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Based on observation, review of hospital policies and procedures and staff interviews, it was determined the hospital did not ensure the kitchen located on a unit of the hospital, Palo Verde, was maintained in a clean and sanitary manner including storage of food items, functioning appliances and monitoring food temperatures prior to serving to patients.

Findings include:

The findings cited below are at a Standard level only.

The hospital's policy and procedure number 44.02.42 on the subject of Food Delivery from TMC Main Kitchen to Palo Verde included: "Purpose: To provide the criteria that shall be used to assure that the food delivered from TMC Main Kitchen meets all quality standards...Procedure: Food is sent from the main kitchen in insulated food containers immediately prior to meal periods...Food temperatures are taken in the main kitchen during production to assure that all foods are cooked and held at proper temperatures...Food temperatures are re-taken upon delivery to Palo Verde just prior to start of services. Any food that does not meet temperature standards are reheated to the appropriate temperature to assure food quality and safety...."

Palo Verde Behavioral Health Unit is a 48-bed inpatient unit for adults with acute psychiatric diagnoses. The unit is located in a building not physically connected to the main hospital but is an organized department of Tucson Medical Center. A tour and observation of the unit was made with hospital staff on 1/8/2014. A pervasive unidentified odor was noted upon entering the building and walking towards the kitchen. Hospital administration acknowledged the odor and stated it has always been there but could not identify the source of it.

There were two dietary staff members present in the kitchen during the tour. They reported that meals for the unit are prepared in the kitchen at the main hospital and then transferred to Palo Verde for serving. The lunch meal was observed in serving pans set up in a buffet-style set-up where patients and staff requested entrees, and were served by the dietary staff.

The kitchen included ovens and stoves which the staff reported had not been used for several years. There were no signs on those appliances alerting staff that they were not to be used. There was visible build up of food bits/crumbs, dirt, dust and debris throughout the entire kitchen area including floors, pipes, connections, shelves, drawers, bins. Food items or supplies/equipment were stored in and/or near those areas.

The faucet at the sink area outside of the dry-food storage area was leaking and had a with a thick deposit of calcium and mineral build-up around the handles and from the faucet itself. One of the dietary staff members stated the sink and faucet were not used; however,there were food items in the sink defrosting.

The dishwashing area also had evidence of water leaks around pipes and connections as evidenced by the thick layer of calcium and mineral deposits. The dietary staff member stated they only used the dishwasher to wash the meal trays. A review of the Mismatching Temperatures log for October, November and December 2013 and 1/1/2014 through 1/8/2014 revealed the dishwasher was not meeting rinse and final rinse high temperatures. The dietary staff member reported the dishwasher had not been functioning properly for a length of time and that prior repair attempts had not been successful. They acknowledged they continued to use the dishwasher even though it was not functioning properly because it was only used to wash the trays.

The "Palo Verde Cleaning Schedule" included specific areas in the kitchen to be cleaned and broken down by the day of week. For example, every Sunday, the staff were to: "Clean all carts (utility, food, etc)...Clean out all debris from under/behind equipment...Sweep and Mop entire kitchen, office, storeroom and fridge." The staff reported they did not maintain documentation that evidenced who completed the cleaning and the date.

Further observations included bread products of rolls/biscuits in clear plastic which were open but not labeled with the open and discard dates. The staff reported the bread product had been opened for the breakfast meal and anticipated the remaining would be served the next morning. They acknowledged the hospital's policy to label all open products with the name of the food item, the date opened and the discard date, but did not routinely do this.

The Dry Storage Room contained numerous cardboard boxes of food and food serving items stacked in the middle of the room. The cardboard boxes had been unloaded directly onto the floor. The staff were not aware if the hospital had a policy on how to store food items. The Director of Food Services later stated during an interview that food deliveries were not to be unloaded directly onto a floor and was not aware that this was the process at the Palo Verde kitchen.

The surveyor requested documentation of food temperatures obtained prior to serving meals. The clipboard provided included eight pages titled "Keep Food Safe Patient Services Temperature Record." Five of the eight pages were dated. The Temperature record dated 1-3-2014 had temperatures recorded for breakfast but not for the lunch or dinner meals. The record dated "Jan. 1, 2014" had the food temperatures for breakfast and lunch but not dinner. Three of the temperature records were not dated and two of the three records had food temperatures recorded for breakfast and lunch but not for dinner.

The Director of Food Services for Tucson Medical Center responded to the Palo Verde Unit kitchen to observe and discuss the above. She acknowledged hospital policies and procedures were not followed and that many of the large appliances were in disrepair and not to be used.