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This standard is not met as evidenced by:
Based on storage, food production and service observations, staff interviews, and document reviews, the hospital failed to ensure the Food and Dietetic Service Director monitored staff practices to ensure they met standards of practice for food service operations at the hospital. These failures had the potential to cause food-borne illness.

Findings:

On 2/11/13 during the initial kitchen tour starting at 9:00 a.m., the following unsafe food handling practices were observed:

1. In walk-in refrigerator number 6, six trays of raw chicken were stored on a tray in an enclosed rolling cart, ready to be cooked. Partially cooked meatballs were stored in a pan located on the same cart, directly underneath the chicken. Precooked ready-to-heat stuffed green peppers were also stored below the raw chicken in the same cart. According to the Federal Food Code 2009, this is an unsafe practice, since raw contaminated chicken juices could spill over onto the cooked foods.

During a concurrent interview, the Food Service Manager (FSM) and Cook II, acknowledged this was an unsafe practice. They immediately moved the meatballs and stuffed peppers to another location. The FSM stated they should not have been stored in that manner.

A review of the hospital policies and procedures entitled "Storage, Labeling and Dating of Food Items" and "Hazard Analysis & Critical Control Points", indicated that foods should be stored at proper temperature and in proper containers to avoid contamination. However, the policies did not indicate specifically how staff should store raw and cooked foods to avoid cross-contamination.

2. In a roll-in refrigerator located next to the food preparation area, eight quart-sized cartons of thawed pasteurized eggs were stored. The egg cartons were not labeled or dated with the date they were removed from the freezer or a "use-by" date.

During a concurrent interview, the FSM and storekeeper acknowledged the eggs should have been labeled. They stated the eggs were received frozen from the vendor on 2/8/13. The storekeeper placed the eggs in the refrigerator upon receipt. The manufacturer's instructions indicated the eggs should be used within seven days of being thawed. The storekeeper stated any unused eggs were discarded on Friday, prior to the arrival of the new shipment of eggs. The storekeeper stated he was training an employee on the process, and acknowledged he failed to train them on the labeling and dating procedure.

A review of the hospital policy and procedure, "Storage, Labeling and Dating of Food Items" indicated, "Date" when removed from freezer to thaw. Follow manufacturer's guidance. Examples: liquid eggs, once thawed, use within 5 days."

This standard is not met as evidenced by:
Based on staff interview and record review, the hospital failed to ensure the nutritional needs of patients were met in accordance with recognized dietary practices when menus were not analyzed to ensure they met the Recommended Dietary Allowances (RDA) or the Dietary Reference Intake (DRI) adopted by the Food and Nutrition Board of the National Research Council of the National Academy of Sciences. Lack of complete nutrient analysis of patient menus could potentially place patients at risk of not receiving required nutrients, thereby compromising medical care.

On 2/11/13, at 1:00 p.m., the director of dietary (DD) and the dietitian (RD 1) provided copies of the hospital's nutrient analysis. A sample of the analysis for the "regular" and "cardiac" diets (diet modified for patients with heart disease) was reviewed. The analysis indicated some days were inadequate in some nutrients, for example calories and fiber. During a concurrent interview, the DD and RD 1 acknowledged they were in the beginning stages of reviewing the menu analysis for adequacy, but had not implemented any menu changes to address these inadequacies.

The analysis contained errors, for example, it was not clear for the item spaghetti/meat sauce on Day 3 lunch, if it included just the sauce, or if it included the sauce, meat, and noodles. RD 1 acknowledged they had not reviewed and ensured the analysis was accurate and complete for all the products used by the hospital.

The analysis did not include how the menus met the diet requirements as outlined in the diet manual (handbook that defines hospital-based diets). RD 1 acknowledged this part of the analysis was not completed, but was pending.

Based on observation, staff interviews and document review, the hospital's Infection Prevention Manager (IPM) failed to develop an effective system for maintaining the kitchen ice machine clean and sanitized and complete directions for cleaning and sanitizing. Interior parts and the bin door were observed with black and yellow-brown slimey substance.

This presents a potential of food-borne illness when food equipment is not maintained clean and sanitary.

Findings;

On 2/11/2013 starting at 9:00 a.m., during a tour of the main kitchen, the following were observed in the bin ice machine:

1. There was a black substance found on the interior bin door when it was wiped with a white paper towel. Food Service Manager (FSM) stated the food service staff was responsible for cleaning the bin section of the ice machine one time per month. He stated the ice machine had been cleaned by food service staff one to one-half weeks prior. FSM stated he was responsible for inspecting the ice machine and did not specifically look at this part of the ice machine.

2. The Director of Dietary (DD) removed the upper panel on the ice machine and there was yellow and brown slimy substance on the under panel of the mechanical section when wiped with a white paper towel. FSD and DD stated they did not know who was responsible for cleaning this part of the ice machine. They stated it was probably the Facilities Department since this area was not accessible without taking off the upper panel. They stated this machine had been cleaned by facilities in December 2012, and was cleaned on a quarterly basis.

Review of the Policy, "Ice Machine and Ice Distribution" dated 1/2013, documented "Ice dispensed for human consumption or patient care purposes will be handled in a sanitary manner to prevent contamination with potentially pathogenic microorganisms. "

The Facility and Maintenance Department directions documented, "6. Check for any repair and inspect for buildup of "mould", and "7. Thoroughly clean machine and parts with detergent de-scale mineral buildup."

The policy did not specify to sanitize the removable parts with a sanitizing solution of the 50 to 100 ppm (parts per million) solution of sodium hypochlorite (sanitizing chemical) as specified by the manufacturer.

The policy did not specify who was responsible for thoroughly inspecting the entire mechanical and bin storage areas to ensure proper cleaning and sanitizing of all areas of the ice machine.

The Dietary Department Ice Machine and Ice Distribution policy did not include directions for the food service staff to clean and sanitize the bin, specify the time frames or specify the required cleaning and sanitizing products. The FSM stated this was the responsibility of the food service department. He acknowledged there was nothing in writing to show staff how to clean and sanitize the ice machine in accordance with the manufacturer's directions, including a sanitizing solution concentration.

The manufacturer's directions specified a descaling chemical (remove lime scale) and sodium hypochlorite concentration of 50 to 100 ppm.