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Welcome
A Surveyor’s Perspective
of the Dining Experience
1-1October 20, 2014
Angela Williams
Nurse Consultant
CMS Region IV
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Objectives
• Lesson objectives
– Identifying benefits of the dining experience
– Understanding of the survey process for the
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– Understanding of the survey process for the
dining observation
– Knowledge of common F tags associated with
dining
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• Why is the dining experience so important?
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experience so important?
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Background
Food and dining requirements are core
components of quality of life and quality
of care in nursing homes and provides:
– Increased meal consumption
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– Increased meal consumption
– Decreased weight loss
– Decreased supplement use
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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
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order to receive a nutritional supplement
• The prevalence of protein energy under-
nutrition for residents is estimated from
23-85%
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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
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Survey Process
• Meal times
• Dining locations
• All dining rooms will be observed
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• A second observation will be conducted IF
concerns are identified
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F371
• Dietary Sanitation
– Preventing eating surfaces from coming in
contact with staff’s clothing
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– Handling cups/glasses on the outside of the
container
– Handling knives, forks and spoons
– Does staff use proper hand hygiene
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F441
• Infection Control
– Determine whether staff have open areas on their skin,
signs of infection, or other indications of illness.
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F241
• Dignity
– Provide meals to all residents at a table at the
same time
– Provide napkins and non-disposable cutlery and
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– Provide napkins and non-disposable cutlery and
dishware (including cups and glasses)
– Consider residents’ desires when using clothing
protectors
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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
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– Talk with residents for whom they are providing
assistance rather than conducting social
conversations with other staff who are assisting
other residents
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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
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way that maintains confidentiality
– Respond to residents’ requests in a timely
manner
– Remove beverages from containers
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F252
• Homelike Environment
– Meals served on trays in a dining room
– Medication administration practices that
interfere with the quality of the dining
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interfere with the quality of the dining
experience
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F242
• Choices
– Where to eat?
– Refuse meal?
– Substitutes offered?
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– Substitutes offered?
– Did the resident choose when to eat?
– Were food preferences honored?
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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
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in their room
– How staff identify and provide any special dietary requirements or adaptation of utensils
– Staff availability during the dining process
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– Provision of assistive devices
– Proper positioning to maximize eating ability (wheel chairs fit under tables, etc)
– Assistance provided to resident’s dependent on
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– Assistance provided to resident’s dependent on staff
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F364
• Food Quality
– Mechanically altered diets, such as puree, were
prepared and served as separate items
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– Food placement, colors and textures were in
keeping with the residents needs
– Resident interviews regarding the food
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F364
Test Tray Procedures:
• Send the meal to the unit that is the
greatest distance from the kitchen
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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
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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
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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
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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
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F464
• Ventilation
– Good air circulation
– Acceptable temperature and humidity
– Avoidance of drafts at the floor level
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– Avoidance of drafts at the floor level
– Adequate removal of smoke exhaust and odors
– F464
October 20, 2014
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F258
Sound Levels
Do residents or staff need to raise their
voices to be heard?
Can residents be heard over the background
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Can residents be heard over the background
noises?
Do residents have control over unwanted
noises?
October 20, 2014
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F257
Comfortable and Safe Temperatures
• Do residents complain about heat or cold in
dining areas?
• What does staff do if residents complain?
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• What does staff do if residents complain?
• Measure the temperature of the room
October 20, 2014
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F464
Furnishings and Space
• Observe table height to determine whether
it provides the residents easy visibility and
access to food.
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access to food.
• Observe whether furnishings are
structurally sound and functional
• Can residents enter and exit the room
independently?
October 20, 2014
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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
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Questions
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