CMS SOM App. U, Tag R142

The RNHCI must serve meals that furnish each patient with adequate nourishment

in accordance with the recommended dietary allowances of the Food and Nutrition

Board of the National Research Council, National Academy of Sciences. The

RNHCI must do the following:

(1) Furnish food that is palatable, attractive, and at the proper temperature and

consistency.

Interpretive Guidelines: §403.734(b)(1)

CMS prohibits prescription of therapeutic diets or parenteral nutrition in this program, as

these are considered medical practices. However, altering food consistency

(mechanically altered food; chopped, cut, ground, pureed, etc.) is not considered a

medical practice, but is designed to meet the needs of the patient.

“Food-palatability” refers to the taste and/or flavor of the food.

“Food-attractiveness” refers to the appearance of the food when served to patients.

The RNHCI must provide for each patient:

• Food with adequate nourishment: food should be prepared by methods that

conserve nutritive value, flavor, and appearance;

• Food and drink that is palatable, attractive, and at a safe and appetizing

temperature: food should be prepared to meet individual needs and should

accommodate allergies, intolerances, and preferences;

• Appealing options of similar nutritive value to patients who choose not to eat food

that is initially served or who request a different meal choice; and

• Drinks, including water and other liquids, sufficient to maintain patient hydration

and consistent with patient needs and preferences.

Survey Procedures:

• Identify concerns such as appearance or meal quality (such as color and texture of

vegetables or meats and, preparation and presentation of mechanically altered

foods).

• Evidence for palatability and attractiveness of food, from day to day and meal to

meal, may be strengthened through sources such as additional observation,

patient, and staff interviews.

o Does food have a distinct aroma or odor?

o Is the appearance varied in color and texture?

o Is food generally well seasoned (use of spices, herbs, etc.), and acceptable to

patients?

o Is food served at preferable temperature (hot foods are served hot and cold

foods are served cold) as discerned by the patient and customary practice? Is

food held and served at proper temperatures?