complaint·September 9, 2024

Interviews with staff revealed that prior to 2020, the facility’s menu was submitted to the facility’s corporate office for review and assessment once or twice a year. Interviews with facility management revealed that the facility has not provided their corporate office with a sample menu for review since at least 2021. Interviews with staff revealed that neither the Chef or Restaurant Manager are nutritionists, dietitians, or home economists. Review of a nutritional assessment of the facility’s menu revealed that the facility’s menu was reviewed by a dietitian on 8/15/2024. Interviews with facility management revealed that the facility’s menu had not been overseen by a dietitian, nutritionist, or home economist since at least 2018. The Department has investigated the above-mentioned allegation and based on interviews and records review, the preponderance of the evidence has been met, therefore, this allegation is deemed substantiated. The following deficiency for the facility menu not being overseen by a qualified individual is cited per CA Code of Regulations Title 22 and noted on the attached LIC9099-D page. An exit interview was conducted with General Manager Karl Miller, whose signature below confirms receipt of a copy of this report and the Licensee Appeal Rights (LIC9058 3/22). Review of the facility’s prescribed diet order form revealed that residents’ physicians are notified that the facility is only able to accommodate low sodium (GLS), limited concentrated sweets (LSC), and mechanical soft diets. Review of the facility’s dining room menu for May 2024, healthy items menu, and chef specials menus revealed that the facility offered multiple different meal items using different meats such as beef, pork, chicken, salmon, and turkey as well as a no added sugar dessert options. Review of the facility’s food guide regarding GLS revealed that sodium is restricted on that diet and residents are encouraged to limit the consumption of high salt meats such as ham, sausages, packaged seasoning mixes, soups, sauces, gravies, salad dressing, and marinades. Meals should be made with fresh herbs and soup stocks. Review of the facility’s food guide for LCS revealed that the diet is a liberalized diabetic diet and allows for residents to consume most types of food while following recommended portion sizes, except for desserts. Residents following this diet should be offered diet options of foods such as jelly, syrup, Jell-O, and pudding. Interviews with staff revealed that in August 2024, the facility began using a new electronic meal ordering system which allowed dining staff to view each resident’s dietary preferences, physician ordered modified diets, and allergies. During a visit on 8/14/2024, LPA Ruiz observed a demonstration of the new electronic ordering system which showed the resident’s name and listed the resident’s dietary preferences, modified diets, and allergies in red text under the resident’s name on an electronic tablet. The system also marked any meals in red if that meal contained ingredients or was prepared in a way that does not align with the resident’s dietary restrictions. Facility staff were able to modify meals by removing or substituting ingredients and placing sauces or dressings on the side. Once the meal has been modified to meet the resident’s dietary restrictions, the meal no longer showed red in the system. The system would print out a ticket in the kitchen that listed the resident’s name, meal order, dietary preferences, modified diets, and allergies in red text. Kitchen staff stated that they often marinate meats for entrees and will set aside a few meats that are not marinated to allow residents with dietary restrictions to order that meal. Staff stated that they are able to make modifications to most meals to allow residents to eat whichever meal the resident chose to eat but stated that there are a few times that the staff could not meet a resident’s request to eat a certain meal. Kitchen staff stated that in that case, staff would speak with the resident to explain the reason that staff cannot accommodate the resident’s dining request and offer alternative meal choices. Continued on LIC9099-C page… During interviews with dining and kitchen staff, as well as facility management revealed that residents who had a physician ordered modified diet must be willing to follow the requirements of the diet, and staff cannot force residents to choose specific meals or restrict certain meal items. The facility’s prescribed diet order form includes language to physicians that residents must be aware of the physician order diet, must be willing to follow the diet, and that the resident could not be forced to follow the diet. Interviews with dining staff and facility management provided supporting evidence that residents were not required to adhere to the physician ordered diet. Interviews of residents with modified diets did not reveal any concerns with the meals offered at the facility. Some of the residents interviewed denied that they were following any modified diets while others stated that they were modifying their diet independently without a physician order. Residents did not voice any concerns that the facility did not offer a variety of meals that allowed residents with different meal preferences or requirements to have choices in their meals. The Department has investigated the above-mentioned allegation and based on interviews and records review, the preponderance of the evidence has not been met, therefore, this allegation is deemed unsubstantiated. An exit interview was conducted with General Manager Karl Miller, whose signature below confirms receipt of a copy of this report and the Licensee Appeal Rights (LIC9058 3/22).