HospitalInspections.org

Based on observation and interview conducted on 01/17/17, it was determined that the Director of Food and Dietetic Services failed to manage the dietary department on a daily basis and and failed to ensure safety practices for food handling.
The findings included:
During the kitchen/food service sanitation tour conducted of hospital's main kitchen on 01/17/17 at 9:30 AM, accompanied with the facility's Regional Risk Manager, Regional Quality Manager, Quality Management Specialist, Chief Financial Officer, Director of Physical Plant Operations, Food Service Director (FSD), and Executive Chef, it was noted that the kitchen was not operating in a safe and sanitary environment as per the following:
1) During the observation of walk-in refrigerator #1, it was noted that the floor and walls had numerous areas of dried food matter. The internal fan covers (4) were noted to have a build-up of black dust. A pan of cooked noodles failed to be labeled with a preparation date. The FSD stated that the walk-in had not been cleaned on a regular basis.
2) Observation of walk-in freezer #1 noted that floor contained numerous food, stains, pieces of dried food matter and trash. A sheet pan a breaded eggplant (approximately. 30 portions) failed to be covered and was freezer burned. The FSD stated that the floor had not been properly cleaned and that foods were not properly covered by cooking staff.
3) Three male staff (Staff A, Staff B, and Executive Chef) were noted to be working in food preparation and food serving areas. Further observation of the 3 staff noted heavy facial hair that failed to be covered with a mustache/beard restraint. The FSD stated that staff are aware that facial hair requires proper covering.
4) A soiled broom and soiled dust pan were noted to be leaning directly against the stem table line. The FSD stated that the soiled equipment was improperly stored.
5) Observation of reach-in refrigerator #1 noted that the door gaskets had large tears and reach-in the door gaskets of reach-in refrigerator #2 had a layer of black mold type matter. The FSD stated that the gasket of #1 had just been replaced and that the gasket of #2 was scheduled for a new door gasket.
6) Observation of the can rack located in the food preparation area noted that there were 2 #10 cans of food that were heavily dented. Can #1 contained Pinto Beans and had a large dent in the center of the can of approximately 6 inches long. Can #2 contained Pureed Pumpkin and had a large dent of approximately 3 inches on top of the can. The FSD stated the cans should not have been put on the can rack for intended use. The FSD also stated that it is the policy of the contracted food service that dented cans may be used.
7) Observation of 7 of 7 food preparation pans/skillets were noted to have the internal Teflon coating peeling off. It was discussed with the FSD at the time of the observation that each time the pan is used, pieces of the Teflon coating is coming off into the foods and potential ingested by patients. The surveyor requested to the FSD that the pans be discarded immediately.
8) Observation of two ceiling mounted air-conditioning vents and surrounding ceiling areas were noted to have a build-up of black dust/dirt. The FSD stated that the vents are not a regular maintenance cleaning schedule.
9) Two large trash containers were noted to be stored directly next to a food preparation table and surface. Further observation noted that the cans were full of garbage and trash and were not covered. The FSD stated that the garbage cans should have lids and be properly covered at all times.
10) Observation of the clean pot & pan storage rack located in the food preparation area noted that the clean pots and pans were not inverted when stored. Further observation noted that 3 of the large cooking pots were noted to have numerous pieces of dried food matter in them. The FSD stated that the pans were not properly stored and that pieces of food fall into them during food preparation. The surveyor requested that the pans be re-washed and sanitized prior to use.
11) Observation of the beach mounted mixer noted that the exterior of the mixer was covered with numerous areas of a white dried food matter. Further observation noted that the mixing bowl was clean. The FSD stated that the staff cleaned the mixing bowl but failed to clean the exterior of the blender.
12) Observation of the small pass-way located between the hot and cold food preparation areas noted that the was a large storage rack of what appeared to be discard food. Further observation and interview with the FSD noted that there were approximately 15 large pans of discarded food/garbage that were open to the air without covers. It was discussed with the FSD that numerous fresh foods, staff, clean dishes and carts pass directly next to the open garbage pans throughout the day and there is the potential food contamination of food staff, dishes and equipment. The FSD further stated that the contracted food service company requires that all leftover foods and garbage be held and weighed at the end of the day to ensure that there is an over production of foods. The surveyor requested that the contract policy be reviewed and to cease holding open left overs and garbage in the food production areas. The surveyor requested that pans of garbage be discarded immediately.
13) Observation of the cold food production area noted that the preparation sink located in the middle of the food preparation table contained to large containers of open garbage. The FSD stated again the garbage must be saved and weighed at the end of the day per contracted food policy. The surveyor requested that the 2 containers of open garbage be removed immediately from the sink and be discarded.
