SMQT Dietary and Nutrition Services 4 — Questions and Answers
Question 1: A surveyor observes that a tray delivered to a resident's room shows the hot entrée at 95°F. The minimum required serving temperature for hot foods in long-term care is:
- 100°F
- 110°F (Correct answer)
- 120°F
- 140°F
Correct answer: 110°F
CMS requires that hot foods be served at a minimum of 110°F to ensure food is palatable, safe, and meets the regulatory standard for proper temperature.
Question 2: During a nutrition review, a surveyor notes a resident with a pressure ulcer has not had a nutritional assessment update in 6 months despite a significant change in condition. This is MOST likely a deficiency in:
- Physician notification requirements
- Comprehensive assessment/reassessment (F636) (Correct answer)
- Medication management (F756)
- Activities programming (F679)
Correct answer: Comprehensive assessment/reassessment (F636)
A significant change in condition such as a new pressure ulcer requires a reassessment under F636; failing to update the nutritional assessment violates this requirement.
Question 3: A resident who is Muslim requests that pork products never be served to them. Under resident rights regulations, the facility must:
- Explain that the standard menu cannot be altered for individual requests
- Provide a pork-free alternative that is nutritionally adequate (Correct answer)
- Transfer the resident to a facility that specializes in religious diets
- Offer only vegetarian meals to all residents to avoid the issue
Correct answer: Provide a pork-free alternative that is nutritionally adequate
Facilities must make reasonable accommodations for residents' religious and cultural dietary preferences, providing nutritionally adequate alternatives.
Question 4: A food service worker is observed using a cloth towel to wipe food contact surfaces between uses. Under food safety standards, this practice is:
- Acceptable if the cloth is laundered daily
- Acceptable only for dry food surfaces
- A violation because wiping cloths must be stored in sanitizer solution between uses (Correct answer)
- Acceptable if the towel is color-coded for kitchen use
Correct answer: A violation because wiping cloths must be stored in sanitizer solution between uses
FDA Food Code requires that wiping cloths used on food contact surfaces be kept in a sanitizer solution between uses to prevent bacterial contamination.
Question 5: A surveyor wants to evaluate whether residents are receiving adequate nutrition. Which clinical indicator is the MOST objective measure for reviewing nutritional status during a survey?
- Staff reports of resident appetite
- Resident satisfaction survey scores
- Trending body weight documentation and laboratory values (Correct answer)
- Number of menu choices offered
Correct answer: Trending body weight documentation and laboratory values
Serial weight documentation and relevant laboratory values (such as albumin, prealbumin) are objective clinical indicators of nutritional status used in survey review.
Question 6: When reviewing a facility's diet order system, a surveyor finds that diet orders are changed by the charge nurse without a physician's countersignature. Under federal regulations, diet orders:
- May be changed by any licensed nurse in response to resident preference
- Must be ordered by a physician or authorized practitioner and documented in the medical record (Correct answer)
- Can be changed by a CDM if approved by the dietary director
- Are optional for residents who are cognitively intact
Correct answer: Must be ordered by a physician or authorized practitioner and documented in the medical record
Therapeutic and regular diet orders must be physician-ordered (or by an authorized practitioner) and properly documented, as they are medical orders affecting health.
Question 7: A nursing facility offers only one meal seating time for all residents, and several residents report missing meals due to therapy scheduling conflicts. The MOST relevant regulatory concern is:
- F679 – Activities
- F809 – Frequency of Meals (Correct answer)
- F550 – Resident Rights/Exercise of Rights
- F812 – Food Sanitation
Correct answer: F809 – Frequency of Meals
F809 requires that meals be offered at times that meet residents' needs; a rigid single seating that causes residents to miss meals violates this standard.
SMQT Dietary and Nutrition Services 4
A surveyor observes that a tray delivered to a resident's room shows the hot entrée at 95°F.
The minimum required serving temperature for hot foods in long-term care is: