Failure to Follow Diet Guide Portion Sizes for Chicken Entrée
Penalty
Summary
The deficiency involves the facility’s failure to follow prescribed portion sizes for both pureed and regular-consistency chicken as listed on the Diet Guide Sheets and required by facility policy. During observation of pureed food preparation, a cook stated she was preparing eight portions of pureed chicken, vegetables, and rice for lunch. She placed eight pieces of cooked chicken breast into a commercial blender with two cups of broth without weighing the chicken beforehand, and leftover pieces of cooked chicken remained in the container. When the surveyor later requested that one piece of the cooked chicken breast be weighed, it measured 2.5 oz, and the cook acknowledged she had not weighed the chicken prior to blending, despite the required portion being 3 oz. Further observation showed the cook transferring the pureed chicken to a metal container for reheating and then returning to prepare additional pureed chicken only after realizing the initial pieces were under the required weight. At the lunch tray line, the cook plated meals for residents on regular diets by placing one piece of chicken on each plate. The surveyor noted that the chicken pieces appeared small and requested that one chicken thigh be removed from a plate and weighed. The Food Service Director weighed the thigh at 2.4 oz including bone and skin, then reweighed the edible portion only, which measured 1.4 oz, below the required 3 oz edible portion documented on the Diet Guide Sheet. The Registered Dietitian confirmed that the Diet Guide Sheets should be followed so residents receive the correct items, consistencies, and portions to meet nutritional needs. She stated that for the lunch in question, regular diets should receive 3 oz of chicken and pureed diets should receive a #8 scoop (4 oz) of pureed chicken due to added liquid. She also confirmed that the 3 oz portion for regular diets refers to edible protein excluding bones and skin, and that a 1.4 oz edible portion was incorrect. Facility records showed five residents on pureed diets and 163 residents on regular diets for that meal. The facility’s menu policy requires menus to be planned in advance, meet residents’ nutritional needs, and be served as written, and the cook’s job profile requires following standardized recipes and nutritional guidelines, which were not followed in this instance.
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