HospitalInspections.org

17065

Based on food service observations, dietary staff interview, and dietary document review, the hospital failed to ensure foods were prepared and stored in a manner to prevent the growth of bacteria associated with foodborne illness, as evidenced by the lack of documentation for cooldown of potentially hazardous foods. The hospital also failed to ensure effective sanitation procedures of food contact surfaces, and prepared foods that were frozen for 30 days which were covered by materials not approved for that use. Failure to ensure comprehensive cooldown monitoring and sanitation procedures, and safe food packaging materials may result in food borne illness, resulting in nausea, vomiting, gastrointestinal distress, further compromise of clinical condition and in severe instances may result in death.

Findings:

1. During initial tour on 4/1/10 beginning at 10:10 am, it was noted that there was a cart of previously cooked pasta in the walk-in refrigerator. In an interview on 4/1/10 at 10:35 am, Dietary Staff 1 (DS) was asked to describe the preparation methods of the item. He stated that it was cooked on 3/31 and was to be used on 4/1. He further stated the item was cooked in the kettle, drained and then placed in the oven for browning. He also stated that once the process was complete he placed the cooked pasta in the pans and placed them in the refrigerator. The surveyor also asked whether he did anything else after placing the item in the refrigerator, to which he replied that he did not. He also stated that he knew the item was safe because he cooked it and that it was scheduled to be used within 1 day.

Review on 4/1/10 of the dietary department cool down log dated 3/31/10 revealed that while a cooking temperature of the pasta was recorded as 168 degrees F, there was no monitoring of cool down. It was also noted that the cool down log guided staff that if the product does not reach 40 degrees F within 2 hours, the item should be placed in the blast chiller.

In an interview on 4/1/10 at 3 PM, Contract Staff 2 (CS) was asked how he ensured staff was competent in the job skills related to individual positions. He stated that each employee received a competency evaluation based on specific positions. The surveyor asked how DS 1 was evaluated. CS 2 replied that he completed a competency evaluation by reviewing written policies with the employee on 3/29/10.

Review on 4/1/10 of an undated hospital document titled "2008-2009 Annual Required Elements/Competencies Review" for DS 1 noted that he was on leave during initial competency evaluation. The document also noted that DS 1 "does not use blast chiller" and that DS 1 was given policies and provided handouts upon his return on 3/29/10. While the employee was given the handouts there was no evidence that CS 1 or a departmental representative observed how DS cooled down potentially hazardous foods.

2. On 4/1/10 at 11:25 a.m. during kitchen observations, Dietary Staff 3 (DS) was observed cleaning and sanitizing kitchen equipment and work surfaces. During a concurrent interview, DS 3 stated, "I'm supposed to check the sanitizer at 12:00 p.m." When the surveyor requested, DS 3 demonstrated how to check the sanitizer strength with a colorimetric test strip (a strip of paper treated so that the color changes based on the sanitizer concentration) that is held in the sanitizer for 10 seconds, per manufacturer's use directions. Following the 10 second immersion, the strip was observed to remain the original orange color. During a concurrent interview following the test, DS 3 stated,"It (the test strip) should be green, I'm going to tell my supervisor."

At 11:35 a.m. Dietary Management Staff 4 (DMS) identified himself as the supervisor of DS 2 and stated, "I brought new sanitizer solution. The other wasn't working." During a subsequent interview at 11:45 a.m., Contract Staff 5 (CS5) provided the " Sanitizing Solution Competency Elements for All Front Line Staff " that revealed "solution must be changed at least every 3 hours." CS 5 provided Hospital Policy HS003C "Maintaining Sanitizing Logs" that revealed the sanitizer is checked one time a day at the sanitizer dispensing station, but not at the point of use. During an interview at 11:50 a.m., Contract Staff 6 (CS) acknowledged the once a day test policy was not adequate to ensure effective sanitizer concentration at the point of use. CS 6 stated, "We need to test to see how long it lasts when staff is cleaning with it. It doesn't always last at least three hours."

3. On 4/1/10 at 10:10 a.m. during observations of food stored in the walk-in freezer, a cart was observed to be covered with a thin, lightweight plastic bag, loose, and open at the bottom. Further observations revealed there were six pans of quiche covered with thin plastic wrap and the labels thereon dated, "3/15/10." There was no"Use By"date written on the labels.

At 11:00 a.m. during an interview, DMS 4 stated the observed quiche had been made "in house", and would be kept in the freezer for 30 days. He provided the plastic wrap box labeled "Cling Classic Food Wrap" as the type used to cover the individual trays of quiche, and stated the bag over the cart was a "garbage bag." Dietary management staff was unable to provide documentation from the plastic wrap/garbage bag suppliers that they would ensure safety and quality when used as frozen food wraps for 30 days.




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