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Based on the November 15, 2010 observation of the kitchen, staff activities, and review of staff records, it was determined that potentially hazardous foods was subjected mishandling by staff at Dorchester General Hospital site, which had the potential for transmission of disease.

The findings included:

On November 15, 2010, a tour of the kitchen at Dorchester General Hospital was conducted. Based on observation of the kitchen, staff activities, and review of staff records, foods were prepared in a manner where the transmission of disease was possible.

While touring the food preparation area, entry was made to the walk-in refrigerator. Inside this surveyor discovered four pork briskets on an upper level metal shelf, all inside one large metal pan, all in whole pieces, and the entire metal pan covered in plastic food wrap. Upon touching the outside of the plastic wrap, this surveyor noted that the meat was warm. The surveyor then asked the food service supervisor to remove the pan of meat for closer examination. After being removed, this surveyor used a metal stem food thermometer to determine the internal temperature of the four pork briskets. [The metal stem food thermometer, being an NSF-approved instrument, had been checked for calibration using the ice bath method on November 15, 2010 and prior to the tour of the kitchen.]

Upon using the thermometer to check the temperature of the pork briskets, at 11:05 a.m., they were determined to be at 90, 95, 106 and 107 degrees Fahrenheit, respectively. The surveyor then asked the supervisor for permission to speak to the dietary worker who cooked the pork briskets. This worker was then summoned and the surveyor asked this worker as to the time that the meat was placed into the refrigerator for cooling. The employee replied that it was at 9:30 a.m. this same date. The surveyor then reviewed the requirements for the rapid cooling of potentially hazardous foods (i.e. from hot to 70 degrees Fahrenheit in the first two hours, to 41 degrees Fahrenheit within the four hours following the 70 degree set point). The surveyor then asked if logs were maintained to track the cooling of potentially hazardous foods. This log was then provided to the surveyor for review. Upon reviewing this log, it was revealed that only a beef roast had been entered onto the log during the entire first 15 days of November 2010. No other food items were listed.

The surveyor then re-entered the walk-in refrigerator and found four large turkey breast molded meat pieces. These were sent to the customer in a raw state, pieces of breast meat placed together in a large mass approximately six to 8 inches in thickness, and all of the meat then held together with twine. The surveyor discovered that these four large pieces of turkey were still held together by the twine and in one large piece each. The turkey breast pieces were found to have been cooled; however, as they were not cut into sections that were no thicker than three to four inches, they were not cooled as required or recommended. In addition, the review of the cooling log revealed that turkey breasts had not been tracked during the first 15 days of November 2010.

Due to the fact that this surveyor was able to determine that meats were not being cooled as required by State and local government regulations and as dictated by the standard of practice known as HACCP (Hazard Analysis Critical Control Points), it was revealed that some potentially hazardous foods had been subjected to conditions where disease transmission could have occurred. Further, all hospital food service staff are to ensure adherence to applicable standards and regulations, as well as acceptable hygiene practices and kitchen sanitation. Based on the observations made, the staff failed to monitor and adequately address the the cooling of meat in accordance with food service regualtions and the accepted standards to prevent food bourne disease transmission at Dorchester General Hospital on November 15, 2010.

Based on observation of Dorchester General Hospital on November 15, 2010, concerns related to maintenance, hygiene, safety, control of refuse and pest control were noted.
The findings included the following:
A tour of Dorchester General Hospital was conducted on November 15, 2010. Based on that tour, the following concerns were noted:
a. Observation of the concrete drive from the street to the loading dock revealed portions of the driveway and of curbing were cracked, had fallen apart, were displaced and at different grades on either sides of some cracks (deflection of up to six inches), and the concrete pavement and curbing was not maintained in a safe and sanitary manner.
b. Observation of the entire 200 foot plus linear wall along the rear of the facility revealed that there were as only two rodent catch traps rather than a number as needed to control the pests. In addition, waste concrete was piled up along the rear wall in such a manner that it created areas for rodents to burrow and form nesting locations (harborage).
c. A metal barrel for the collection of waste cooking grease was found on an asphalt covered area rather than on a spill proof impervious surface as required.
d. The dumpster for recycling of cardboard was found on a grassy surface rather than on a spill proof impervious surface as required.
All hospitals must ensure that the buildings and grounds are at an acceptable level of safety and quality. Related elements that would be instrumental towards providing a safe environment include maintenance as required, provision of overall hygiene, exclusion of conditions which encourage harborage of pests and vermin, and a system where facility staff continually monitor for defects and concerns.

Based on observation of Dorchester General Hospital on November 15, 2010, it was determined that refuse was not being stored in accordance with local and State requirements.
The finding included:
Refer to CMS 2567, L, tag number 0701, findings c and d.

Based on observation of Dorchester General Hospital on November 15, 2010, it was determined that refuse was not being stored in accordance with local and State requirements.
The finding included:
Refer to CMS 2567, L, tag number 0701, findings c and d.