Failure to Provide Palatable, Properly Prepared, and Appetizing-Temperature Meals
Penalty
Summary
The deficiency involves the facility’s failure to ensure that food was palatable, properly prepared according to recipes, and served at appetizing temperatures for all residents receiving meals from the kitchen. During lunch service, the posted menu included lemon zest broccoli, chocolate cake with icing, chicken patty on a bun, and rice. Observation of pureed diet preparation showed the Dietary Manager placing chicken patties, lettuce, tomatoes, mayonnaise, and slices of bread into a blender, then adding hot water to thin the mixture to a pudding-like consistency. The Dietary Manager acknowledged he did not use the facility’s recipe cards, relying instead on his own judgment of the desired consistency. He also prepared gravy for puree and mechanical soft diets using only oil, flour, and water, and prepared a rice puree by blending scoops of rice with hot water to a thick, sticky consistency. Review of the lunch spreadsheet showed that cream of rice should have been substituted for rice for residents on a puree diet. A test tray taken later that lunch period showed the chicken sandwich at 106°F, broccoli at 139°F, rice at 120°F, and chocolate pudding at 58°F. The surveyor tasted the items and found the broccoli bland and the chicken sandwich cold; the Dietary Manager confirmed the chicken sandwich was cold and that lemon seasoning, which should have been added to the broccoli, was missing. The Registered Dietician stated that kitchen staff should follow recipe cards and spreadsheets and verified that gravy made only with oil, flour, and water would not taste very good, noting that a chicken or beef base would be expected for flavoring. Review of the facility’s recipe cards showed that the chicken patty on bun for puree diets should have the meat, mayonnaise, and bread pureed together, with gravy added gradually to achieve a smooth consistency, and that gravy should be made with flour, fat from meat drippings, black pepper, chicken or beef base, and water. The facility’s Food and Nutrition Services policy stated that each resident is to be provided a nourishing, palatable, well-balanced diet that meets daily nutritional and special dietary needs.
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