Summers Healthcare Center: Wrong Diet Served to Toothless Resident - WV
That detail sits at the center of an August inspection at Summers Healthcare Center, a 102-bed facility on John Cook Nursing Home Road. A state surveyor visited on August 14, 2025, during the noon meal and found Resident #82 sitting in front of an untouched tray: uncut spaghetti noodles with meat sauce, round zucchini pieces one to two inches wide, and a slice of bread. His diet order was for Dysphagia Mechanical Soft Texture. He had no teeth.
Asked how his lunch was, the resident said: "Sh*t, I can't eat that. They know I don't have any fkg teeth. I was supposed to get tomato soup."
The tray ticket confirmed it. Tomato soup had been listed and then marked out with a black marker.
A nurse aide who spotted the tray said she wanted to check with the kitchen because the resident usually receives pureed food. The Regional Dietary Manager, identified in the report as Staff #155, was called to the hallway. He looked at the tray and told her it was fine to serve.
It was not fine.
The National Dysphagia Diet guidelines that the facility's own Regional Dietary Manager said they follow are explicit: fibrous or rubbery vegetables are to be avoided, and no pieces larger than half an inch. The zucchini on that tray had been cut into pieces up to two inches wide. A facility addendum signed just a month earlier, on July 15, 2025, specified that chopped vegetables for mechanical soft diets should be approximately the size of a dime.
The zucchini was also wrong in a second way. The scheduled menu called for Parmesan Baked Zucchini, Corporate Recipe Number 1462: fresh zucchini sliced to one inch, tossed in olive oil and black pepper, topped with parmesan and minced garlic, baked at 400 degrees for 15 minutes until the cheese browns. What residents received was boiled zucchini with no seasoning, no parmesan, no garlic, no olive oil.
Inspectors didn't take the staff's word for it. At 12:55 p.m., they received a test tray and evaluated the zucchini themselves. Their findings: bitter, tough, hard to chew, watery, stringy, and rubbery. They could not mash it with a fork.
Staff #38, interviewed that afternoon, explained the substitution plainly. "We did not have it," she said of the parmesan. The zucchini was not baked.
Then came the admission that explained how this could happen at all.
Staff #138, a kitchen employee, told inspectors they don't use menus. "I didn't know we had a recipe," she said. She reported they don't use recipes either. When asked how the kitchen determines the right food textures for residents on modified diets, she said the Regional Dietary Manager checks it.
The Regional Dietary Manager had already looked at Resident #82's tray and approved it.
Four days later, on August 18, the Director of Nursing reviewed the facility's own diet consistency addendum and said mechanical soft diets would get softer ground meat and chopped vegetables, then left to ask the dietician for clarification. The Registered Dietician told her vegetables are usually chopped for mechanical soft. The Regional Registered Dietician, reached separately, said the diet guides align with tray tickets and are based on the NDD guidelines, then said she would reach out to corporate for alignment of menus and NDD guidelines.
Nobody in that chain of clarification mentioned Resident #82, who had already gone without lunch.
The inspection was classified as causing minimal harm or potential for actual harm, affecting few residents. The facility census at the time was 102.
Resident #82's tray sat uneaten. His tomato soup, crossed out in black marker before the meal ever reached him, was never explained.
Full Inspection Report
The details above represent a summary of key findings. View the complete inspection report for Summers Healthcare Center from 2025-08-20 including all violations, facility responses, and corrective action plans.
Additional Resources
Data source: This article is based on inspection data downloaded directly from the Centers for Medicare & Medicaid Services (CMS) via Medicare.gov. CMS releases inspection reports in bulk; we publish the findings as documented by state surveyors in the official Form CMS-2567 Statement of Deficiencies.
Plan of correction: The CMS report we receive does not include the facility's plan of correction. Facilities submit plans of correction separately to state survey agencies and those responses may not be reflected in CMS data at the time of publication. The absence of a plan of correction in our data does not mean one was not filed. Readers who want information about corrective steps taken are encouraged to contact the facility directly or their state survey agency.
Corrections may have occurred: Inspection reports reflect conditions observed on the date of the survey. Facilities may have implemented corrections, staffing changes, additional training, or other remediation since the report was issued. We report what CMS provides and encourage readers to seek current information from the facility.
Editorial process: Inspection findings are extracted from CMS source documents and synthesized using AI, reviewed for factual accuracy against the original report by our editorial team.
Corrections: We strive for accuracy in everything we publish. If you believe any fact in this article is incorrect, please contact us with details, and we will review and correct it promptly.
Professional review: All content reviewed by Christopher F. Nesbitt, Sr., NH EMT & BU-trained Paralegal.
Last verified: October 16, 2026 · Our methodology
SUMMERS HEALTHCARE CENTER in HINTON, WV was cited for violations during a health inspection on August 20, 2025.
That detail sits at the center of an August inspection at Summers Healthcare Center, a 102-bed facility on John Cook Nursing Home Road.
Health inspections identify deficiencies that facilities must correct. Violations range from minor documentation issues to serious safety concerns. Review the full report below for specific details and facility response.