HospitalInspections.org

Based on observation, testing, and interview, in the kitchen the provider failed to ensure:
*All wiping clothes were stored in sanitizer solution when not in use.
*Four cutting boards were stored, so they could air dry after being washed.
*Clean dishes were kept in a clean environment at the dish machine.
*Food contact surfaces such as the cutting area of the meat slicer, inside of the microwave, and food container lids were kept clean.
*Taco meat and chicken breasts were cooled from 140 degrees Fahrenheit (F) to 70 degrees F in less than two hours and from 70 degrees F to 41 degrees F in less than four hours.
*The floor of the walk-in cooler under the shelving racks was maintained in clean condition.
Findings include:

1. Observation and interview with the dietary foreman on 11/3/15 from 1:10 p.m. to 2:30 p.m. in the kitchen revealed:
*There were multiple wet wiping cloths laying around the kitchen on the counters.
*She confirmed those wiping clothes when not being used were to be stored in red buckets of sanitizer solution.

2. Observation and interview with the dietary foreman on 11/3/15 at 1:20 p.m. at the three compartment sink revealed:
*Four clean cutting boards were not stored so they could air dry.
-The cutting boards were stacked in a pile flat on the dish rack.
-There was water between the cutting boards.
*She stated the cutting boards were to be stored upright in the dish rack. That would allow the water to drain from them, and they could air dry.

3. Observation and interview with the dietary foreman and the operator of the dishwasher on 11/3/15 at 1:25 p.m. revealed:
*The clean side drain board of the dish machine was contaminated with potatoes, vegetables, and other food particles.
-The water collecting on the drain board was grey in color and had a gritty appearance.
*The food particles building-up on the clean side drain board was from food coming through the dish machine on the dish racks with the clean dishes.
*The operator of the dish machine was not removing the gross contamination from some of the dishes prior to putting them into the dish machine.
*The dietary foreman agreed the dish washing machine was not being operated in a manner that would keep the dishes clean after passing through the dish machine.

4. Observation and interview with the dietary foreman on 11/3/15 from 1:10 p.m. to 2:30 p.m. in the kitchen revealed the following food contact surfaces were not clean:
*The inside of the microwave had a dried brown residue covering the bottom.
-It was supposed to be wiped down after each use to make sure it was kept clean.
*The lids used to cover containers that shipped food to "the houses" were covered with adhesive residue from labels.
-Some lids still had labels on them with resident's names.
-She agreed the lids that had existing labels and label adhesive on them could not be considered clean.
*The meat slicer had a dried white residue around the back of the blade.
-The meat grip assembly had dried meat in the teeth.
-When the sharpener cover was removed from the top of the blade it exposed a large chunk of fat.
-The meat slicer had been used last week.
-She agreed it should have been cleaned after it was used.

5. Observation, testing, and interview with the dietary foreman on 11/3/15 at 2:15 p.m. revealed:
*A large stainless steel square pan (12 x 10 x 8 inches) was covered tightly with saran wrap, labeled taco meat dated 11/3/15.
*The pan was approximately three quarters full with taco meat.
*The temperature of the taco meat was 72 degrees Fahrenheit (F) in the middle top two inches and 59 F at the edge of the pan.
*The taco meat had been prepared before 9:00 a.m. and placed into the walk-in cooler to cool.
*The taco meat should have been cooled from 140 F to 70 F in the first two hours and from 70 F to below 41 F in less than four hours.
*The temperatures of the cooling meat should have been taken every two hours and recorded on the cooling log.
*The cooling log where temperatures were to be recorded was missing.
*She agreed the taco meat was not cooled correctly.

Further observation, testing, and interview at 2:20 p.m. with the dietary foreman and an unidentified cook revealed:
*A smaller stainless steel pan (12 x 6 x 6 inches) was covered tightly with saran wrap, labeled chicken breasts, and dated 11/3/15.
*The pan was approximately three quarters full.
*The temperature of the chicken breasts was 83 F.
*The chicken had been cooked at 1:00 p.m. and had only been cooling for an hour.
*The cook had taken the chicken from the shallow pan it was baked on and placed it into the smaller deep pan. She then sealed it with saran wrap, labeled, and dated it.
*She had not tested the temperature of the chicken prior to putting the chicken into the smaller deep pan and sealing it with saran wrap.
*The dietary foreman agreed putting chicken breasts into a small deep pan and sealing it shut with saran wrap would make it very difficult for the chicken to cool correctly.

6. Observation and interview with the dietary foreman on 11/3/15 at 2:25 p.m. revealed:
*A pool of partially dried blood on the floor of the walk-in cooler under the meat rack.
-The rack where meat was stored had the bottom shelf six inches above the floor, so it could be mopped under.
-The walk-in cooler floor was to be mopped nightly.
-Once a week they would also do a more thorough cleaning of the walk-in cooler where the racks were moved.
-The blood spill should have been mopped up during the nightly cleaning.

On 11/5/15 at 9:15 a.m. policies in regards to the deficiencies identified above were requested from the unidentified cook. She was unable to locate the policy manual. The dietary foreman was not available at that time. A note was left for the dietary foreman with a list of policies and the fax number for my office. At the time of this report no policies had been received on the fax.

Based on observation, interview, testing, and policy review, the provider failed to ensure:
*The appropriate strength of disinfectant was used to clean environmental surfaces in all patient rooms between clients.
*An appropriate disinfectant was used for cleaning environmental surfaces contaminated with Clostridium difficile (C. difficile).
Findings include:

1. Observation, testing, and interview with certified nursing assistants (CNA) A and B on 11/4/15 at 10 a.m. in the care unit revealed:
*CNAs were responsible for cleaning equipment such as bathtubs and beds in resident rooms.
*They used a spray bottle of Simplicity Sanibet multi-range sanitizer for cleaning between patients.
*Each patient bathroom had a spray bottle of sanitizer.
*The sanitizer was used to clean bathtubs and other environmental surfaces between uses by patients.
*The spray bottle tested 200 parts per million Quaternary ammonia.
*To be mixed as a disinfectant the solution should have been greater than 400 parts per million

Policy review and interview with the director of environmental services on 11/4/15 at 3:30 p.m. revealed:
*The Equipment cleaning policy stated "Equipment will be cleaned daily, between patients, and as needed when obviously contaminated to minimize risks associated with the potential transmission of communicable illnesses from contaminated toys and equipment. A facility-approved disinfectant will be used to disinfect equipment."
*She agreed the CNAs should have used a disinfectant to clean environmental surfaces between uses by patients.

2. Interview with housekeeper C on 11/4/15 at 10:45 a.m. revealed:
*To clean a room that had been isolated for C. difficile she would use Virex 256 Quaternary ammonia disinfectant.
*She was not aware Virex 256 was not labeled to kill C. difficile.

Interview with the director of nursing who was also the infection control nurse on 11/4/15 at 12:10 p.m. revealed:
*The nursing department would notify housekeeping when to terminally clean (thoroughly clean) a room that had been isolated including C. difficile rooms.
*The housekeeping department would be expected to clean the room appropriately.
*She was not aware the Virex 256 used by housekeeping was not labeled to kill C. difficile.
*Their last C. difficile patient had been in August 2015.

Policy review and interview with the director of environmental services on 11/4/15 at 3:30 p.m. revealed:
*She was not aware the housekeeping staff was using Virex 256 to clean C. difficile rooms. She thought they were using a chlorine bleach solution.
*The Infection Control for Environmental Services Department policy effective 10/9/14 stated "Freshly prepare facility approved disinfectant-detergent solution per manufacturer guidelines and label all bottles clearly."
-The policy did not specifically address C. difficile.