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F0805
D

Failure to Provide Properly Modified Diet Consistencies for Residents on Thickened Liquids

Aurora, Illinois Survey Completed on 04-23-2025

Penalty

Fine: $111,25532 days payment denial
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The penalty, as released by CMS, applies to the entire inspection this citation is part of, covering all citations and f-tags issued, not just this specific f-tag. For the complete original report, please refer to the 'Details' section.

Summary

The facility failed to provide appropriate modified diet consistencies for two residents who required thickened liquids due to their medical conditions. One resident with diagnoses including Parkinson's disease, dementia, and dysphagia was ordered a pureed diet with nectar thickened liquids, but was observed receiving a bowl of ice cream along with their meal. The resident's meal ticket and care plan both indicated the need for pureed texture and nectar thick liquids, yet the inclusion of ice cream did not meet these requirements. Another resident with a history of cerebral infarction, hemiplegia, vascular dementia, and oropharyngeal dysphagia was ordered a pureed diet with honey thick liquids. This resident was also observed receiving a bowl of ice cream and a nutrition shake (mighty shake) that was not at the required honey thick consistency. The dietary manager stated that ice cream was considered thick and that the shake was already thickened, but the speech language pathologist clarified that ice cream melts to a thin liquid and that the mighty shake was only nectar thick, not honey thick. Facility policy also specified that items like ice cream and shakes that change consistency at room or body temperature are not appropriate for residents on thickened liquids.

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