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Based on observation, review of records, and interviews with staff, the governing body failed to be responsible for the organization, management, and operation of the dietary department, as unsanitary conditions were found throughout the kitchen where patient food is stored and prepared. This could potentially cause food-borne illness in patients of the hospital.

Findings were:

A tour of the kitchen and food preparation and storage areas was conducted at 2:45 pm on 10/28/13 in the company of staff #1, the Director of Dietary; staff #3, the Executive Chef; and staff #8, the Quality Manager. During the tour, unlabeled and undated open containers of food were found in the freezers, pantries and refrigerators. Also found during the tour were multiple areas that were potential infection control hazards. In the food preparation areas were trays and carts with dried-on food substances and were greasy to touch. Also noted in the food storage areas were food crumbs, and wet food juices dripping from defrosting meats. The handles of the freezer and refrigerator, and outer containers of food were covered in black, yellow, brownish and greenish substances and were sticky to touch. Floors contained build-ups of grease and unidentified particles. Pans were stored still dripping water, and the pans were greasy to touch. Air vents had visible dust and grime. Standing water was observed on the floors. A door to the outside was noted to have an opening between the floor and the door large enough for rodents and insects to enter the kitchen areas. For more information, cross refer to tag A0618.

Based on observation, review of records, and interviews with staff, the facility QAPI program failed to ensure that data collected was used to improve the condition of the kitchen and food preparation/storage areas. Cleanliness and food storage problems identified in December 2012 and May and June 2013 were not corrected as of the survey tour of the facility conducted 10/28/13, leaving a potential for food-borne illness in patients of the hospital.

Findings were:

The facility Performance Improvement Plan for 2013 states on page 3 under the section entitled THE PERFORMANCE IMPROVEMENT PROCESS, that monitoring of the hospital in order to improve processes includes gathering data obtained from observations of hospital activities.
The Infection Preventionist, Staff #2, provided a document entitled Environment of Care, Food Service. Staff #2 explained that this form is utilized to identify problems in the kitchen area that need to be addressed and that walk-throughs are performed twice a year. The form provided by Staff #2 is dated 5/23/13, with a 2nd visit on 6/5/13. Additionally, the facility Quality Assurance Manager, Staff #8 provided the same form, which had been completed 12/15/12. According to the form dated 12/15/12, there were general descriptions of holes in the ceiling, dust throughout the kitchen, holes in the walls and debris on the floors. The form dated 5/23/13 with the 2nd visit on 6/5/13, also identified holes in the walls and ceilings, leaking water, and repairs that were needed to floors. These were issues that had not been addressed or repaired, and were identified during the survey tour of the facility, 10/28/13.
A tour of the kitchen and food preparation and storage areas was conducted at 2:45 pm on 10/28/13 in the company of staff #1, the Director of Dietary; staff #3, the Executive Chef; and staff #8, the Quality Manager. During the tour, standing water was noted on the floors, and holes were noted in the ceilings and walls. Also, as identified in the Environment of Care forms dated 12/15/12 and 5/23/13, dust was found throughout the areas of the kitchen.

An in-person interview was conducted with the Quality Manager, Staff #8, the afternoon of 10/30/2012. Staff #8 acknowledged that the findings of the Environment of Care forms filled out on 12/15/12 and 5/23/13 (2nd visit 6/5/13) should have been utilized as tools to improve the condition of the kitchen. Staff #8 acknowledged that the problems identified during the two walk-throughs had not been corrected as of the time of the tour on 10/28/13.

Based on observation, interviews with dietary staff, the facility failed to ensure that food and dietary organization requirements were met, as no polices were provided to the surveyor for work and food handling techniques and implementation of first-in first- out rotation system for all food supplies at all times; as there was unlabeled, undated, food in the freezers, prep refrigerators, storage closets in the dietary department and there was no evidence of stock rotation and unsanitary conditions.

Findings:

During a tour of the dietary department on the afternoon of 10/29/13, accompanied by facility staff # 1, 3, and 9 the following was observed.

Prep refrigerators against the left wall upon entering the dietary department; three fish fillets were observed on one of the shelves with no indication of when the fish was put there. Raw turkey patties, red peppers, salad vegetables (bag was unsecured, with some of the vegetables spilling out) and baked chicken were observed with no date open, available for immediate use.

