Failure to Ensure Proper Training and Competency in Puree Food Preparation for Dysphagia Diets
Penalty
Summary
The facility failed to ensure that kitchen staff were routinely trained and evaluated for competency in preparing pureed foods for residents on a dysphagia puree diet, as required by the International Dysphagia Diet Initiative (IDDSI) guidelines. During observation of the trayline, a cook was unable to verbalize or demonstrate the correct preparation of pureed mixed vegetables to achieve the required consistency. The pureed mixed vegetables were observed to be too thick and did not pass the spoon-tilt test, a standard method for assessing appropriate texture for safe swallowing. The cook stated that her method for checking consistency was limited to mixing the puree and adjusting with liquid or thickener based on feel, without performing the required spoon-tilt test. The Dietary Director confirmed that oversight was provided through spot checks and taste testing, but acknowledged that the puree mixed vegetables did not pass the spoon-tilt test during the trayline and should have been adjusted before service. The facility's recipe and policy documents specified that all IDDSI texture modifications must pass established testing methods at the start and every 15 minutes during service, but this protocol was not followed. Review of the competency checklist for the cook revealed that it did not include topics related to IDDSI Level 4 testing, such as the spoon-tilt or fork-drip tests. The facility's diet manual and IDDSI guidelines require that pureed foods for residents with dysphagia be lump-free, not sticky, and able to fall off a spoon in a single spoonful, with no separation of liquid and solid. The failure to properly prepare and test the puree consistency as outlined in facility policy and IDDSI standards resulted in the serving of food that did not meet safety requirements for residents on a dysphagia puree diet.