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Based on observation, interview, and document review, the facility failed to ensure glucometer testing solution was maintained in accordance with manufacturer's guidelines and in a manner to ensure efficacy.

This failure created the potential for erroneous test results when checking patients' blood sugars.

Findings:

FACILITY POLICY

According to Abbott Precision Blood Glucose Monitoring System, last revised 10/2014, discard all unused solution 90 days after initial opening.

REFERENCE

According to manufacturer's guidelines for the MediSense Glucose & Ketone Control Solutions, do not use control solutions 90 days after opening or if they are expired.

1. The facility did not ensure the glucometer testing solution was used prior to the discard date.

a) On 12/08/14 at 1:50 p.m., a tour of the facility was conducted with the Director of Nursing (DON). Inspection of the glucometer at the Unit 200 nursing station revealed two opened bottles of glucometer control solution, both Hi and Lo, with a handwritten "use by" date of 11/14/14 on both bottles.

b) Interview with the DON was conducted during the tour. The DON stated s/he did not know why the control solutions were not labeled when opened and confirmed both bottles should have been thrown out. The DON also stated quality control checks were performed every 24 hours and the expired control solutions should have been replaced.

Based on observation, interview and document review, the facility failed to have a process in place which ensured food items were labeled and disposed of by the expiration date.

This failure created the potential for patients to experience illness due to exposure to food borne pathogens if unlabeled food or expired/unsafe food was served to patients.

FINDINGS:

FACILITY POLICY

According to the policy, Nourishment and Stock Levels, review date 11/2013, all snacks will be rotated on a daily basis so that dietary staff can ensure only non-expired snacks are stocked.

According to the policy, Storage of Refrigerated Food Items and Dry Goods, sandwiches will be labeled and dated the day they were made and date to discard. Sandwiches will be discarded after the 3rd day.

Perishable food items will be discarded after the 3rd day.

1. The facility failed to ensure food items were labeled and dated the were made and when they were to be removed from patient nourishment refrigerators located in the nursing units.

a) On 12/08/14 at 12:55 p.m., a tour of Nursing Unit 400 was conducted with the Director of Nursing (DON) and the dietitian. During the tour, inspection of the patient nourishment refrigerator revealed the following items: 10 ham and cheese sandwiches with the dates 12/4/14, 12/5/14, 12/6/14, 12/7/14; three containers of Dannon Light and Fit yogurt (expired 12/7/14), Strawberry Jello 4-pack (expired 11/20/14). Observation also revealed individual containers of fruit juice with no labels or dates, including nine apple juice, four cranberry juice and 12 orange juice.

An interview was conducted with the DON and Dietitian regarding the expired items in the patient nourishment refrigerator. The DON stated the dietary person who delivered the snacks would ensure there were no expired items in the refrigerator. The Dietitian agreed the dietary person would have pulled the old snacks before s/he restocked. The DON and Dietitian stated they were unaware of what the dates represented on the sandwiches and why there were no dates on the juice cups.

During the interview a floor staff member (telemetry tech) called the dietary department to ask what the dates on the snacks represented. S/he reported the dates indicated when the items were to be removed from the refrigerator.

b) On 12/09/14 at 9:40 a.m., a tour of the kitchen was conducted with the Kitchen Supervisor. Inspection of the refrigerator revealed 2 clear plastic bags of sliced oranges dated 12/20 (11 days after the tour) and 2 bags of fresh kale dated 12/20 and 12/15 (6 days after the tour).

An interview with the Kitchen Supervisor was conducted on the process for dating perishable food items and garnishes was conducted. S/he stated garnishes would be good for 3 days. S/he stated the dietary aide would have been responsible for preparing the garnishes and would have dated them before they were placed in the refrigerator.

An interview with the dietary aide was conducted. During the interview, the surveyors witnessed a kitchen staff member changing the dates on the sliced oranges and kale. The dietary aide stated garnishes would be good for 3-5 days, but typically 3 days. When asked why the date of 12/20 was on the sliced oranges and kale, the dietary aide stated s/he only did the 2 bags on the right side, 1 bag of sliced oranges and 1 bag of kale. The dietary aide stated the Lead Cook at night would have been responsible for the other bag of sliced oranges and kale. When asked why the perishable items were labeled with an expiration date of 12/20 (11 days after the observation) the dietary aide stated "I must have made a mistake."

An interview with the Lead Cook and the Kitchen Supervisor was conducted on the process of labeling and dating perishable food items. S/he stated the items would be dated and expired 3-5 days from the time they were placed in the refrigerator. When asked about the date of 12/20 (11 days after the bags were placed in the refrigerator) on the bag of sliced oranges and kale, the Lead Cook stated s/he prepared these and "might" have dated them 12/20, but does not recall.

c) Further interview with the Kitchen Supervisor on the process for labeling and dating individual juice cups was conducted. The Kitchen Supervisor stated it would be the responsibility of the snack person to label individual items with expiration dates before they were placed into a refrigerator; however, s/he could not provide an answer on how long the juice cups were good for once placed into a refrigerator.