CMS SOM App. J, Tag W460

and specially prescribed diets.

Guidance §483.480(a)(1)

“Well balanced diets” are defined as diets that contain a variety of foods from the food groups

currently recommended by the Academy of Nutrition and Dietetics (AND).

"Modified and specially-prescribed" diets are defined as diets that are altered in any way to

enable the client to eat (e.g. food that is chopped, pureed) or diets that are intended to correct

or prevent a nutritional deficiency or health problem.

Refer to W463 and W474 regarding modified and specially prescribed diets.

The following may be indicators of or may lead to compromised nutritional status:

• Unplanned significant weight gain or loss;

• Fever/infection;

• Diarrhea;

• Chronic disease;

• Chewing and Swallowing problems;

• Teeth and gum diseases;

• Excessive use of laxatives;

• Abnormal laboratory values;

• Brittle, dry hair;

• Ridged or spoon shaped nails;

• Dry flaky skin; and

• Unexplained changed in mood such as general fatigue, apathy, irritability, lack of

concentration.

If one or more of these indicators are present, determine the facility’s response through

observation, interview, and record review.

Surveyors should assure the facility is responsive to client food allergies and the potential for

adverse food/drug interactions. If surveyors suspects these may exist, investigate further.

Examples of facility responsiveness to allergies and food/drug interactions include, but are not

limited to:

• Clients on long term anticonvulsant drug regimens (e.g., phenobarbital, phenytoin,

primidone) are periodically monitored per facility policy for decreased serum levels of

folic acid and vitamin D;

• Therapeutic doses of nutrients are provided to decrease the likelihood of anemia and

prevent decreased bone density, etc.; and

• Fiber and fluids are increased in the diet of clients to decrease the likelihood of

constipation.

Guidance §483.470(a)(1)

Clients of grossly different ages, functional levels, and/or social needs should not be housed

together unless all of the following documentation support the placement:

• Assessment;

• Client program plan;

• Staff documentation of client response to training programs; and

• QIDP notes.