to eat

F366

Food Substitutes

• Did staff attempt to determine the reason

for the refusal and offer a substitute item of

equal nutritive value or another food item

1-19October 20, 2014

equal nutritive value or another food item

of the resident’s choice?

• If there is no alternate item offered, ask the

resident if it happens frequently

• Determine what is available for substitutes

F256 or F464

• Lighting

– Are illumination levels task-appropriate with

little glare?

– Does the lighting support independent

1-20

– Does the lighting support independent

functioning?

– F464 or F256

October 20, 2014

F464

• Ventilation

– Good air circulation

– Acceptable temperature and humidity

– Avoidance of drafts at the floor level

1-21

– Avoidance of drafts at the floor level

– Adequate removal of smoke exhaust and odors

– F464

October 20, 2014

F258

Sound Levels

Do residents or staff need to raise their

voices to be heard?

Can residents be heard over the background

1-22

Can residents be heard over the background

noises?

Do residents have control over unwanted

noises?

October 20, 2014

F257

Comfortable and Safe Temperatures

• Do residents complain about heat or cold in

dining areas?

• What does staff do if residents complain?

1-23

• What does staff do if residents complain?

• Measure the temperature of the room

October 20, 2014

F464

Furnishings and Space

• Observe table height to determine whether

it provides the residents easy visibility and

access to food.

1-24

access to food.

• Observe whether furnishings are

structurally sound and functional

• Can residents enter and exit the room

independently?

October 20, 2014

F362 and F368

Frequency of Meals

– Is there enough staff to prepare and serve

meals as scheduled?

– The evening meal and breakfast should have no

1-25

– The evening meal and breakfast should have no

greater time lapse than 14 hours.

October 20, 2014

Questions

1-26October 20, 2014