14) An opened large container (16 ounce) of food thickener was located on the food preparation table. Further observation noted that the can failed to be documented with an opening date. The FSD stated that staff are trained to label and date all open foods.
15) A chemical test was conducted on 3 cleaning rags buckets that were located within the dietary department. The test results revealed that 1 of the 3 buckets failed to have the minimum regulatory requirement of 150-200 parts per million of the Quaternary Chemical Solution (QAC). It was further revealed that the solution failed to have any chemical present and the FSD stated that the wrong chemical was used in the solution.
16) Observation of the 2 commercial tilt-kettles noted that #1 had a heavy carbon build-up and build-up of dried food matter. The FSD stated that the kettle was very old and could no longer be cleaned properly.
16) Observation of 2 of 2 cutting boards noted that the boards were heavily stained, worn, and had areas of potential black mold build-up. The FSD stated that they are new cutting boards in the office and the surveyor requested that the old boards not to be used and be discarded.
17) Observation of the cold preparation room noted that a commercial telephone was located on a shelf next to clean preparation equipment. The surveyor discussed with the FSD that the phone handle and mouth piece are contaminated and should not be stored with clean equipment. The FSD stated that she did not know why the phone was located within the cold food preparation area.
18) During the observation of the dish machine room the following were noted:
(a) There was cross contamination between garbage/refuse, soiled dishes and clean dishes. Specifically, it was noted that open carts containing soiled patient dishes were being stored prior to wash in the cold preparation area and the clean dish storage area. It was also noted that bags of garbage, open containers of garbage/trash, and a soiled mop bucket and mop were being stored in the clean end of the dish machine directly next to where clean dishes exit the dish machine. The FSD stated that that due to the kitchens design all bagged trash, carts containing soiled patient dishes, and cleaning equipment are being stored in the clean dish section of the dish machine area.
(b) Observation of the ceiling mounted air-conditioning vent noted that it had a build-up of condensation which was noted to be dripping. It was discussed with the FSD that the dripping condensation is contaminated and could potentially drip on to clean dishes, clean food preparation equipment, and staff working under the vent. The FSD stated that she was unaware of the issue.
(c) Observation of the ceiling frame located over the dish machine area noted that the frame was covered in what appeared to be a black mold type substance. The FSD stated that she was unaware of the issue.
(d) Observation of the floor area noted that there were numerous broken and/or missing floor tiles. Further observation noted that soiled contaminated water had filled into the broken and missing tiles. It was discussed with the FSD that this build-up of standing water will harbor bacteria and that staff walking through the dish room will cross contaminate other parts of the dietary department.
19) During the observation of the pantry/dry storage room it was noted the three 8 ounce cans of Nepro (renal nutritional supplement) were severely dented and were located on the supplement shelf. It was discussed with the FSD that the supplements are used for renal patients and that potentially use of a contaminated supplement could jeopardize patient health.
20) Observation of the commercial storage bins rice, flour, and sugar noted that the exterior of the bins had heavy build-up of dried food matter. It was discussed with the FSD that each time the bins are open there is a potential that decayed dried food matter may fall into the products resulting in contamination. The FSD stated that the bins were not being cleaned on a regular and as needed basis.
21) During the observation of the hot food storage cabinet located within the hot food preparation area, the surveyor requested that the chef take temperatures of the hot foods. Further observation noted that the chef took his digital thermometer out of his pocket and wiped the thermometer stem with a paper towel and attempted to stick the contaminated thermometer into the food product. The surveyor intervened and stopped the chef from taking the temperature of the foods. It was discussed with the chef and the FSD that all thermometers are required to be thoroughly sanitized with a chemical solution before and between taking the temperatures of any foods.
21) During the observation of the cafeteria serving line it was noted that cold foods that included tuna fish, cooked chicken slices, and sliced cooked eggs were piled excessively high in their individual pans. A t the surveyors request, the temperatures of the foods were taken with the facility's calibrated digital thermometer. The results revealed that the cold foods were not being held at the minimum regulatory requirement of 41 degrees F (Fahrenheit) or below. The temperatures were recorded as follows:
Chicken Slices = 51 degrees F
Tuna Fish = 57 degrees F
Sliced Eggs = 52 degrees F
It was discussed with the FSD that patients may eat occasionally foods from the cafeteria and visitors may bring cafeteria food to patients.
22) Observation of the cook refrigerator/freezer located on the cooking line in the cafeteria noted that fan cover located within the refrigerator had a heavy build-up of dried matter. Observation of the freezer section noted that the thermometer was broken and there was a heavy build-up of ice. The FSD stated she will replace the thermometer and request a work order to clean the fan cover.
A review of the employee file for the Food service Director on 01/18/17 revealed documentation that the director ensures compliance to food safety, sanitation, and overall workplace standards

