Failure to Provide Properly Prepared Pureed Diets
Penalty
Summary
The facility failed to provide food prepared in a form designed to meet the individual needs of two residents who required a pureed diet. Both residents had significant cognitive impairments and were dependent on staff for feeding, with physician orders and care plans specifying a pureed diet due to diagnoses including dementia and dysphagia. Despite these requirements, observations over several days revealed that meals served to these residents did not meet the IDDSI Level 4 Pureed standard, as the food was not smooth, contained lumps, stringy meat, rice that was not pudding consistency, and vegetables with skins and chunks. Staff interviews confirmed that the food provided was not of the appropriate consistency for a pureed diet. Certified Medication Aides and Certified Nursing Assistants noted that the meals were not smooth, contained stringy pieces, and included items such as corn with husks and peas with skins, which are specifically listed as foods to avoid for pureed diets. The dietary manager acknowledged that on at least one day, the food was not pureed long enough and did not meet the required consistency, and further admitted that the meat and vegetables were not smooth enough on subsequent days. The Registered Dietitian stated that the facility followed the IDDSI guidelines and used the spoon test to assess food consistency, but was unable to provide documentation of the policy when requested. The Nursing Home Administrator also stated there was no written policy for mechanically altered food, as the facility relied on the IDDSI. Despite staff awareness of the requirements, the facility did not consistently ensure that pureed diets were prepared and served according to prescribed standards, resulting in residents receiving food that was not appropriate for their needs.