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Based on observation, interview and document review, the director of food services failed to have a process in place which ensured opened food items were labeled and disposed of by the expiration date.

This failure created the potential for patients to experience illness due to exposure to food borne pathogens if unlabeled food or expired/unsafe food was served to patients.

FINDINGS:

FACILITY POLICY

According to the facility's policy, Food and Supply Storage, the "Expiration Date" is the last date that food should be eaten. Except for eggs, foods not consumed by this date should be discarded. For food products that are opened and not completely used, or prepared at the facility and stored, the product should be labeled as to its contents and used by dates. Follow Food Storage Guidelines available on Nutrition Services Website to determine used by date.

According to a "Label, Date and Rotate: Principles of Food Storage" inservice, completed on 01/25/14, staff were to discard food that had exceeded the use-by date or expiration date indicated by the manufacturer or according to the Food Storage Guide (Food Storage Guidelines). Leftovers were to be discarded if not used within three days of preparation.

1. During a tour of the kitchen, on 02/25/14 beginning at 2:10 p.m., the facility's Food Services Manager and Chief Clinical Officer were asked how the facility determined the length of time food could be safely stored and consumed. The Food Services Manager provided a copy of the facility's "Food Storage Guidelines," dated 09/04/12, and stated s/he would follow the guidelines and discard food past the recommended timeframes.

a) While touring, with the Food Services Manager and Chief Clinical Officer, several food items were noted to be unlabeled and past the identified expiration date.

The 4-door refrigerators contained the following unlabeled or expired items:

-an opened container of tuna dated 02/20 with an expiration date of 02/24.

-an opened, unlabeled plastic container of baby corn. There was no date when the item was opened or expiration date noted. According to the Food Storage Guidelines, canned vegetables could be kept for three to five days after opened.

-two opened packages of leaf lettuce with a received date of 02/05/14. There was no date which indicated when the lettuce was opened and when it would expire. The Food Storage Guidelines noted fresh lettuce should be used within five to seven days.

-two unopened packages of leaf lettuce with a received date of 02/05/14. Per the Food Storage Guidelines the unopened fresh lettuce should be used within five to seven days.

The walk-in refrigerator had a container of cooked turkey, dated 02/20/14 with no expiration date. Per the Food Storage Guidelines, cooked meat could be stored in the refrigerator for 3-4 days.

b) A subsequent kitchen tour, with the Food Services Manager and Chief Clinical Officer, was conducted on 02/26/14 at 1:40 p.m. During the tour, observation of the walk in refrigerator showed there continued to be expired items. As example, an opened container of vegetable soup base was labeled as opened on 02/17/14 with an expiration date of 02/24/14.

During the tour, employee #2 was asked if s/he checked for unlabeled and expired items on 02/24/14 (the date prior to the first tour). Employee #2 stated s/he had been in charge of that on 02/24/14 but thought s/he was only supposed to look at items prepared by the facility. The employee stated s/he was unaware s/he was to look at the lettuce. Employee #2 stated if s/he came across an unlabeled, undated item s/he would date it with the previous day's date, indicating the date it had been opened. Employee #2 acknowledged there was no definitive way to know if the date was accurate.

Additionally, during the kitchen tour, on 02/26/14 at 1:40 p.m., employee #3 stated s/he had been with the facility for less than two weeks and was still in orientation. Employee #3 stated s/he had been taught by coworkers that all items should be marked with an expiration date of seven days after the open date. This was in contrast to the Food Storage Guidelines used by the facility.

c) During the kitchen tour, on 02/25/14 at 2:10 p.m., the Food Services Manager was asked what the process was to ensure food items were properly labeled and disposed of if expired. The Manager stated s/he had implemented a PM Cook Closing Daily Checklist a few weeks prior to correct the problem and was monitoring the checklists for completion.

On 02/27/14 at approximately 12:15 p.m., the Chief Clinical Officer was asked to provide a copy of the PM Cook Closing Daily Checklists from 02/20/14 through 02/26/14. At 1:50 p.m., the Chief Clinical Officer provided the sheets for all the requested dates except 02/24/14 (the date prior to the first kitchen tour). The Chief Clinical Officer stated s/he was unable to find that sheet and the Food Services Manager was looking for it.

On 02/27/14 at 1:55 p.m., the Food Services Manager provided a PM Cook Closing Daily Checklist, dated 02/24. However, review of the checklist showed employee #4 as the employee who completed the tasks instead of employee #2 who had stated in interview s/he had checked for unlabeled and expired items on 02/24. Upon further questioning the Food Services Manager acknowledged s/he had just completed the form prior to providing it the surveyor.