Failure to Provide Physician-Ordered Mechanical Soft Diet Consistency
Penalty
Summary
The deficiency involves the facility’s failure to provide food in the physician-ordered mechanical soft (dental soft) consistency for a resident with multiple medical conditions and a moderate cognitive deficit. The resident was admitted with diagnoses including Parkinson’s disease, spondylolysis, repeated falls, COPD, heart disease, adult failure to thrive, anxiety, and a cognitive communication deficit. The resident’s MDS documented a Brief Interview for Mental Status score of 09, indicating a moderate cognitive deficit. The physician’s order summary specified an NCS (no concentrated sweets) diet with mechanical soft texture and thin liquids, along with super cereal at breakfast, health shakes three times daily with meals, and fortified foods three times daily. The current care plan documented a nutrition focus area noting potential nutritional problems and referenced both a mechanical soft texture diet and, in a later intervention entry, a regular texture diet, while also instructing staff to provide and serve the diet and supplements as ordered. On the morning of the survey observation, the resident was observed in his room with a breakfast tray that included fruit loops, orange juice, milk, a mighty shake, coffee, cookies, pears, and a bowl of milk. The resident’s meal card identified the required texture as dental soft (mechanical soft). The resident reported that staff told him to dunk his cookie in the bowl of milk, and he demonstrated dunking a cookie and attempting to bite it, stating that he only had one set of teeth and that the cookies were not soft enough for him to eat. The facility dietitian stated that peanut butter cookies for any resident on a mechanical soft diet should have been softened prior to being served. The dietary manager stated that the peanut butter cookies were supposed to be softened in milk before serving but that a cognitively intact resident could do this themselves. The facility’s Therapeutic Diets Policy required that mechanically altered diets be treated as therapeutic diets and that a tray identification system be used to ensure each resident receives the diet as ordered, but the resident nonetheless received cookies that were not pre-softened to the ordered mechanical soft consistency.
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