This regulation requires nursing facilities to accommodate each resident's food allergies, intolerances, and preferences, and to offer appealing, nutritionally equivalent alternatives when a resident refuses an initially served food item or requests a different meal. Facilities must ensure staff are aware of individual resident dietary needs and that substitutions are consistent with the facility's usual food offerings. Surveyors are directed to observe meal service, interview residents and staff, and verify that dietary information is reflected in assessments and care plans.
View official sourceF806 (Rev. 173, Issued: 11-22-17, Effective: 11-28-17, Implementation: 11-28-17) §483.60(d) Food and drink Each resident receives and the facility provides— §483.60(d)(4) Food that accommodates resident allergies, intolerances, and preferences; §483.60(d)(5) Appealing options of similar nutritive value to residents who choose not to eat food that is initially served or who request a different meal choice; and GUIDANCE §483.60 (d)(4)-(5) Facilities should be aware of each resident’s allergies, intolerances, and preferences, and provide an appropriate alternative. A food substitute should be consistent with the usual and/or ordinary food items provided by the facility. For example, the facility may, instead of grapefruit juice, substitute another citrus juice or vitamin C rich juice the resident likes. PROCEDURES §483.60(d)(4)-(5) Observe meal services. If a resident appears to refuse food or drink items, determine if he or she is offered the opportunity to receive substitutes. PROBES §483.60(d)(4)-(5) • Ask residents how the food meets their preferences, allergies and/or intolerances. • If residents who refuse food or drinks, ask them if they are offered substitutes. • Interview residents or staff to determine how alternate food choices are communicated to the residents? • How are food textures, allergies, intolerances, and preferences accommodated per a resident’s assessment, care plan and choice and how is this information communicated to staff? POTENTIAL TAGS FOR FURTHER INVESTIGATION §483.60(d)(4)-(5) During the investigation of F806, the surveyor may have identified concerns with additional requirements related to outcome, process, and/or structure requirements. The surveyor is advised to investigate these related requirements before determining whether non-compliance may be present at these other tags. Examples of some of the related requirements that may be considered when non-compliance has been identified include, but are not limited to, the following: • §483.20(b), F636, Comprehensive Assessments o Determine if the resident’s allergies, intolerances, preferences, or need for a therapeutic diet were comprehensively assessed. • §483.21(b)(1), F656, Comprehensive Care Plans o Determine if a comprehensive care plan was developed to include the resident’s allergies, intolerances, preferences, or need for a therapeutic diet. • §483.21(b)(2), F657, Comprehensive Care Plan Revision o Determine if the care plan was reviewed and revised by appropriate staff, in conjunction with the interdisciplinary team and with input from the resident or his/her legal representative, to try to address any allergies, intolerances, preferences, or need for a therapeutic diet. • §483.21(b)(3)(i), F658, Care provided by Qualified Persons in Accordance with the Plan of Care o Determine whether the care plan for a resident with allergies, intolerance, preferences, or a therapeutic diet is adequately and/or correctly implemented. • §483.25(g)(1)-(3), F692, Nutrition/Hydration o Determine if the facility has managed the resident’s nutritional interventions to meet the resident’s nutritional needs, while accommodating the resident’s allergies, intolerances, preferences, or need for a therapeutic diet.