Plan of Correction / Allegation of Compliance F-368 – Offering/Serving Bedtime Snacks

Tag Cited: F368

§483.35(f)(3) – Offering of Bedtime Snacks

Issue Cited:
“Offering/Serving Bedtime Snacks on a Daily Basis”
Preparation and/or execution of this plan do not constitute admission or agreement by the provider that a deficiency exists. This response is also
not to be construed as an admission of fault by the facility, its employees, agents or other individuals who draft or may be discussed in this
response and plan of correction. This plan of correction is submitted as the facility’s credible allegation of compliance.

1. Immediate action(s) taken for the resident(s) found to have been affected include:
Nursing and Dietary Services were immediately in-serviced on our standard of practice (SOP) for
offering and serving bedtime snacks.

2. Identification of other residents having the potential to be affected was accomplished by:
The facility has determined that all residents have the potential to be affected.

3. Actions taken/systems put into place to reduce the risk of future occurrence include:
All nursing and dietary staff have been in-serviced on the facility’s “Offering/Serving Bedtime
Snacks” policy and standard of practice. In-service training included observation of individuals
performing the procedure. A “Validation Checklist” was completed for each individual observed to
determine if the individual was performing the procedure in accordance with our SOP. Findings
were reviewed with each individual observed. Corrective action was provided as needed.

4. How the corrective action(s) will be monitored to ensure the practice will not recur:
The Director of Nursing Services (DNS), or designee, will complete random weekly audits of staff
offering/serving bedtime snacks for six (6) consecutive weeks. Random verification checklists will
be completed to ensure that bedtime snacks are being offered in accordance with our policy and
standard of practice (SOP).
Audit records and validation checklists will be reviewed by the Risk Management/Quality Assurance
Committee until such time consistent substantial compliance has been achieved as determined by the
committee.
Audit results will be shared with the Resident/Family Group Council for comment and suggestions.
Corrective action completion date: _________________________.
Policy Offering/Serving Bedtime Snacks

Offering/Serving Bedtime Snacks 
Date Implemented:    Date Reviewed/Revised:    Reviewed/Revised By:   

Standard:

It is the practice of this facility to offer and serve residents with a nourishing snack at bedtime on a
daily basis.

Standard Explanation and Compliance Guidelines:

1. The nursing staff offers bedtime snacks to all residents on a daily basis.
2. All diabetic or special diet bedtime snacks are labeled and dated. Each label contains the
resident’s name and room number.
3. Dietary services delivers bedtime snacks to each nurses’ station. The Charge Nurse is made aware
of the delivery of the snacks.
4. Nursing staff delivers and serves snacks to residents in accordance with our standard of practice
(SOP) entitled Offering/Serving Bedtime Snacks.

5. Inquiries concerning this policy should be referred to the Director of Nursing Services (DNS)
who may be reached by calling ____________________________ or by dialing extension
____________.
Standard of Practice (SOP/Checklist) Offering/Serving Bedtime Snacks
 
Standard of Practice (SOP)
Offering/Serving Bedtime Snacks
   
Why You Do It :

The reason for offering bedtime snacks is to provide residents with adequate nutrition.

First Things First:

1. Review the resident’s care plan and note any special needs.
2. Check the snack tray to be sure that it is the correct tray and diet for the resident.

What You Need:

1. Snack Tray (with silverware (as appropriate), napkin, straw, etc.).
2. Special feeding devices (as applicable).
3. Condiments (as diet permits).
4. Wash cloth.
5. Gown, Gloves, Mask, Eyewear (as appropriate).

Serving the Snack:

1. Wash your hands.
2. Offer the snack to the resident. Tell the resident what the snack is.
3. If the resident indicates he/she wants the snack, place the snack on the overbed table or serving area. Adjust
table to comfortable position and height.
4. Assist the resident to a comfortable position as needed.
5. Place the snack within easy reach of the resident. Open beverage cartons as necessary. Position napkin.
6. Assist resident with snacks as appropriate. Encourage resident to feed self as much as possible.
7. Be sure the call light device is within easy reach of the resident.
8. Inform resident you will be back to remove the snack tray. Allow resident ample time to eat his/her snack.
9. Remove the snack tray when the resident has finished the snack or upon request of the resident.
10. Offer the resident the wash cloth to wash his/her face and hands. Assist as necessary.
11. Clean overbed table. Return to proper position.
12. If resident is in a chair and wishes to go to bed, assist him/her to bed as necessary.
13. Reposition bedcovers. Lower bed as indicated. Be sure resident is comfortable before leaving the room.
14. Be sure the call light device is positioned within easy reach of the resident.
15. Discard any PPE equipment used in the appropriate trash container in the room.
16. Turn room light(s) off or leave on (as requested by the resident).
17. Wash your hands.

Write It Down:
Document:
1. The date and time you served the snack.
2. Your name and position title.
3. The amount of the snack eaten (e.g., 25%, 50%, 75%, 100%).
4. If the resident refused the snack and why, and any food substitutes offered or interventions taken.
5. Other information as indicated or appropriate.

