Failure to Provide Physician-Ordered Therapeutic Diets and Thickened Liquids
Penalty
Summary
Surveyors identified that the facility failed to ensure residents received their physician-ordered therapeutic diets. One resident with impaired cognition, few teeth, and a need for maximum assistance with feeding was ordered a regular puree diet with thickened liquids and extra gravy with all meals. Review of the resident’s meal ticket confirmed the extra gravy requirement. On multiple observed meal times, CNAs were feeding this resident without any extra gravy on or near the tray, and a bedside water pitcher contained liquids that were not nectar thickened as ordered. Staff verified that the extra gravy was not provided and that the water in the pitcher was not thickened, despite acknowledging that the resident sometimes needed additional gravy to ensure a smooth swallow. Another resident with diagnoses including hemiplegia, convulsions, cerebral infarction, dementia, and aphasia, and who was totally dependent on staff for feeding, had a physician order for a regular dysphagia advanced diet with nectar thickened liquids, with permission for regular texture foods for pleasure only. During observations, this resident was repeatedly provided a dark soda poured into a cup with a straw that was not thickened. A CNA confirmed the liquid was not thickened. Later, an RN and a speech therapist both verified that the physician’s order allowed regular texture foods for pleasure but did not include regular consistency liquids for pleasure. The facility’s own therapeutic diet policy stated that therapeutic diets are ordered by the physician to increase nutrients or provide foods residents are able to eat, yet the ordered diet consistencies were not followed for these residents.
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