Failure to Provide Appropriate Food Texture for Residents on Modified Diets
Penalty
Summary
The facility failed to provide food in the appropriate texture for two residents who were prescribed a Soft and Bite-Sized diet due to limited swallowing ability. On the specified date, both residents were observed being served regular bread stuffing without gravy, instead of the required pureed bread stuffing with smooth thick gravy as indicated on the facility's dietary spreadsheet. Observations at the kitchen steam table confirmed that no pureed bread stuffing was available for service. Both residents' tray cards clearly indicated the need for a Soft and Bite-Sized diet, yet they received regular texture food items. Interviews and policy reviews further established that the dietary staff did not follow the facility's written menus and dietary guidelines, which require food to be prepared and served in a form that meets each resident's individual needs as per their assessment and care plan. The Registered Dietitian confirmed that cooks are expected to follow the dietary spreadsheet and that serving regular texture food to residents on a Soft and Bite-Sized diet could pose a risk of choking and decreased meal intake. Facility policies also specify that texture-modified diets must be prepared and served as prescribed by the attending physician and as indicated on the daily spreadsheet.