Failure to Provide Ordered Diet Texture to Resident with Chewing Difficulties
Penalty
Summary
The facility failed to provide the prescribed diet texture to a resident with severe cognitive impairment who required supervision and setup assistance for eating. The resident had an order for a mechanical soft, bite-sized diet (IDDSI #6), but was observed being served foods such as french toast cut into large triangles and a fish fillet sandwich on a bun, both of which did not meet the required soft and bite-sized criteria. The resident struggled to eat the french toast, was unable to break off bites, and had difficulty manipulating the food, ultimately only eating bite-sized watermelon when it was provided. Staff interviews confirmed that the resident had trouble chewing and would only take very small bites, and that bread and toast were not appropriate for the ordered diet texture. The dietary manager acknowledged that the resident should not have been served foods like french toast or hamburger buns, and that all dietary staff had been trained on diet orders and could reference posted diet information in the kitchen. The registered dietitian confirmed that the IDDSI #6 diet required soft, easily mushed, bite-sized foods and that bread products were not suitable without a specific consult. The director of nursing was aware of the issue and noted the absence of a qualified dietitian on site every day. Facility policy required assessment of nutritional needs by a registered dietitian or designated personnel, including review of diet orders and the need for assistance.