Multiple containers of condiments mayo, mustard, salad dressings, olives, were observed open with no open date visible on the outside of the containers.

Two dishes of pesto identified by staff # 3 were observed unlabeled, not dated, plastic wrap did not form a complete seal covering the dishes thus exposing the pesto to the refrigerator elements.

Seven open unsealed, not dated bags of pasta, and rice, were in one container and the other two containers contained flour, and corn meal. The three containers were greasy to touch on the outside, with splatters and discolored particles appearing to be grease, food and dirt buildup on the outside of the containers.

Containers of barbecue sauce, ketchup, vinegars, and various condiments were observed on a small metal table across from the prep fridges next to three containers. The containers were open; looking at the outside of the containers heavy dark brownish blackish thick material was visible clinging to the insides of the containers. There was no date identifying when the containers had been open.

The three prep refrigerators contained two metal carts each inside the prep refrigerators, trays located in the carts inside the freezer carts contained greasy yellow brownish slimy substances in the corners and on the outside. The shelving in the carts was dirty, and greasy to touch.

Raw chicken legs and thighs was observed in a pan in the freezer that was wet, contained food crumbs, and greasy to touch with plastic wrap that was not sealed over the pan. No labeling was observed indicating how long the chicken had been there. Two rolls of ground beef were observed in pans containing red watery substance dripping down into the shelves below on the cart located in the refrigerator. The surveyor asked the why these meats where there. Staff # 3 stated, "The meats are defrosting for tomorrow meals." Three boxes of guacamole sauce, and a box of sausage, were open exposed to the freezer elements.

Uncooked mixed vegetables were observed in open plastic bags lying in pans which contained greasy, brownish, yellowish, substances in and outside of the pans on shelves inside the freezer. The shelves had what appeared to be food particles, and irregular spots splashes of unknown substances.

Trays located in the freezer carts contained greasy yellow brownish slimy substances in the corners and the outside. All of the carts shelves observed in the refrigerators and freezers were greasy to touch, food crumbs was observed on some of the shelves. The handles on the prep refrigerator doors were covered in black, yellow, brownish and greenish substance sticky to touch.

The rubber casing on the inside of the prep fridges, freezers, beverage coolers doors and covers of the ice machine contained black grimy thick substance with the consistency of tar, apprearing thick, black and oozing. The doors on the outside of the ice machine left a white powdery substance on the surveyors' hands after touching.

The floor corners inside the prep refrigerators and freezers contained a buildup of yellowish, brownish greasy, grimy substance that was sticky to touch, pieces of orange/green particles appearing to be vegetables and food crumbs was observed on the floors.

A black cart used was observed next to the freezer covered with whitish, grayish, powdery substance. Staff # 3 stated, "the cart is used to transport food received to the storage areas."

The exit door next to the ice machine was covered with blackish, grimy, and sticky to touch substance. The surveyor observed a 2 inch opening between the floor and the door, causing a potential for rodents, insects to enter into the dietary department.

There were several areas of the floor in the dietary department was wet and slippery. Water was observed dripping from the ice machine. A blue shovel was hanging on the wall opposite the freezer which was covered with black, grimy, and sticky residue. Staff # 3 stated, "The shovel is used to scoop ice."

Water was observed dripping from a pipe attached to the tilt skillet. The floors in the pots washing area were wet and slippery. Water was dripping from the garbage disposal. Celling and wall vents were observed to have dust hanging out of the vents. The vents were black, dark brown, greasy appearing. Celling light covers were yellow, greasy with black particles containing what appear to be insects. Gray color paint was observed peeling in several areas on the floor exposing the concrete.

Areas on the walls behind the prep refrigerators, coolers, freezers, stoves, prep lines, and the dish washer contained dirty, grimy, and greasy to touch residue. All wall and counter surfaces were greasy and/or wet to touch.

Pans and pots were observed on a metal cart which staff # 3 identified as clean, ready for immediate use. Seventeen prep trays and two stacks of baking pans were wet and sticky to touch. The inside of the pans and pots contained yellowish, brownish blackish substance. The substance on the outside of the baking pans appeared to be a buildup of burnt residue.

