cms_WV: 54
Data source: Big Local News · About: big-local-datasette
| rowid | facility_name | facility_id | address | city | state | zip | inspection_date | deficiency_tag | scope_severity | complaint | standard | eventid | inspection_text | filedate |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 54 | GUARDIAN ELDER CARE AT WHEELING | 515002 | 20 HOMESTEAD AVENUE | WHEELING | WV | 26003 | 2018-05-03 | 805 | E | 1 | 1 | X20F11 | > Based on observation, interview and record review, the facility failed to ensure food was prepared in a form to meet individual needs of the residents. Specifically, the facility failed to ensure proper pureed texture and failed to follow recipes for pureed food items for 12 residents that received a pureed texture out of 146 residents. This failed practice had the potential to affect more than a limited number of residents. Facility census: 142. Findings included: a) Facility policy The Progressive dysphagia diet: Puree policy, revised 01/2018, was provided by the Assistant Director of Nursing (ADON) #88 on 5/3/18 at 9:00 AM. The policy documented in pertinent part, .The diet uses slurried, blenderized, or pureed food that has a moist, pudding-like consistency without pulp or small food particles . Blenderized foods do not require chewing. They should have a pudding-like consistency without lumps (i.e., sour cream or mayonnaise thickness/moistness). All foods are appropriate if the consistency is pureed smooth without fibrous particles . b) Observations On 5/1/18 at 11:34 AM, Cook #119 was observed to remove two pans from the oven to take their temperatures. Cook #119 stated one was the mechanical texture pork and one was the pureed pork. The pureed pork was observed to have a similar texture as the mechanical pork. It appeared chunky. At 11:36 AM, the pureed cabbage was pulled out of the oven. The cabbage was observed to have visible chunks of cabbage in it. Staff began to plate meals for the lunch service at 11:54 AM, including pureed meals. The pork and cabbage were observed to be very chunky and the cabbage was watery. At 12:02 PM, the pureed pork and cabbage were taste tested . Neither of the puree food items had a smooth texture. Particles of meat and cabbage could be visualized and felt. On 5/2/18, the preparation of the pureed foods was observed from 10:08 AM to 10:30 AM. At 10:08 AM, Cook #119 was observed to place a third of the mixed vegetables in a 2.5 quart food processor. She processed the mixed vegetables and placed some melted butter and hot water in the mixture. She placed the pureed vegetables in a pan and proceeded to puree another third of the vegetables and then the last third of the vegetables. She placed the pureed vegetables together in the same pan. The texture was observed to have small particles from the vegetables in it. It was not smooth. She did not use a recipe while making the puree vegetables. She also did not taste it. The process of making the vegetables a third at a time could result in an inconsistency of texture throughout the mixture. At 10:24 AM, Cook #119 started making the pureed fish. She took one full pan of fish from the oven and spit it into two deep pans. She placed one pan into the 2.5 quart food processor and started to process the food along with some water. She checked the consistency with a spatula and put more water in the mixture. She then processed it again. At 10:27 AM, she placed the fish back into the pan. At 10:28 AM, the pureed vegetables and fish were taste tested . The vegetables were not completely smooth. They contained small particles from the vegetables that could be visibly seen and felt. The week 3 menu was reviewed on 5/1/18 at 11:10 AM. The lunch meal for Tuesday, 5/1/18, consisted of roast pork and haluski (a cabbage and noodle blend). The lunch meal for Wednesday, 5/2/18, consisted of lemon baked fish and California blend vegetables. The pureed recipes were reviewed on 5/3/18 at 9:30 AM. The pureed roast pork recipe was for 13 servings. The recipe called for 2 pounds and 7 ounces of roast pork, half cup and 2.5 tablespoons of thickener, and 2 5/8 cups of hot water. The method consisted of: 1. Place portions of meat (2 oz (ounces) each, no bone) needed into a food processor. Process to a fine texture. 2. Prepare slurry for the meat with the thickener and hot liquid. Mix well with a wire whip. 3. Add 1/2 of the slurry to the meat; process for 1 minute. If too dry, add more slurry until meat is pudding consistency. 4. With a rubber spatula, scrape down sides of the bowel; reprocess 30 seconds. The pureed haluski recipe was for 13 servings. The recipe called for 2 quarts and 1 3/4 cups of haluski, 1/4 cup and 1 1/4 tablespoons of thickener, and 2 cups of hot water. The method consisted of: Place portions needed from regular prepared recipe into a food processor. Process to a fine texture. Prepare a slurry with the thickener and hot liquid. Add the slurry to the processed noodle/cabbage mixture. Process until smooth. The pureed lemon baked fish recipe was for 13 servings. The recipe called for 13 fish, 3/4 cups and 1 tablespoon of thickener, and 2 5/8 cups of hot water. The method consisted of: Place portions needed from regular prepared recipe into a food processor. Process to a fine texture. For every 5 portions needed, prepare a slurry with 5 tbsp (tablespoons) and 1 cup hot liquid (water, milk, or broth); mix well with a wire whip. Add 1/2 of the slurry; process for 1 minute. If too dry, add more slurry until meat is pudding consistency with a rubber spatula, scrape down sides of the bowel; reprocess 30 seconds. The California blend vegetables recipe was for 13 services. The recipe called for 1 quart and 2 1/2 cups of vegetables and 1/4 cups and 2 1/2 tablespoons of thickener. The method consisted of: Remove portions needed from regular prepared recipe and place into a food processor. Process until fine; for every 5 portions needed, add 2.5 tbsp thickener; process until smooth. Scrape down sides of the bowl with a rubber spatula; reprocess 30 seconds. c) Interviews In an interview on 5/1/18 at 12:20 PM Cook #119 said there were 12 residents that received a pureed diet. She had made the pureed pork and cabbage. She said she always tasted the purees when she made them. She was told the purees were always supposed to be the consistency of mashed potatoes. She felt the pureed pork and cabbage were the appropriate consistencies. In an interview on 5/2/18 at 10:35 AM Cook #119 said she used to robo coupe for heavy meats and used the food processor for all other items. The recipe book was underneath the preparation table. She said she did not use the recipe book because she had been making purees for so long that she knew how it was supposed to look. She said she went by how each food item looked. She said the purees should never have pieces in them, as that was a good way for residents to choke. She said cabbage was hard to puree and get smooth but she thought all the purees for Tuesday and Wednesday were the appropriate consistency. In an interview on 5/3/18 at 10:08 AM the Dietary Manager stated she preferred when the cooks used the recipe book when making the pureed foods. Some of the cooks knew what the recipes were because they had made them so many times. She said the consistency of the purees should always be smooth with no chunks. She did not provide any oversight to ensure the purees were the appropriate consistency. She left it up to the cook to determine if it was the correct smoothness. If the cook did not think it was smooth enough then they would ask her what she thought. She said they used the robo coupe for bigger items and the processor for smaller items. The process for making the mixed vegetables was described to the Dietary Manager. She said the cooks should not be pureeing items in portions. It should all be done at once so the consistency was the same throughout the mixture. The cooks should use the robo coupe for everything unless it could all fit into the processor at once. She expected the cooks to taste test the puree to ensure it tasted good and was the proper consistency. | 2020-09-01 |