Failure to Provide Diet Consistent With Ordered Mechanical Soft Requirements
Penalty
Summary
The deficiency involves the facility’s failure to provide food in a form consistent with an ordered dysphagia mechanical soft diet for a resident with severe cognitive impairment and high assistance needs for ADLs. The resident had a care plan identifying risk of malnutrition related to the need for a therapeutic and mechanically altered diet, with interventions to explain and reinforce the importance of maintaining the ordered diet and to monitor, document, and report signs and symptoms of dysphagia such as pocketing, choking, coughing, and drooling. Despite these orders and care plan interventions, the resident was observed sitting in the hallway near the nursing station, coughing, while holding and eating a chewy granola bar. During this observation, staff walked past the coughing resident without intervening until the surveyor inquired about what was in the resident’s hand, at which point the resident revealed the chewy granola bar. A CNA stated the resident had obtained the granola bar from a drawer and commented that it was the last one. When the surveyor checked the resident’s room, no food was found in the drawer, but a breakfast tray labeled with another resident’s name was present on the bedside table, containing remnants of scrambled hard eggs and hashbrowns with crispy, crunchy edges. When questioned about this tray, the CNA, who was assisting the roommate, shrugged her shoulders. In a subsequent interview, the speech therapist and registered dietician both agreed that the resident should not have had the chewy granola bar or the crispy hashbrowns, confirming that these items were inconsistent with the ordered mechanical soft diet.
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