This week’s Ftag of the Week is F810 Assistive Devices – Eating Equipment/Utensils, which is part of the Food and Nutrition Services regulatory group. F810 requires nursing facilities to provide any special eating equipment and utensils that a resident needs to maintain their current abilities related to eating and drinking or, if possible, to improve them. A facility is also responsible for providing necessary staff assistance to ensure that the resident can use the assistive devices that are part of the resident’s plan of care.
Let’s look at several scenarios regarding how this has been cited on survey in 2019:
- A surveyor observed the dining room for two lunch meals over two days and noticed a resident with significant hand tremors trying to eat. The resident and the floor underneath him both had spilled food on them. The resident was interviewed and stated he should have had weighted utensils and a wrist cuff, which were part of the resident’s nutritional care plan, but were not provided during the observed meals.
- A surveyor observed that a resident had regular utensils during a meal observation, and the tray ticket did not include instructions for built up utensils as per the resident’s plan of care.
- Staff were seen in the dining room, but not assisting or cueing a resident with her meal and the resident was not provided with a scoop plate as ordered.
- A resident was observed eating mashed potatoes with her fingers, and then at another meal, the resident was observed asleep in front of her cold breakfast tray. Staff passed by the resident without interacting or offering assistance. A nurse said the resident is not always provided with utensils because she likes to eat with her hands, however, the dietary director stated that she had not assessed the resident for the use of finger foods to make eating easier.
It is very easy for someone to observe things going wrong with meal service, not just during survey, but on any given day related to provision and use of adaptive equipment as well as necessary staff oversight an assistance being provided. The issues cited above are not unique situations that only happen to be observed when a surveyor is conducting a meal observation! Issues related to assistive devices should be proactively addressed through management observation of meal service and routine auditing to avoid a “gotcha” deficiency. There needs to be a strong system in place to ensure that tray tickets match tray items, not just for assistive devices, but for food items and proper consistencies as well.
Let’s also not forget the importance of staff education regarding their responsibility for sharing information that a resident is refusing or is no longer able to use the adaptive equipment provided to assist them in remaining independent or require a lower level of assistance with eating or drinking. We should not be observing a CNA feeding a resident with built-up utensils due to lack of Nursing staff communicating with each other or with the Dietary Department that the adaptive equipment is no longer needed. Think about what a positive outcome there could be if there were timely communication of a decline in use of or refusal to use certain equipment and we coupled that with timely revision to the plan of care.