Based on observation, interview, and record review conducted on 01/17/17 and 01/18/17, it was determined that the physical plant and the environment in the food service department and garbage/refuse area were not maintained in such a manner to ensure they are free from pests.

The findings included:

During the review of the facility's documentation of the pest control of the food service department on 01/17/17, it was noted that the department had a current contact with a local pest control company (Premier Exterminators, Inc.). A review of the pest controls servicing of the food service department from 10/11/16 through 01/13/17 indicated a pest control issue (roaches), lack of routine cleaning and sanitation, lack of pest control company's ability to provide routine spraying and fogging, and failure to follow pest control recommendations as per the following:

01/13/17 - Due to patients eating in the dining room I was unable to spray with insecticide. Upon arrival inside the kitchen it was prepared for fogging treatment.

01/10/17 - I was unable to treat the cafeteria due to cafeteria being used for dinner.

01/03/17 - Inspected the kitchen line that was treated for roach infestation and found that there were dead roaches on top of wall that divides cooking line. The roaches have not been removed since the last treatment was applied.

12/30/16 - Inspected the kitchen that was treated for roaches on 12/29/16 and found that all the dead roaches have not been removed at all and looks like that no one cleaned after our services. Facility representative walked with us and he saw the same thing.

12/29/16 - Heavy roach activity was found before and after the treatment around the cooking line. Please try and clean area around the cooking line and inside the kitchen to help prevent further issues. Also fogged both offices inside the kitchen and found roach activity after treatment. Please try to remove boxes and keep floor clear and clean to prevent further issues. Unable to fog cafeteria because it wasn ' t prepped for fogging treatment as well as the storage area closets because it was full of uncovered equipment.

12/27/16 - Inspected all possible areas for roaches and found that the most affected area in the cooking line had debris, build-up of cooking oils, grease, food scraps. The objects and build-up need to be removed for an effective pest control service.

12/20/16 - I was unable to treat cafeteria due to cafeteria being used for lunch.

12/13/16 - Inspected cooking line and found that it had not been properly addressed in sanitation. Found roach activity and applied coat of insecticide.

12/06/16 - I was unable to treat cafeteria due to cafeteria being used for lunch.

11/08/16 - Inspected all floor drains and all drains need to be sanitized. Unclean drain pipes will continue to cause insect problems. Treated complaint for roaches inside the cabinet holding the seasonings and the rest room in the kitchen. Bathroom has a big hole in wall that may be giving roaches a way inside.

11/01/16 - Advised to have fogging on night service.

10/18/16 - All floor drains need to be sanitized and will continue to cause insect problems.

10/14/16 - At the time of the visit we were approached by the person in charge of the kitchen and she had complaints of roach activity in the cooking line area. After a close walk through and inspection of the kitchen we pointed out areas that needed regular cleaning and sanitation.

10/11/16 - Inspected general kitchen areas pointed out in previous visits and they have not been taken care of. If these areas are not addressed there will be future infestation.

10/04/16 - Kitchen drains in back of cooking line have not been cleaned.

Following the review of the facility's pest control documentation on 01/17/17, it was confirmed with the administrative staff the there was a lack of cleaning and sanitation of the kitchen, failure to follow the pest control company's recommendations, and lack of facility's cooperation to allow the pest control companies to properly treat the food service e department.

