Improper Preparation of Pureed Foods Reduces Nutritional Value and Palatability
Penalty
Summary
The facility failed to prepare pureed foods for ten residents according to established recipes and methods that conserve nutritive value, flavor, and appearance. During meal preparation, the dietary cook did not use measuring tools and added unmeasured amounts of water to various foods, including pasta, meatballs, and spinach, to achieve a pureed consistency. The cook also did not have pureed diet recipes available at the workstation during food preparation. Observations revealed that water was used as the primary thinning agent for pureed foods, rather than recommended liquids such as low sodium broth or gravy. For example, the cook added unmeasured water to pasta and spinach, and used cooking juice and water for the meatballs, resulting in a watery consistency. The cook expressed dissatisfaction with the texture of the pureed spinach and continued to add more water to adjust it. These practices were inconsistent with the facility's documented recipes and guidelines, which specifically state that water should not be used as it dilutes flavors and results in a poorly accepted product. The registered dietitian confirmed that adding water to pureed foods can dilute taste and alter the nutrient content of meals. Review of facility documents and recipes further supported that water should not be used in pureed foods, and that warm liquid such as broth or gravy should be added gradually to achieve the desired consistency. The failure to follow these procedures affected the quality and nutritional value of meals provided to the residents on pureed diets.
Plan Of Correction
Nutritive Value/Appear, Palatable/Prefer Temp How the corrective action(s) will be accomplished for those residents found to have been affected by the deficient practice: a) Dietary Cook 1 disposed of the pureed that was made with water on 04/07/2025. How the facility will identify other residents having the potential to be affected by the same deficient practice and what action will be taken: b) Registered Dietician / designee completed an audit of resident meals on 05/02/2025 looking at preparation of pureed food to ensure it was prepared according to the recipe to maintain nutritional value. All residents have the potential to be affected by this deficient practice. No other residents were affected. What measures will be put into place or what systemic changes you will take to ensure that the deficient practice will not recur: c) In-Service was completed by the Registered Dietician / designee to Dietary Staff on 04/11/2025 through 04/15/2025 regarding the importance of following the recipe for pureed food to ensure that residents are provided the correct nutritional content. d) Registered Dietician / designee completed an audit of resident meals on 05/02/2025 looking at preparation of pureed food to ensure it was prepared according to the recipe to maintain nutritional value. All issues identified will be brought forth to the DON and/or designee for immediate review and resolution. How the facility plans to monitor its performance to make sure that solutions are sustained. The facility must develop a plan for ensuring that correction is achieved and sustained. This plan must be implemented, and the corrective action must be evaluated for its effectiveness. The plan of correction is integrated into the quality assurance system: f) Registered Dietician / designee completed an audit of resident meals on 05/02/2025 looking at preparation of pureed food to ensure it was prepared according to the recipe to maintain nutritional value. All issues identified will be brought forth to the DON and/or designee for immediate review and resolution. Issues identified will be reported to the Administrator and/or DON for immediate resolution. Dietary Manager and/or designee will do trending/analysis and will report to the quarterly QAPI Committee for further evaluation and/or recommendations. 05/02/2025 F 804