Failure to Follow IDDSI Level 4 Pureed Diet Standards
Penalty
Summary
The facility failed to ensure that standardized recipes for pureed diets were followed during lunch service, resulting in pureed foods that did not meet the required International Dysphagia Diet Initiative (IDDSI) Level 4 consistency. Observations during the tray line service revealed that pureed meat, corn, and potato had a thin and loose consistency, spreading out flat on the plate and failing to hold their shape. When tested, the pureed foods dripped through the fork prongs and were described as being on the liquid side. Both the Dietary Supervisor and the cook confirmed that the pureed foods were not at the correct consistency, with the cook admitting to using more liquid than the recipe specified in an attempt to make the food smoother. A review of the facility's recipes for pureed meats and vegetables indicated that foods should be pureed to a paste consistency before adding any liquid, and the finished product should be smooth, free of lumps, hold its shape, and not separate into liquid and solid. The recipes also required that the pureed foods pass IDDSI Level 4 testing methods, including the fork drip, fork pressure, and spoon tilt tests. The IDDSI guidelines further specify that Level 4 pureed foods should fall off a spoon in a single spoonful, hold their shape on the plate, and not have liquid separation. These requirements were not met during the observed meal service.