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F0805
E

Failure to Prepare Pureed Diets to Required Consistency

Elkhart, Texas Survey Completed on 04-09-2025

Penalty

No penalty information released
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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 ensure that pureed diets were prepared to the required consistency for four residents with orders for pureed diets due to conditions such as dysphagia, muscle weakness, and dementia. Observations revealed that the staff member responsible for preparing pureed foods did not use a recipe, added milk and thickener to all items, and did not taste test or routinely check if foods were fully blended. The pureed meatloaf and roasted potatoes served contained chunks and did not meet the pudding consistency required by the facility's diet manual. The dietary manager confirmed that the equipment used for pureeing, a blender, was inadequate after the Robot Coupe had stopped working over a year prior, making it difficult to achieve the correct texture for certain foods. Interviews with the registered dietitian and the administrator confirmed that the pureed foods were not being sampled for texture and that the current preparation process did not ensure a smooth, palatable, and nutritional product as required. The facility's own diet manual specified that pureed foods should be blended to a mashed potato or pudding consistency for residents unable to tolerate solid food. The failure to properly prepare pureed foods was directly observed and acknowledged by staff, with the risk of choking and decreased nutritional intake noted by those interviewed.

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