Failure to Follow Dietician-Approved Menus and Puree Diet Requirements
Penalty
Summary
The deficiency involves the facility’s failure to provide meals according to the registered dietician–approved menus, including required items and portions, for both regular and pureed diets during two observed meal services. Surveyors observed cook #1 pureeing canned carrots and lasagna using a blender that was started by sliding a butter knife between the housing and cover to engage the safety mechanism. During the noon meal, a pureed plate was served with pureed lasagna, carrots, and a whipped dessert, but without the required breadstick/bread component, despite the extended menu specifying pureed garlic bread and defined scoop sizes for each pureed item. Cook #1 stated they would not puree breadsticks and reported that residents would not eat pureed bread, and that substitutions were written on a paper on the wall for the registered dietician to review. During the evening meal observation, surveyors noted a partial loaf of white bread on top of the toaster and observed a dietary aide providing a pureed tray consisting only of mashed potatoes, applesauce, and chicken broth without noodles or meat, instead of the specified pureed chicken noodle soup, pureed pimento cheese sandwich, pureed vegetable blend, pureed bread, and pureed pears. A regular diet tray was served as half of a grilled cheese sandwich, diced peaches, and chicken noodle soup, rather than the full menu of chicken noodle soup, pimento cheese sandwich, cucumber onion salad, saltine crackers, and pears. Multiple dietary staff, including cook #2 and dietary aides, reported they were unaware of the extended menu, did not know dietary requirements for pureed diets, and followed what was written on the board by the daytime cook. The DON confirmed there was no dietary manager, that cook #1 functioned as an interim lead, and acknowledged issues with the evening cook’s training, while staff also cited lack of management and training in the kitchen.
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