Health inspection·March 14, 2024

F 0803 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many Ensure menus must meet the nutritional needs of residents, be prepared in advance, be followed, be updated, be reviewed by dietician, and meet the needs of the resident. Based on observations, staff interview, and review of the menu and whiteboard, the facility failed to follow the prepared menus and failed to ensure the changes to the menu were approved by a qualified clinical nutrition professional for nutritional adequacy. This affected four of four meals reviewed during the survey. This had the potential to affect the 22 residents who received meals from the kitchen. The facility census was 24. Finding include: Review of the facility's menu for Fall and Winter 2023 to 2024 revealed they menu was signed but it was unknown who the person was because it was not the Registered Dietitian (RD) for the facility. The lunch menu for Wednesday 03/13/24 was chicken barbeque, macaroni and cheese, baked beans, and a peanut butter bar. The white board (located in the hallway near the residents' rooms) revealed the residents would be receiving hamburger gravy, mashed potatoes, green beans, and pudding. The dinner menu for Wednesday 03/13/24 was taco salad, refried bean, lettuce and tomato, crackers, and cream pie. The white board revealed the residents were to receive barbeque chicken nuggets, baked beans, mixed vegetables, and fruit. The lunch menu for Thursday 03/14/24 was baked ziti, garlic bread, green beans, and fruit salad. The white board revealed the residents were to receive breaded chicken with gravy, macaroni and cheese, bean and carrot medley, and apple pie. The dinner menu for Thursday 03/14/24 was pork riblet, creamed corn vegetable medley, dinner roll, and sherbert. The white board revealed the residents would receive stuffed pepper soup, grilled cheese, and fruit. Observations on 03/13/24 and 03/14/24 at lunch and dinner revealed the residents were served the meals which were noted on the whiteboard and not what listed in the menu for these days. Interview with [NAME] #600 on 03/13/24 at 12:01 P.M. verified he did switch the lunch and dinner menu for this day. [NAME] #600 was unsure if the RD was aware of changes made to the menu, because he does not notify anyone of the changes. [NAME] #600 stated he does not do the ordering and it was the dietary manager who does the ordering. When he makes changes to the menu, he writes it on the whiteboard first thing in the morning for the residents to see and if they may want a substitution. Page 1 of 2 366002 366002 03/14/2024 Crestline Rehabilitation and Nursing Center 327 West Main Street Crestline, OH 44827

F 0803 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many Interview with Dietary Manager (DM) #700 on 03/14/24 at 9:15 A.M. verified he usually works on Wednesday and was completing the menu for Wednesday. DM #700 did not want to serve the residents the taco salad due to the residents having received salad on Monday when he changed the menu from pork loin to chili because he did not have the pork loin. DM #700 stated he was sick and had corporate make out the food order. DM #700 said the facility did not receive the pork loin. DM #700 verified he substitutes for other foods because he does not have time to look through all the search through the facility's online food order guide. The residents do not like pork riblets, so another pork item was substituted. DM #700 does not know if the RD was aware of the changes and he does try to substitute meat for meat and a potato for potato, like fries because the residents do not like them. DM #700 does not speak to the RD and does not report to anyone when he makes changes to the menu. DM #700 stated he did not know why the cook yesterday substituted the lunch and supper meals because the food for those meals was here. DM #700 does not document the food substitutions. Telephone interview on 03/14/24 at 10:33 A.M. with RD #800 verified she does not review the menus or approve the menus. The menus were approved in the the corporate office. Interview with Director of Culinary for Ohio #900 on 03/14/24 at 1:29 P.M. verified Food Contract Company #750 develops the menus and the RD at the Food Contract Company approves the menus. Director of Culinary for Ohio #900 said there should be a substitution log and the RD should be aware of changes to the menu and be approved by the RD. This deficiency represents non-compliance investigated under Complaint Number OH00151649. 366002 Page 2 of 2