Food For Thought

Food Costs Are A Hot Topic!

Survey Trends with RD Surveyors

We know that a survey with one (or more!) of the RDs from CDPH will be especially thorough for the dietary department and that the consultant dietitians' clinical documentation will be thoroughly scrutinized as well. This is a compilation of survey issues from our Nutricopia RDs that may help you identify deficiencies in your health care communities and provide guidance to correct them before the next survey. 

Dining:

1. Are residents at the same table served at the same time?
2. Do residents with food have to wait for assistance to eat?
3. Are residents provided their food/beverage preferences?
4. Do test trays at end of trayline meet minimum hot temperatures of 120 degrees?
5. Are trayline temps taken, recorded and correct per food code?
6. Does nursing offer substitutes, and are they appropriate replacements when residents refuse the meal?  
7.  Are adaptive devices provided per orders? 

Menus:

1.  Are menus for regular and therapeutic diets posted in resident areas for the current week and following week (Title 22)?
2. Do posted menus reflect changes or substitutions made?
3. Have menus been approved by the RD, or an approval form signed by the RD?
4. Are menus and recipes for all diets followed?
5. Does staff know how to read the production and spread sheets and know the scoop sizes?
6. Do alternates meet the same nutritional content as the regular menu?
7. Are vegetarians receiving the same quantity of protein per the regular menu?
8. Are the renal diets being followed correctly?
9. Is the puree diet receiving the correct menu items prepared according to the recipe?
10. Does the staff know the procedures for puree preparation and proper consistencies?
11. Does staff use a scale to weigh the meat portion to assure accurate portion before meal service?
12. Does breaded meat provide the stated quantity of protein portion without the breading? 

Food Safety and Sanitation:

1. Are all thawing foods labeled and dated with pull date and use-by date?
2. Are thawed cartons of shakes dated with a use-by date?
3. Are there accurate thermometers inside refrigerators and freezers?
4. Is there a cool down temperature log correctly documented for all leftovers and hot foods per policy and procedure?
5. Does staff know the proper procedure and time/temperature requirements for cooling?
6. Is the ice machine cleaned and sanitized according to manufacturer's directions with correct cleaning and sanitizing products?
7. Is the juice machine cleaned and sanitized and hoses up off the floor?
8. Can dietary staff demonstrate proper use of the 3 (or 2) compartment sink for manual ware washing and sanitizing?
9. Is there a cleaning schedule with the frequency of cleaning and does it match the policy and procedure?
10. Are food thermometers routinely calibrated and do staff know the proper calibration procedures?
11. Are all foods labeled and dated?
12. Are staff following the proper procedures for handwashing and glove use?

Nutrition/Hydration:

1.  Are care plans updated?
2. Has the RD and IDT addressed weight variances; have root causes of variances been addressed and is edema addressed by RD and communicated with nursing?
3. Has the MD and RD been notified of residents with poor fluid intake?
4. Does MD address poor fluid intake in notes?
5. Does the facility follow their I&O policy? 

 Emergency Preparedness:

1. Does the plan provide adequate staff guidance?
2. Is there adequate food and water in the emergency supply?
3. Does the food supply include adequate amounts for staff and visitors?
4. Does the food supply include items for residents with restricted diets such as renal or low sodium diets?
5. If the emergency water supply includes the hot water tanks, is there equipment and procedures in place to drain the tanks using food grade hoses into sanitary containers?
6. Is the disaster food supply rotated per policy and procedure and no outdated food?