SMQT Dietary and Nutrition Services 5 — Questions and Answers
Question 1: A surveyor reviews a facility where enteral tube feeding is used for a cognitively intact resident who had not consented to this intervention. This scenario MOST directly raises concerns under:
- F812 – Food Sanitation
- F578 – Request/Refuse Treatment; Formulate Advance Directives (Correct answer)
- F804 – Nutritive Value of Foods
- F636 – Comprehensive Assessment
Correct answer: F578 – Request/Refuse Treatment; Formulate Advance Directives
A cognitively intact resident has the right to refuse any treatment including tube feeding; proceeding without consent violates F578 (right to refuse treatment).
Question 2: During a dietary observation, a surveyor notes that thickened liquids ordered for a resident with dysphagia are being prepared inconsistently by different staff members. The MOST appropriate system-level corrective action is:
- Issue verbal warnings to non-compliant staff
- Develop a standardized protocol with pre-measured thickening agent quantities and competency training (Correct answer)
- Switch the resident to pureed solids only
- Remove the thickened liquid order and substitute IV hydration
Correct answer: Develop a standardized protocol with pre-measured thickening agent quantities and competency training
Consistent thickened liquid preparation requires standardized protocols with precise measurements and staff competency validation to ensure resident safety.
Question 3: A facility's food safety log shows that a steam table was holding mashed potatoes at 130°F during lunch service. The required minimum hot holding temperature for cooked foods is:
- 130°F
- 135°F (Correct answer)
- 145°F
- 150°F
Correct answer: 135°F
The FDA Food Code requires hot foods to be held at 135°F or above to prevent bacterial growth in the temperature danger zone.
Question 4: A surveyor is evaluating a facility's nutritional supplement program and finds that supplements ordered by the dietitian are routinely given between meals but never documented in the medical record. This is MOST likely a deficiency in:
- F812 – Food Sanitation
- F842 – Medical Records (Correct answer)
- F803 – Menus and Nutritional Adequacy
- F692 – Nutritional Status
Correct answer: F842 – Medical Records
Failure to document supplement administration in the medical record is a medical records deficiency under F842, as all interventions must be documented.
Question 5: A resident at high risk for aspiration is found eating in the supine position without staff supervision. The MOST immediate concern for the surveyor is:
- Resident's food preferences are not being followed
- Imminent danger to the resident's health and safety (Correct answer)
- The dining room is understaffed
- The food is not at the correct temperature
Correct answer: Imminent danger to the resident's health and safety
A resident at high aspiration risk eating supine without supervision represents an immediate jeopardy situation due to the high likelihood of aspiration pneumonia or asphyxiation.
Question 6: Under OBRA regulations, the role of the dietitian in a SNF includes all of the following EXCEPT:
- Developing individualized nutrition care plans
- Performing nutrition-focused physical assessments
- Prescribing medications to treat malnutrition (Correct answer)
- Counseling residents and families on nutritional needs
Correct answer: Prescribing medications to treat malnutrition
Dietitians are not licensed to prescribe medications; their scope includes assessment, care planning, education, and nutritional intervention, not pharmacological prescription.
Question 7: A surveyor observes that a resident with diabetes who requires carbohydrate-consistent meals consistently receives the standard menu without any modification. The facility's dietitian states no order is on file for a diabetic diet. The NEXT appropriate step in the survey process is:
- Immediately cite the facility for an F-tag violation without further investigation
- Review the resident's medical records to determine if a physician order for a diabetic diet exists or was indicated (Correct answer)
- Interview the attending physician by phone during the survey
- Disregard the finding since diabetes management is a medical issue
Correct answer: Review the resident's medical records to determine if a physician order for a diabetic diet exists or was indicated
Before citing a deficiency, the surveyor must verify the facts by reviewing the medical record to determine whether a diet order was indicated, ordered, or properly refused by the resident.
SMQT Dietary and Nutrition Services 5
A surveyor reviews a facility where enteral tube feeding is used for a cognitively intact resident who had not consented to this intervention.
This scenario MOST directly raises concerns under: