Failure to Prepare Pureed Foods to Required Consistency
Penalty
Summary
The facility failed to prepare pureed foods in a form designed to meet the individual needs of residents on a pureed diet. During observation of meal preparation, staff were seen adding potato flakes to pureed pasta without measuring, relying instead on visual assessment and a spoon tilt test. When the pureed pasta was evaluated by the Dietary Supervisor and Registered Dietitian, it was found to contain small pasta particles and to be sticky, rather than smooth and pudding-like as required. The Dietary Supervisor confirmed that the sticky consistency would require more chewing and could pose a problem for residents with chewing and swallowing difficulties. The facility's policies, diet manual, and standardized recipes all specify that pureed foods should be smooth, moist, and free of lumps, and that recipes should be followed with correct ingredient measurements to achieve the proper texture and consistency. Eighteen residents on pureed diets were potentially affected by this failure, as the pureed pasta did not meet the required standards for texture and consistency. The facility's menu, policies, and IDDSI guidelines all require that pureed foods be smooth, not sticky, and pass specific consistency tests, but these standards were not met during the observed meal preparation. The deficiency was identified through direct observation, interviews with dietary staff, and review of facility documentation.