Failure to Provide Proper Food Texture for Resident on Dysphagia Diet
Penalty
Summary
A deficiency occurred when a resident with a physician-ordered dysphagia advanced mechanical soft texture diet was served cubed chicken pieces instead of the required ground chicken during a lunch meal. The resident's meal ticket and physician's order specified ground chicken fajita filling, but the kitchen staff provided chicken cut into larger, cubed pieces. Multiple staff members, including a CNA, Dietary Services Supervisor, cook, and the Director of Nursing, confirmed that the meal did not meet the specified dietary requirements and acknowledged that the resident should have received ground chicken as ordered. The resident involved had a history of chronic pain syndrome, falls, and muscle wasting, and required substantial to maximal assistance with eating. The resident was assessed as having moderately impaired cognition but was able to make her needs known. The care plan and dietary orders emphasized the need for modified diets according to the resident's tolerances and preferences, with specific instructions for food texture to reduce the risk of choking or difficulty swallowing. Facility policies reviewed indicated that food products should be prepared using standardized recipes with adjustments for therapeutic and consistency modifications, and that therapeutic diets are to be planned and served in consultation with a dietitian. Despite these policies, the kitchen staff did not follow the meal ticket instructions, resulting in the resident receiving food in a form inconsistent with her dietary needs.