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Based on observation, staff interview and record review, the hospital failed to evaluate the nursing care for one patient (Patient 101) when the nursing admission form indicated Patient 101's food preferences as vegetarian and this essential information was not integrated into the patient's care. This had the potential of compromising patient medical care and outcome.

Findings:

Patient 101 was admitted to the facility on 9/21/12 with a diagnosis of major depressive disorder. During a record review on 10/4/12 at 1:15 p.m., Patient 101's nursing admission record dated 9/21/12 indicated a food preference of "Vegetarian and history of eating disorder."

The physician order dated 9/21/12 was Regular, Mills 21 day, no coffee.

The Medical Nutrition Therapy nursing referral (initial Assessment by Registered Dietitian) dated 9/22/12, indicated regular diet with decaffeinated beverages. Patient 101's nutrition status was reviewed for history of eating disorder but not assessed for nutrition status or vegetarian food preference as indicated on the nursing admission form.

Food Service Management 6 provided regular selective menus dated 10/3/12 and 10/4/12. Selective menus did not provide vegetarian alternatives Patient 101 could select. Food Service Management 6 stated that the menu providing the vegetarian entrees and selection would be on a vegetarian selective menu and the dietary department would need to be notified of the patient's preference for a vegetarian diet.

Nurse Manager stated on 10/4/12 at 2:50 p.m., that the process was for the nurse to communicate the patient's food preferences to the food service and this was not done for Patient 101.

Based on observation, staff interview, and document review, the hospital failed to have a Food Services Director responsible for the daily management of the department who:
1) Ensured food service staff was knowledgeable, supervised, and obtained accurate documentation of food temperatures to ensure serving palatable cold foods when fruit cup was served at Mills campus at 57-59 degrees Fahrenheit (F). Failure to ensure the overall operational effectiveness of the food service department including the supervision and accurate documentation of food temperatures service of food at palatable and appropriate temperatures may result in patients receiving food at unpalatable temperatures that may not meet their nutritional needs and compromise their medical status.

Finding:

On 10/4/12 starting at 11:30 a.m., the food service operation at the Mills campus consisted of patient trays transported to the Mills Campus approximately 20 minutes from the main campus. Food Service Management 2 stated at 12:00 a.m., that the cold food including the fruit cups were blast chilled at the main campus and they were 32 degrees F at 11:00 a.m., when patient trays were served there today.

Starting at 12:30 p.m., at the Mills campus, the food service staff, using digital thermometers, took the temperatures of 3/3 fruit cups (cut up fresh melons) a potentially hazardous food (food capable of pathogenic growth of microorganisms and food borne illness). The fruit cups measured 57 to 59 degrees F. Food temperatures were taken from each of the three carts that were reheated in a reheating/refrigerated system. One of one fruit plates was 57 degrees F. Food Service Management 2 stated that he was the Supervisor responsible for the lunch meal.

The lunch food temperatures were recorded on log titled Mills Retherm (reheated) Temperature Log Breakfast, Lunch and Dinner. The log indicated the Cold holding standard was " maintain cold potentially hazardous foods at 41 degrees F or below. "




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