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Based on observation, interview and record review, nursing staff failed to adhere to hospital policy regarding disposal of controlled substance transdermal patches during 1 applicable observation related to Patient # 3. Findings include:

During observation of medication administration and nursing care for Patient #3 on 3/25/29 at 2:15 PM, the RN (Registered Nurse) placed the used fentanyl transdermal patch (a type of pain relieving controlled medication) on a paper towel and transported it to the Medication Room and disposed of the patch in the appropriate wall receptacle. When the RN was asked if 2 staff were required to waste controlled substances, s/he replied "no", stating that they do not require a witness for wasting the fentanyl patches. The Pharmacy Nursing department policy entitled Disposal of Controlled Substance Patches, effective date of 1/27/07, under Procedure:, stated "Routine Destruction:"
" Destruction (or wastage) of any controlled substance must be done in the presence of two (2) licensed individuals who are authorized to control and handle these drugs. The destruction of partial doses of controlled drugs must be done and recorded by two (2) nurses."

The failure of the RN to follow the hospital's policy/procedure related to disposal of controlled substances was confirmed during interview with the Chief Nursing Officer (CNO) on 3/26/19 at 11:30 AM and later, during interview with the RN at 2 PM.

Based on observation, staff interview and record review, the Food Service Director (FSD) failed to ensure that all perishable food items were handled in accordance with CAH policies related to safe food handling practices. Findings include:

During a tour of the hospital's food service and storage areas on 3/25/19 at 10:30 AM, accompanied by the FSD, the following unsafe food handling practices were identified:
1. Per review of the refrigerator/freezer temperature monitoring sheet for the month of March, 2019, the walk-in refrigerator temperatures recorded daily for 3/1/19 - 3/27/19, showed that the temperature was above 40 degrees Fahrenheit (F) for 16 of the 27 dates. (Out of range temperatures were from 41 - 44 degrees F. and covered multiple days in a row.) During interview, the FSD stated that the walk-in refrigerator temperatures are monitored 24/7 and will alarm if the temperature is below 41 degrees F. There was no evidence that there was any action taken by hospital facility's staff to adjust the walk-in refrigerator compressors to achieve and maintain less than 41 degrees F.*
2. Per observations in the walk-in refrigerator, a package of defrosting raw poultry was observed stored on the next to the bottom shelf with no drip proof container to prevent cross contamination.*
3. Cooked meats (turkey and ham) were observed stored on the shelf above avocados.*

The hospital policy entitled: General Food Preparation and Handling, under Procedure: 3. "Food Preparation. a. Meats, fish and poultry are defrosted using safe thawing practices: " ....in the refrigerator in a drip proof container, and in a manner that prevents cross contamination."

Additionally, the following interview confirmed that safe food handling practices were not followed related to the re-use of salad bar foods ( foods that had been put out for service and the leftovers re-used on a second day).
4. Several salad bar inserts were observed on a cart in the walk-in. The items included vegetables and facility mixed salads (i.e., tuna salad and chicken salad). During interview, the FSD stated that they do refrigerate remaining salad bar foods at the end of the day and put them out for service the following day. Since there was no method to assure that the foods were consistently maintained at temperatures below 41 degrees F. and in a sanitary manner, these foods should not be re-used.*

* Reference: Serve Safe Manager, 6th edition, Chapters 4 and 5, safe food handling and storage practices.