Nutrition F-Tags & Survey Elaine Farley-Zoucha, RD, LMNT Objectives Identify 3 ways nutrition is involved in resident care. Demonstrate a basic knowledge of nutrition related F-Tags and how they affect resident care. Understand how to utilize the QIS Forms as an effective Quality Assurance Tool. Who needs to know Food Service Director and Employees Executive Director or Administrator Nursing Staff Activities or Life Enrichment Director 1
Nutrition and Resident Care Nourishing, Life Sustaining Emotional, Social, Spiritual Dignity, Independence F-360 The facility must provide each resident with a nourishing, palatable, wellbalanced diet that meets the daily nutritional and special dietary needs of each resident. F-361; Staffing The facility must employ a qualified dietitian either full-time, part-time, or on a consultant basis. 483.35(a)(1) If a qualified dietitian is not employed full-time, the facility must designate a person to serve as the director of food service who receives frequently scheduled consultation from a qualified dietitian. 483.35(a)(2) A qualified dietitian is one who is qualified based upon either registration by the Commission on Dietetic Registration of the American Dietetic Association, or on the basis of education, training, or experience in identification of dietary needs, planning, and implementation of dietary programs. 2
Director of FSD Requirements SNF-NF-ICF (175 NAC 12) 12-006.04B2c Director of Food Service: When the director of food service is not a qualified dietitian, the director must have at least 15 hours of continuing education related to dietetics each year, 5 hours of which relate to sanitation. Evidence of credentials and of continuing education must be available within the facility. *These are specific to Nebraska Regulations Director of FSD Requirements 12-006.04D2a to qualify as director of food service the employee must be one of the following: 1) A graduate of a dietetic technician program approved by the American Dietetic Association; 2) An individual with a bachelor s degree in foods and nutrition; 3) A graduate of a dietetic assistant program approved by the American Dietetic Association, qualifying certification by the Dietary Manager s Association; F-362; Support Staff The facility must employ sufficient support personnel competent to carry out the functions of the dietary service 3
F363 Standard Menus & Nutritional Adequacy Menus must: (1) Meet the nutritional needs of residents in accordance with the recommended dietary allowances of the Food and Nutrition Board of the National Research Council, National Academy of Sciences; 483.35(c)(2) and (3) Menus and Nutritional Adequacy 483.35(c)(2) Be prepared in advance; and 483.35(c)(3) Be followed. F-364; Food Each resident receives and the facility provides: (1) Food prepared by methods that conserve nutritive value, flavor, and appearance; (2) Food that is palatable, attractive, and at the proper temperature; F-365 & F-366 F365 Food prepared in a form designed to meet individual needs; and F366 Substitutes offered of similar nutritive value to residents who refuse food served 4
F-367 Therapeutic Diet Therapeutic diets must be prescribed by the attending physician. Therapeutic Diet is defined as a diet ordered by a physician as part of treatment for a disease or clinical condition, or to eliminate or decrease specific nutrients in the diet, (e.g., sodium) or to increase specific nutrients in the diet (e.g., potassium), or to provide food the resident is able to eat (e.g., a mechanically altered diet). F-368; Frequency of Meals (1) Each resident receives and the facility provides at least three meals daily, at regular times comparable to normal mealtimes in the community. (2) There must be no more than 14 hours between a substantial evening meal and breakfast the following day, except as provided in (4) below. (3) The facility must offer snacks at bedtime daily. (4) When a nourishing snack is provided at bedtime, up to 16 hours may elapse between a substantial evening meal and breakfast the following day if a resident group agrees to this meal span, and a nourishing snack is served. F-369; Assistive Devices The facility must provide special eating equipment and utensils for residents who need them. The intent of this regulation is to provide residents with assistive devices to maintain or improve their ability to eat independently. For example, improving poor grasp by enlarging silverware handles with foam padding, aiding residents with impaired coordination or tremor by installing plate guards, or providing postural supports for head, trunk, and arms. 5
F-363; Paid Feeding Assistants Paid Feeding Assistants- (3) State-approved training course. A facility may use a paid feeding assistant, as defined in 488.301 of this chapter, if The feeding assistant has successfully completed a Stateapproved training course that meets the requirements of 488.160 before feeding residents; and The use of feeding assistants is consistent with State law. Supervision. A feeding assistant must work under the supervision of a registered nurse (RN) or licensed practical nurse (LPN). In an emergency, a feeding assistant must call a supervisory nurse for help on the resident call system. Sanitation F-Tags The Facility Must: F 370 - Procure food from sources approved or considered satisfactory by Federal, State or local authorities; F371 - Store, prepare, distribute, and serve food under sanitary conditions; and F-372; Garbage Disposal 483.35(i)(3) Dispose of Garbage and Refuge Properly Interpretive Guidelines The intent of this regulation is to assure that garbage and refuge be properly disposed. 6
CLINICAL TAGS F-314; Pressure Ulcers 483.25(c) Pressure Sores Based on the comprehensive Assessment of a resident, the facility must ensure that-- (1) A resident who enters the facility without pressure sores does not develop pressure sores unless the individual s clinical condition demonstrates that they were unavoidable; and (2) A resident having pressure sores receives necessary treatment and services to promote healing, prevent infection and prevent new sores from developing. F-324 & F325; Nutrition 483.25(i) Nutrition - Based on a resident s comprehensive assessment, the facility must ensure that a resident F-325 (1) Maintains acceptable parameters of nutritional status, such as body weight and protein levels, unless the resident s clinical condition demonstrates that this is not possible; and 7
F-326 Therapeutic Diet 483.25(i)(2) Receives a therapeutic diet when there is a nutritional problem Intent 483.25(i) The intent of this regulation is to assure that the resident maintains acceptable parameters of nutritional status, taking into account the resident s clinical condition or other appropriate intervention, when there is a nutritional problem. F-324 F-326 Interpretive Guidelines 483.25(i) This corresponds to MDS 3.0 sections G, I, J, K and L when specified for use by the State. Parameters of nutritional status which are unacceptable include unplanned weight loss as well as other indices such as peripheral edema, cachexia and laboratory tests indicating malnourishment (e.g., serum albumin levels). F-327; Hydration 483.25(j) Hydration. The facility must provide each resident with sufficient fluid intake to maintain proper hydration and health The intent of this regulation is to assure that the resident receives sufficient amount of fluids based on individual needs to prevent dehydration. 8
SURVEY PROCESS Surveyors enter the building Notify Dietary Staff Complete a quick walk through of the kitchen. Notify RD if not in-house Gather requested documentation QIS FORMS 9
Resources for Regulations Nebraska Department of Health and Human Services http://www.dhhs.ne.gov/reg/t175.htm Long Term Care Survey Process Manual Nebraska Health Care Association, www.nehca.org Questions? THANK YOU! ELAINE FARLEY-ZOUCHA 10