Report:
1. If the resident refused the snack and why.
2. Chewing/swallowing difficulties, skin conditions, complaints, etc.
Standard of Practice (SOP/Checklist) Offering/Serving Bedtime Snacks
 
Standard of Practice - Validation Checklist
Offering/Serving Bedtime Snacks
Purpose: To determine if the individual offering or serving the bedtime snack is doing so in accordance with the
facility’s standard of practice. Record observations below. Review findings with the individual being observed. Provide
corrective action as needed.

Individual Being Observed: _______________________________________________________________ Date: ___________________________________

Observed By:___________________________________________________________________________ Title: ____________________________________

Satisfactory
# Procedure Observed Comments
Y N NA
1 Reviewed care plan.
2 Washed hands.
3 Followed RR protocol (e.g., knocked on door, maintained privacy, etc.)
4 Offered the resident a bedtime snack.
5 Checked tray to ensure right resident and right diet.
6 Placed snack track on overbed table / serving area.
7 Described snack to resident.
8 Assisted resident to comfortable position (as necessary)
9 Placed napkin. Opened beverage containers, straws, etc. (as necessary)
Assisted resident with snack (as necessary). Encouraged resident to feed
10
self as much as possible.
11 Positioned call light device within easy reach of resident.
12 Allowed resident ample time to finish snack.
13 Removed snack tray and offered resident wash cloth.
14 Cleaned and stored overbed table.
15 Assisted resident to bed (as applicable/requested by resident)
16 Repositioned bed covers. Assisted resident to comfortable position.
17 Placed call-light device within easy reach of the resident.
Followed IC protocol (e.g., washed hands, use of PPE, discarded soiled
18
items into appropriate containers etc.).
19 Recorded/Reported appropriate data.
20
21
22

Observer: List procedures (if any) that requires corrective action.

# Procedure Corrective Action Taken/Recommended

Signature – Individual Being Observed:

Signature – Observer:
 Audit Form Offering/Serving Bedtime Snacks

F-368 – Frequency of Meals

(For use in determining compliance with F368 - §483.35(f)(3))

Offering/Serving Bedtime Snacks

Confidential Data: Risk Management/QA Committee Work Document
Purpose: To determine if nursing and dietary staff are following the facility’s Offering/Serving Bedtime Snacks standard of practice (SOP).

Instructions: Randomly select a floor/hall/wing to observe the offering and serving of bedtime snacks. Observe staff performing the procedure. Record responses below. Record
additional information in the “Comments” section. Provide completed report to the Risk Management/QA Committee. Use additional copies of this form as necessary.
(Abbreviations: SOP = Standard of Practice; NS = Nurses’ Station).

Time Snack Service Began: _____________________

Date: Time Snacks Delivered to NS: Was Delivery Timely? [ ] Yes [ ] No *
Ended: _____________________

Floor/Hall/Wing Observed: Observed By: Job Position/Title:

Observations
Snack Snack SOP
Resident Observed Comments
Offered Served Followed
Y N* Y N* Y N **

0 EXAMPLE: SMITH, Marvin √ √ √

10

11

12

13

14

15

16

17

18

19

20

* If NO, provide explanation in “Comments” Column. ** If NO, complete Verification Checklist.

Inservice Training-Instructor Guide/Attendance Record Offering/Serving Bedtime Snacks

Offering/Serving Bedtime Snacks

In-Service Training Guide

F-368 – Frequency of Meals

Review Regulation(s):
§483.35(f)(3) - The facility must offer snacks at bedtime daily.

§483.35(f)(4) - When a nourishing snack is provided at bedtime, up to 16 hours may elapse

between a substantial evening meal and breakfast the following day if a resident group agrees to
this meal span, and a nourishing snack is served.
Review Intent of Regulation:
The intent of this regulation is to assure that the resident receives his/her meals at times most
accepted by the community and that there are not extensive time lapses between meals. This
assures that the resident receives adequate and frequent meals.
Review Interpretive Guidelines (How Surveyors Interpret the Regulations):
“Nourishing snack” is defined as a verbal offering of items, single or in combination, from the basic
food groups. Adequacy of the “nourishing snack” will be determined both by resident interviews and
by evaluation of the overall nutritional status of residents in the facility, (e.g., Is the offered snack
usually satisfying?)

Facility Policy and Standard of Practice

Review:
• Facility’s Offering/Serving Bedtime Snacks – Policy
• Facility’s Offering/Serving Bedtime Snacks – Standard of Practice
• Facility’s Offering/Serving Bedtime Snacks – Validation Checklist
• Facility’s Offering/Serving Bedtime Snacks – Audit Form
• Facility’s Offering/Serving Bedtime Snacks – Plan of Correction
Record of Training
Complete Record of In-service Training and Attendance Form. Be sure all participants sign-in.
 Inservice Training-Instructor Guide/Attendance Record Offering/Serving Bedtime Snacks

Offering/Serving Bedtime Snacks

Record of In-Service Training and Attendance Form

The following personnel attended the Offering/Serving Bedtime Snacks in-service training
program conducted on _____________________________.
License Number
Printed Name Signature
(as applicable)

Time Started: Instructor (Printed Name) Instructor (Signature)

Time Ended:

Use additional sheets as necessary.