A resident with COPD, schizoaffective disorder, anorexia nervosa, anxiety, and HTN was ordered a regular diet with mechanical soft texture and thin liquids, but was served a whole cube steak instead of the required ground texture. Staff confirmed the resident was on a mechanical soft diet, and the DM verified the meat should have been ground per the ordered diet and the facility's tray identification process.
Pureed Foods Not Prepared to Required Consistency: A dietary cook prepared pureed dinner items, but tasting showed the beets had a crunchy texture with liquid separation rather than a smooth puree. The cook stated she had never tasted pureed foods for consistency or taste, and the DM verified the texture was not consistent with the facility’s puree diet standards. The issue had the potential to affect nine residents on a puree diet.
Mechanical soft diet meals were not prepared in the required texture for residents who needed them. Surveyors observed that residents ordered for a mechanical soft diet were served regular texture ham and beans, greens, and cornbread instead of ground or chopped items. The DM confirmed the modified ham and beans were not available, and the dietitian reported minimal kitchen oversight and was unaware of the issue.
The facility failed to prepare and provide food in the correct pureed consistency for several residents with physician-ordered pureed diets. During a lunch meal observation, pureed rice on the steam table was found to be gritty with large clumps instead of smooth, and the Dietary Supervisor confirmed it was not the correct puree texture. Review of the diet list showed multiple residents were ordered pureed diets, and facility policy defined therapeutic diets, including texture-modified diets, as physician- or practitioner-ordered as part of treatment for clinical conditions.
Pureed diet food was not served at a smooth consistency for safe swallowing. A pan of preprepared pureed ham appeared chopped and separated, and a second pan contained clumps that were verified by the Dietary Manager and Therapy Director. The facility identified five residents on a pureed diet, and the recipe and diet manual stated pureed food should be blended until smooth and have a consistency like moist mashed potatoes or pudding.
A resident with dementia, CKD, dysphagia, a pressure ulcer, and risk for malnutrition had physician orders and a care plan for large protein portions and bite-sized meats/entrées to support wound healing and nutritional status. Despite these orders and clear instructions on the meal ticket, staff served a breakfast tray with a whole piece of ham, uncut bread, and only a small portion of scrambled eggs, not meeting the ordered large protein portion or bite-sized preparation. The resident reported repeated problems with the kitchen not following his diet preferences and needs, and a CNA confirmed the meal did not match the ticket or facility portion-size policy.
A resident with dementia and dysphagia had a physician order and care plan for a mechanically soft diet with pureed meats and thin liquids, requiring maximum assistance with eating. During a breakfast observation, the resident was being fed oatmeal, scrambled eggs, and ham that appeared chunky rather than pureed. The CNA confirmed the resident’s meat should be pureed and acknowledged the ham was not in pureed form. Review of facility policy showed pureed foods must have a smooth, lump-free consistency, confirming that the meat served did not meet the ordered diet texture or policy requirements.
Surveyors found that pureed cabbage served to multiple residents on pureed or mechanical soft diets was prepared with all of the cooking liquid instead of draining excess water as required by the facility’s recipe, then held on a steam table until service. Despite adding thickener and reblending, the pureed cabbage remained runny, spread across the plate, and did not hold its shape when portioned, which the district manager acknowledged was an inappropriate consistency and not in accordance with the facility’s therapeutic diet procedures.
Pureed foods were not consistently prepared to a smooth consistency for residents on pureed diets. A resident reported poor taste and incorrect texture, and staff observed pureed pasta and pureed ham with visible chunks during meal preparation and tray line service. The RDM and DM both tasted the items and confirmed they were not smooth, despite recipes directing that the foods be processed and blended until smooth.
Pureed Diet Prepared to Improper Texture: A dietary staff member served chipped beef and gravy puree that still contained larger meat pieces for residents on a pureed diet. The staff member did not taste the food to check texture, and the DON was observed advising the staff member to puree it longer before a smoother texture was later seen.
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