Failure to Provide Physician-Ordered Pureed Diets and Proper Food Consistency
Penalty
Summary
The facility failed to provide four residents with the physician-ordered pureed diet as required, instead substituting menu items and not following the prescribed modifications. Medical record review for one resident with severe cognitive impairment and a pureed diet order revealed that, during meal service, the resident received pureed chicken, pureed vegetables, pureed wheat bread, and pudding, rather than the specified menu items. Observations of the tray line and test trays showed that the correct pureed alternatives were not prepared or served, such as substituting pureed wheat bread for cream of rice and using chicken instead of beef for pureed and mechanical soft diets. The Food Service Director (FSD) confirmed these substitutions were made without consulting the Registered Dietitian (RD) and that test trays were not routinely performed to check for appropriate texture or taste. Further review and interviews revealed that the pureed foods served did not consistently meet the required smooth, homogenous consistency, with items being grainy, pasty, or containing noticeable strings and gristle. Temperatures of the food items were also found to be below preferred serving temperatures. The RD confirmed that menus were to be followed and that modified diets should receive the items as written on the menu production sheets. Facility policy required that pureed foods be smooth and free of lumps or chunks, and that texture modifications be individualized and prepared as ordered by the physician and interdisciplinary team. These requirements were not met, resulting in residents not receiving food in the form designed to meet their individual needs.