Black bowls were on the top shelf left a sticky blackish residue on the surveyor's hand. The surveyors ask staff # 3 again if these items are clean. Staff # 3 stated, "Yes they are supposed to be clean." All of the bake and cookware on the cart was greasy, grimy, containing dusty sticky residue. Cooking utensils were observed in metals square pans on the second shelf were watery and greasy to touch.

A large dead cock roach was observed on the floor between the cart and the wall.

Four stoves were observed against the wall across from the walk in prep refrigerator. The pilot lights were observed to be burning in the grill area. Opening the oven doors beneath the burners, card boxes, papers, rubbish were observed. The walls, doors, and the burners were covered with black hardened substance. The trays under the burners contain black, yellow, brownish greasy to touch, particles and pools of brown/black sticky liquid appearing to be grease. Staff # 3 stated, "We do not use these ovens." The grill located next to the stoves was hot. The tray below the grill burner contained a large amount of black, yellow, brownish greasy to touch, particles and pools of brown/black sticky liquid appearing to be grease.

Black, grimy substance was observed on the hand washing sink, and the back splash behind the sink. A green hose apparatus was attached to the wall near the sink, a sign was posted on the wall stating "eye washing." The top of the hose for the water to exit was covered with a white powdery substance.

The mixer was observed to have brownish sticky substance on the grate under the handle, when moving the handle dark flakes fell into the mixing bowl.

Review of the policy manual did not contain polices for food handling or food rotation. No policy was offered or provided to the surveyors indicating food rotation, labeling, covering of food and supplies at all times.

The findings were confirmed during the tour of the dietary department on the afternoon of 10/29/13 by staff # 1, 3 and 9.

Based on observation, interviews, and review of documentation, the facility Infection Prevention Officer failed to ensure implementation of infection control practices in that infection control practices were not adhered to in the dietary department causing a potential for food borne illnesses and transmissions of infections.

Findings:

During a tour of the dietary department on the Dietary Department at Park Plaza Hospital on 10/28/2013 at 2:45 pm with staff #3, #1, and #9 the following were observed.

Prep refrigerators against the left wall upon entering the dietary department; three fish fillets were observed on one of the shelves with no indication of when the fish was put there. Raw turkey patties, red peppers, salad vegetables (bag was unsecured, with some of the vegetables spilling out) and baked chicken were observed with no date open, available for immediate use.

Multiple containers of condiments mayo, mustard, salad dressings, olives were observed open with no open date visible on the outside of the containers.

Two dishes of pesto identified by staff # 3 were observed unlabeled, not dated, plastic wrap did not form a complete seal covering the dishes thus exposing the pesto to the refrigerator elements.

Seven open unsealed, not dated bags of pasta, and rice, were in one container and the other two containers contained flour, and corn meal. The three containers were greasy to touch on the outside, with splatters and discolor particles appearing to be grease, food and dirt buildup on the outside of the containers.

Containers of barbecue sauce, ketchup, vinegars, and various condiments were observed on a small metal table across from the prep fridges next to three containers. The containers were open; looking at the outside of the containers heavy dark brownish blackish thick material was visible clinging to the insides of the containers. There was no date identifying when the containers had been open.

The three prep refrigerators contained two metal carts each inside the prep refrigerators, trays located in the carts inside the freezer carts contained greasy yellow brownish slimy substances in the corners and on the outside. The shelving in the carts was dirty, and greasy to touch.

Raw chicken legs and thighs was observed in a pan in the freezer that was wet, contained food crumbs, and greasy to touch with plastic wrap that was not sealed over the pan. No labeling was observed indicating how long the chicken had been there. Two rolls of ground beef was observed in pans containing red watery substance dripping down into the shelves below on the cart located in the refrigerator. The surveyor asked the why these meats here are. Staff # 3 stated, "The meats are defrosting for tomorrow meals." Three boxes of guacamole sauce, and a box of sausage were open exposed to the freezer elements.

Uncooked mixed vegetables were observed in open plastic bags lying in pans which contain greasy, brownish, yellowish, substances in and outside of the pans on shelves inside the freezer. The shelves had what appeared to be food particles, and irregular spots splashes of unknown substances.

Trays located in the freezer carts contained greasy yellow brownish slimy substances in the corners and the outside. All of the carts shelves observed in the fridge, and freezers were greasy to touch, food crumbs was observed on some of the shelves.

