Failure to Provide Physician-Ordered Pureed Diet in Correct Consistency
Penalty
Summary
The facility failed to provide a physician-ordered pureed diet in the correct consistency for one resident who required a pureed texture with nectar-thick liquids. The resident, who had a history of kidney disease, depression, anemia, heart disease, and a gastrostomy tube, was observed receiving a bowl of oatmeal that was lumpy and not of the required smooth, pureed consistency. Staff interviews revealed uncertainty about what pureed consistency should look like, with one CNA noting the oatmeal resembled regular oatmeal rather than the expected pudding-like texture. The cook responsible for preparing the meal admitted to not pureeing the oatmeal due to time constraints and demonstrated a lack of clear understanding regarding the proper preparation of pureed foods. Review of the facility's policy indicated that pureed foods should be prepared using standardized recipes, with appropriate liquids such as broth or milk, and should not be thinned with water. The policy also required that pureed foods have a smooth, applesauce-like consistency and retain the flavor of the original menu item. However, the cook reported using water and thickener when pureeing foods and was not certain about the correct texture. The dietary manager, new to the facility, had not yet assessed the staff's knowledge or observed the preparation process prior to the incident. There was also no evidence in the resident's medical record of a dietician or speech therapy assessment supporting any change from the prescribed pureed diet. Observations confirmed that the resident did not receive the prescribed pureed diet at breakfast, and staff interviews highlighted gaps in training and understanding of pureed food preparation. The resident reported difficulty eating the oatmeal and indicated a preference for softer foods that were easier to swallow. The deficiency was further underscored by the lack of documentation supporting any dietary waiver or change in the resident's prescribed diet, as well as the absence of proper monitoring and adherence to facility policy regarding pureed food preparation.