Additional interview with the Food Service Director on 01/17/17 revealed that there was a pest control-roach infestation in the main kitchen recently. The director further stated that she thought that the roach infestation is was under control.

A review of the hospital's policy and procedure for Pest Control noted that the policy was originally developed on 07/01/96 and last updated on 09/08. The purpose of the policy was to ensure that the Nutrition Services Department is pest and vermin free. The procedure included a preventative pest control in the kitchen and cafeteria of inspections at least on a monthly basis by the pest control company and treatment as needed. The inspections were to include garbage areas and treatments that include fogging. Pest control notifications any employee sighting any pest control issues to report their supervisor, or manager. The supervisor, manager, director immediately notifies the pest control company.

Based on observation, interview, and record review conducted on 01/17/17 and 01/18/17, it was determined that the hospital failed to implement polices for the proper storage of trash and routine cleaning of the refuse area.

The findings included:

During the kitchen/food service sanitation tour conducted of hospital's garbage/refused area on 01/17/17 at 11 AM accompanied with the facility's Regional Risk Manager, Regional Quality Manager, Quality Management Specialist, Chief Financial Officer, Director of Physical Plant Operations, Food Service Director, and Director of Environmental Services the following were noted:

(1) Upon entering the garbage/refuse area located in the rear of the hospital adjacent to the receiving dock, it was noted that there was an offensive garbage/waste smell permeating throughout the area.

2) Upon entering the area, it was noted that there were three garbage/refuse containers (#1, #2, and #3). The following observation were noted:

(a) Garbage/Refuse Container #1 was a closed compactor dumpster that was designated by the Director of Physical Plant Operations as cardboard/paper waste only. Observation noted that the ground area around the was strewn with paper /trash. It was also noted that there were used gloves also on the ground area. The ground area was covered with what appeared to be a black mold type substance. Interview with a diet aide who was dumping boxes into the compactor revealed that the ground area around the dumpster is littered with used boxes/trash and no one is assigned to clean the area.

(b) Container #2 was designated by the Director of Physical Plant Operations as a storage vessel for used dietary grease/cooking oils. Observation of the large vessel noted that a thick layer (2-3 inches) of black grease/oil on the top, on the sides and continued on to the ground area. There was an offensive smell coming from the area. The Director of Environmental Services stated the he did not know what hospital staff was responsible for the care of the container or how often the container is empty. There was a name and phone number on the side of the contained however grease was to thick to read the information.

(c) Garbage/Refuse Container #3 was designated by the Director of Physical Plant Operations as a closed compactor dumpster that is used for hospital waste only. Observation noted that the ground area to both sides and the end of the compactor were heavily strewn with hospital waste which included trash, garbage, and nursing/patient waste (gloves, and non-identifiable waste). The platform for which the waste is put into the dumpster was littered with garbage, trash, and blood collection tubes (5). The area also had an offensive foul smell and there was standing areas of soiled water around the dumpster. Also noted were large rodent traps (2) to the side of the dumpster. Interview with Director of Environmental Services revealed again the he did not know how often the area is cleaned/sanitized or checked by his staff.

(d) Two open containers of what appeared to be linens was on the dock near the dumpsters. Further observation and interview with the Food Service Director at the time of observation revealed that the open containers contained soiled dietary linens and uniforms. The director stated that the soiled linens are required to be bagged and sealed at all times. The Director further stated that there was a current issue, that the company responsible for the collection of the soiled linens, have not been picking up the linens.

Following the tour of the garbage/refuse area, the findings were again confirmed with the administrative representatives. It was further discussed that the area is a potential health threat, infection control threat, and pest control threat to the hospital. It was also discussed that the area is not being properly maintained on a daily basis and that the environmental administrative staff do not know who or what staff are responsible for the area.

A request for a copy of the hospital's policy and procedure for the cleaning and maintenance of the garbage/trash refuse area was made via phone on 01/18/17. During an interview with the Regional Risk Manager via phone on 01/18/17, it was revealed that the hospital has not developed or implemented a policy for the routine cleaning and maintenance of the garbage/trash refuse area.