Three white containers containing seven open unsealed, not dated bags of pasta, rice, flour, and corn meal were greasy to touch on the outside, with splatters and discolor particles appearing to be grease, food and dirt buildup on the outside.

The handles on the prep refrigerator doors were covered in black, yellow, brownish and greenish substance sticky to touch.

The rubber casing on the inside of the prep refrigerator, freezers, beverage coolers doors and covers of the ice machine contained black grimy thick substance with the consistency of tar appearing thick, black and oozing. The doors on the outside of the ice machine left a white powdery substance on the surveyors' hands after touching.

The floor corners inside the prep refrigerators and freezers contained a buildup of yellowish, brownish greasy, grimy substance that was sticky to touch, pieces of orange/green particles appearing to be vegetables and food crumbs was observed on the floors.

A black cart used was observed next to the freezer covered with whitish, grayish, powdery substance. Staff # 3 stated, "the cart is used to transport food received to the storage areas."

The exit door next to the ice machine was covered with blackish, grimy, and sticky to touch substance. The surveyor observed a 2 inch opening between the floor and the door, causing a potential for rodents, insects to enter into the dietary department.

There were several areas of the floor in the dietary department was wet and slippery. Water was observed dripping from the ice machine. A blue shovel was hanging on the wall which was covered with black, grimy, and sticky residue; opposite the freezer. Staff # 3 stated, "The shovel is used to scoop ice."

Water was observed dripping from a pipe attached to the tilt skillet. The floors in the pots washing area were wet and slippery. Water was dripping from the garbage disposal. Celling and wall vents were observed to have dust hanging out of the vents. The vents were black, dark brown, greasy appearing. Celling light covers were yellow, greasy with black particles containing what appear to be insects. Gray color paint was observed peeling in several areas on the floor exposing the concrete.

Areas on the walls behind the prep fridges, coolers, freezers, stoves, prep lines, and the dish washer contained dirty, grimy, and greasy to touch residue. All wall and counter surfaces were greasy and/or wet to touch.

Pans and pots were observed on a metal cart which staff # 3 identified as clean, ready for immediate use. Seventeen prep trays and two stacks of baking pans were wet and sticky to touch. The inside of the pans and pots contained yellowish, brownish blackish substance. The substance on the outside of the baking pans appeared to be a buildup of burnt residue.
Black bowls were on the top shelf left a sticky blackish residue on the surveyor's hand. The surveyors asked staff # 3 again if these items are clean. Staff # 3 stated, "Yes they are supposed to be clean." All of the bake and cookware on the cart was greasy, grimy, containing dusty sticky residue. Cooking utensils were observed in metals square pans on the second shelf were watery and greasy to touch.
A large dead cock roach was observed on the floor between the cart and the wall.
Four stoves were observed against the wall across from the walk in prep refrigerator. The pilot lights were observed to be burning in the grill area. Opening the oven doors beneath the burners, card boxes, papers, rubbish was observed. The walls, doors, and the burners were covered with black harden substance. The trays under the burners contain black, yellow, brownish greasy to touch, particles and pools of brown/black sticky liquid appearing to be grease. Staff # 3 stated, "We do not use these ovens." The grill located next to the stoves was hot. The tray below the grill burner contained a large amount of black, yellow, brownish greasy to touch, particles and pools of brown/black sticky liquid appearing to be grease.
Black, grimy substance was observed on the hand washing sink, and the back splash behind the sink. A green hose apparatus was attached to the wall near the sink, a sign was posted on the wall stating "eye washing." The top of the hose for the water to exit was covered with a white powdery substance.
The mixer was observed to have brownish sticky substance on the grate under the handle, when moving the handle dark flakes fell into the mixing bowl.
Review of Food and Nutrition services IC. 4.10 effective date was blank, revision date 1/10/2013 stated, " The food and nutrition services department maintains a sanitation program. Purpose: To maintain a clean, safe, and effective environment of care, and to prevent the transmission of disease carrying organisms. Procedure: The Executive chef with assistance from the supervisors and Sous chef monitors sanitizing scheduled and procedures. Equipment, walls, floors and storage areas are routinely cleansed with the appropriate sanitizing compounds. Reference local and state sanitation requirements to be in compliance."
During the tour of the Dietary Department at Park Plaza Hospital on 10/28/2013 accompanied by staff #3, #1, and #9, the findings were confirmed.