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Based on interview and document review the Hospital A failed to ensure at:

1. Hospital A -The Director of Food and Dietetic Services at Hospital A met qualifications in California Health and Safety Code HSC 1265.4 where the full time Dietetic Services Supervisor meets requirements as stated in subdivision (b) (1) a baccalaureate degree with a major studies in food and nutrition, dietetics, or food management and has one-year experience in the dietetic service of a licensed health facility.

2. Hospital B - Accurate labeling of foods capable of supporting bacterial growth associated with foodborne illness.

This failure puts patients at risk of foodborne illness, consumption of expired food items, and compromised nutrition care.

Findings:

1. On April 18, 2019 the Director of Food and Nutrition (DFN) qualifications were reviewed. The Food and Nutrition Services Organization Chart for Hospital A, dated April 1, 2019, and Job description, dated April 9, 2019, showed the DFN is responsible for the operation of the Food and Nutrition Services.

A review of the DFN's credentials showed a Bachelor of Science from [name of university] dated May 2008. The diploma does not state the program completed.

A review of the DFN's resume showed a program of "Food and Nutrition, Dietetics", no previous work experience in dietetic services, in a licensed health care facility, prior to employment at licensed health care facility in California was referenced.

During an interview with the Regional Food Manager (RFM) on April 18, 2019, at 10:45 AM, the RFM acknowledged the Food and Nutritionist Services Director did not meet Health and Safety Code requirements and the department would be restructured to meet the requirements.


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2. During initial tour of the kitchen in Hospital B on April 17, 2019, at 9:10 AM, there was a large, clear rectangular container of tuna salad labeled with preparation and expiration dates of April 16, 2019, and April 19, 2019.

During an interview on April 19, 2019, at 10:15 AM, Dietary Staff 1 (DS 1) stated the tuna salad was produced by mixing canned tuna from the dry food storage area with chilled mayonnaise. Once the item was completed it was placed in the freezer for cooling. DS 1 further stated temperatures were checked hourly. Once the temperature of the item was 41 degrees Fahrenheit (F) or below, the tuna was moved to the refrigerator. DS 1 also stated temperatures were recorded on a log posted on the freezer door.

A concurrent review of the departmental document titled "Cooling Log for Cold/Room Temp [temperature] Foods" from April 14, 2019 - April 17, 2019, revealed there was an entry for tuna salad, however the entry was dated April 14, 2019. In a concurrent interview Chef 1 stated it was likely an unidentified staff member took the tuna salad out of the original mixing bowl and placed it in the plastic rectangular container at which time the preparation date of April 14, 2019 was not carried forward, rather dated April 16, 2019, the date the item was transferred into a different container.
Chef 1 stated the production date of the tuna salad should have been maintained.

Based on staff interview and document review Hospital B failed to ensure dietitians were regularly scheduled to ensure the nutritional aspects of patient care was covered seven days per week in a large acute hospital.

Failure to provide timely nutrition care for a 420 bed acute hospital puts patients at risk of compromised nutrition.

Findings:

A review of Hospital B services showed there are 420 licensed beds with Medical, Intensive Care Unit (ICU), Rehabilitation and Behavioral Health units.

A review of Hospital B's Dietitian schedule for February 2019 to April 2019, showed weekend coverage was either one Saturday or one Sunday per weekend, and only one dietitian.

During an Interview with the Regional Food Manager (RFM) on April 18, 2019, at 10:45 AM, regarding Hospital B's clinical Dietitian coverage, RFM acknowledged the daily census for Hospital B was around 200 to 220 patients. RFM acknowledged the Dietitian coverage could be changed to provide Dietitian coverage seven days a week to ensure patients received timely nutrition care

Based on observation and interview the hospital failed to ensure the trash disposal at Hospital A and Hospital B was maintained in a sanitary condition and met FDA Food Code Requirements.

This failure posed a threat for pest contamination.

Findings:

According to the US Food Code 2013, 5-501.113 Covering Receptacles, receptacle units for refuse shall be kept covered ...with tight fitting lids ...after they are filled.

1. On April 17, 2019, at 9:30 AM, during an observation and concurrent interview with Food Service Manager A (FSM A) a tour of the trash disposal area was conducted. One of two dumpsters had a lid that did not securely and completely close. FSM A stated dumpster lids should be closed at all times.

On April 17, 2019, at 9:30 AM, the area around the trash dumpsters was littered with plastic containers and debris on the ground around the dumpsters. A policy regarding the trash disposal was requested at this time but no policy was provided.

2. On April 18, 2019, at 9:30 AM, during an observation and concurrent interview with FSM B and Infection Control staff at Hospital A, three dumpsters had lids in open position, pinned at the back of the trash enclosure, in such a way the lids were not able to be closed. DM and IC confirmed staff could not move the dumpsters out to free the lids and therefore close the lids as required when filling with trash.