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Based on observation, interview and record review, it was determined that the hospital did not ensure that food was stored under safe and sanitary conditions.

Findings include:

1. During the tour of the kitchen on 9/18/12 at 8:30 AM, conducted with the hospital director of food services, the executive chef, and the clinical nutrition manager, the surveyor observed 3 containers of salad dressing inside the left-side refrigerator that had not been properly labeled: (1) a container of honey mustard dressing contained no evidence of the date opened nor the expiration date of the dressing; (2) a container of thousand island dressing contained no evidence of the date opened nor the expiration date of the dressing; (1) a container of a light gold-colored liquid contained no label to evidence what the liquid was, nor any opened date or expiration date. The hospital food services director stated that it was a bottle of Italian dressing.

2. The surveyor also observed 5 gallon bottles of salad dressing located behind the smaller containers of salad dressing: 1 each of ranch, honey Dijon, blue cheese, Caesar, and Italian. None of the 5 gallon bottles contained evidence of the date they were opened. The hospital sous-chef stated that dressings were discarded 4 days after opening. The surveyor asked how they would know when to discard the dressings if they didn't know when they were opened, and the food services director stated that they wouldn't know.

3. In the walk-in refrigerator, the surveyor observed a large rectangle pan with an uncovered piece of some type of meat in liquid. There was no label as to what the meat was, nor when it was placed in the refrigerator. The executive chef stated that the meat was, "today's pork" and that the refrigeration was "part of the cooking process."

4. The surveyor observed many jars of spices that had the dates opened written on them, but evidenced only the month and day, with no year written. There were no expiration dates on the spices. The surveyor asked how they would know when the spices were no longer safe to use. The sous-chef stated that the spices were safe for 1 year after opening, but that they usually used them up in a few months.

5. On 9/18/12 at 8:45 AM, an interview was held with the diet tech on duty. The surveyor asked her to describe her duties. She stated that she helped stock supplies, cleaned, and managed the tray line. The surveyor asked how she would know which products to use. She stated that they were trained to use the oldest products first and that she would date a new bottle of dressing if she opened it. She stated that employees were trained to date food items when they were opened.

6. An interview was conducted on 9/18/12 at 8:50 AM with the hospital food services director, the executive chef, and the clinical nutrition manager. The surveyor asked how new food service employees were trained on food safety and proper storage and refrigeration. The executive chef stated that he was responsible for new employee orientation. He stated that during the first hour or two that new employees worked, he trained them on all kitchen procedures. He said this was when he trained them regarding the proper dating of opened jars and labeling all food items.

7. The surveyor asked to review minutes of in-services held for dietary personnel. The food services director stated that he had agendas for monthly in-services, but did not have any documented minutes or sign-in logs.

8. The surveyor reviewed a contract between the hospital and [Thomas Cuisine] the food service company that was responsible for all hospital food preparation and storage. On page 4 of the contract under 9.1, it contained a statement that the contracted food service company would comply with all requirements concerning "the sanitation, safety and health in providing services."

Based on observation, it was determined that the hospital did not maintain the hospital environment in such a manner that the safety and well-being of patients was assured. Specifically, there were demonstrated areas of concern in the labor and delivery unit, post partum unit and nursery, as well as the central supply storage room.

Findings include:

A tour of the hospital was conducted on 9/19/12 and 9/20/12. Initial observation of patient rooms demonstrated areas of concern in the labor and delivery unit (L&D), post partum unit and nursery, as well as the central supply storage room.

The L&D unit, room five, a portable bedside table was observed to have plastic missing on the side with exposed wood. This made the table unable to be sanitized.

The L&D unit, room six, a rolling stool was observed to have a large tear with the filling protruding out of the tear. This made the stool unable to be sanitized.

The post partum unit, room 150, had chipped laminate below the bathroom sick with exposed particle board. This made that area under the sink unable to be sanitized. Additionally, the toilet had a paper wrap around it indicating that it had been cleaned by housekeeping. The toilet water and bowl was very brown and appeared to be unclean and unsanitary.

The post partum unit, room 153, had a tile missing on the floor base by the shower entrance; there was exposed wall and what appeared to be rust. This made that area of the wall unable to be sanitized. Additionally, the toilet had a paper wrap around it indicating that it had been cleaned by housekeeping. The toilet water and bowl was brown and appeared to unclean and unsanitary.

The nursery had several wooden bassinets with areas of worn varnish. This made those areas unable to be sanitized.

The central supply storage room had two areas with missing linoleum and exposed flooring. This made that area of the flooring unable to be sanitized.