Resident Meal Intake and Satisfaction Log

Tracks resident meal intake percentage and dining satisfaction feedback across meal periods, capturing food acceptance patterns, portion preferences, and actionable insights to improve nutritional outcomes and dining experience in long-term care and senior living settings.

Meal Period & Resident Identification

• Meal period being recorded
  Select the meal period this log entry covers (Breakfast, Lunch, Dinner, or Snack)
• Date of meal service
  Enter the date of the meal service (MM/DD/YYYY)
• Resident room or unit identifier
  Enter the room number or unit designation (do not include resident name to support privacy practices)
• Staff member completing this log
  Name or ID of the dietary aide, CNA, or nursing staff recording this entry
• Dining location
  Where did the resident consume this meal? (e.g., Main dining room, In-room tray service, Assisted dining area, Family-style dining)

Meal Intake Observation

• Estimated percentage of meal consumed
  Select the closest intake estimate: 0%, 25%, 50%, 75%, 100%. Per CMS F803 guidance, intake below 75% on two or more consecutive meals should trigger a dietitian notification.
• Estimated percentage of beverage/fluid consumed
  Select the closest fluid intake estimate: 0%, 25%, 50%, 75%, 100%. Supports hydration monitoring per care plan.
• Was a therapeutic or modified-texture diet served as prescribed?
  Confirm whether the resident received their prescribed diet order (e.g., pureed, mechanical soft, low-sodium, diabetic). Select: Yes / No / Not applicable
• If intake was below 75%, describe observed reason
  Document observable factors: resident refused, fatigue, nausea, pain, disliked food item, dental/swallowing difficulty, distraction, or other. Required when intake is 50% or below.
• Was a meal substitution or alternative offered?
  Select: Yes — accepted / Yes — declined / No substitution offered / Not needed

Food Quality & Dining Experience Ratings

• Food temperature was appropriate when served
  1 = Strongly disagree (food was too cold or too hot) → 5 = Strongly agree (temperature was just right)
• Food appearance and presentation was appealing
  1 = Strongly disagree → 5 = Strongly agree
• Food flavor and seasoning met the resident's preference
  1 = Strongly disagree → 5 = Strongly agree. Note: flavor perception is a leading driver of food acceptance in older adults.
• Portion size was appropriate for the resident's appetite
  1 = Strongly disagree (too much or too little) → 5 = Strongly agree (portion was right)
• The dining environment was comfortable and conducive to eating
  1 = Strongly disagree (noisy, rushed, uncomfortable) → 5 = Strongly agree (calm, pleasant, unhurried)
• If any rating above was 3 or below, describe the specific concern
  Open follow-up for detractor scores. Describe what was unsatisfactory — this feedback directly informs menu adjustments and service improvements.

Resident Feedback & Preferences

• Overall, how satisfied was the resident with today's meal?
  1 = Very dissatisfied → 5 = Very satisfied. This is the primary engagement driver metric for dining satisfaction reporting.
• Did the resident express a specific food preference or request for future meals?
  Document verbatim preferences when possible (e.g., 'prefers soup over salad', 'wants smaller portions', 'requested eggs for breakfast'). These feed into individualized care plan updates.
• Did the resident express any food dislikes or items to avoid?
  Record specific dislikes to update the resident's food preference profile and reduce future plate waste.
• Was the resident able to self-feed, or was assistance required?
  Select: Independent / Set-up assistance only / Partial physical assistance / Full physical assistance / Refused assistance

Clinical Flags & Follow-Up Actions

• Does this meal entry require a dietitian or nursing notification?
  Flag for clinical follow-up. Select: Yes — intake below 75% on 2+ consecutive meals / Yes — new swallowing or chewing concern observed / Yes — significant weight loss concern / No follow-up needed
• Was a clinical referral or care plan update initiated as a result of this observation?
  Select: Yes — dietitian notified / Yes — care plan updated / Yes — speech therapy referral initiated / No action needed at this time
• Additional clinical observations or notes
  Document any behavioral, physical, or environmental observations relevant to this resident's nutritional status or dining experience that are not captured above.
• Is there anything else about this resident's dining experience that should be shared with the care team?
  Open-ended catch-all for observations that don't fit structured fields. All entries are reviewed by the Dietary Manager during weekly rounds.