HospitalInspections.org

Based on observation, interview and review of documentation, the hospital failed to have organized dietary services, directed and staffed by adequate, qualified personnel as evidenced by:

* The Dietary Director failed to follow facility policy as well as basic cleanliness and food safety standards by not maintaining a sanitary food preparation area, not ensuring that dietary equipment was in proper working order, not guarding against contamination of food products and not properly rotating food stock (cross refer to A0620)

Based on observation, interview and a review of documentation, the hospital failed to employ a full-time director of the food and dietetic services who was responsible for the daily management of the dietary services.

Findings were:

A tour of the kitchen was conducted on the afternoon of 2-13-19. Staff #3 (COO) and staff #15 (Dietary Director) accompanied the surveyor on the tour.

* Staff #15 was asked to demonstrate operation of the dishwashing machine in order to observe the wash/rinse cycle water temperatures and the ppm [parts per million] sanitizer concentration. Staff #15 ran the machine and reached on top to obtain a sanitizer test strip from a stack of 2-3 tests strips loose, on top of the machine. The sanitizer test strip indicated a negative result after the sanitizer was added. Staff #15 was asked to obtain a test strip from the appropriate bottle of strips. Staff #15 produced a shattered, plastic bottle marked "chlorine test papers" that had no lid. Staff #15 was asked to obtain an intact bottle. After opening a fresh, sealed bottle of test strips, staff #15 was again asked to run the machine and test the sanitizer concentration. After 3-4 additional runs with negative sanitizer test results, the tubing was traced to a 5-gallon plastic bucket that contained approximately 1 tablespoon of sanitizing solution in the bottom of the bucket. In an interview with staff #15, staff #15 was asked how long the machine had been running without sanitizer and staff #15 stated that the sanitizer cycle tested positive for the appropriate 100 ppm of sanitizing concentration during a machine load run after lunch.

A document for the temperature of the dishwasher rinse cycle was hanging on the wall in the dish room. The document stated "If rinse cycle temperature is below 125 degrees F[ahrenheit] for more than 2 rinse cycles, notify Dietary Manager or Maintenance immediately. If rinse cycle temperature is below 120 degrees F[ahrenheit], notify Maintenance before using dishmachine." For the 38 loads recorded thus far in the month of February, 30 of the 38 temperatures had been listed as less than 120 degrees. There was no indication that maintenance had been notified.

* In the dry goods storage area, a bottomless, wooden pallet measuring 23" x 31" was on the floor near the door. Dry goods were stacked on top of the pallet. An inspection of the floor under the pallet revealed a dried, sticky substance, numerous sweetener packets, a layer of food debris and dead insects.

* In the dry goods storage area, 2 of 2 glass jars of Heinz Homestyle Gravy (each 18 oz) and 1 of 1 can of chicken breast (10 oz) bore no date indicating the date it arrived at the facility.

* In the dry goods storage area, boxes were stacked on shelves and were within 11" of the ceiling.

* In the dry goods storage area, 12 external shipping boxes were noted. External shipping boxes can transport bacteria and dirt into the facility.

* In the dry goods storage area, 12 dented cans were found, still available for use.

* In the walk-in refrigerator, 9 sheet pans of raw bacon were stacked on top of each other, with the underside of each pan sitting against the raw bacon in the pan underneath it. Stacking the uncovered pans contaminates the food in the pan with organisms on the underside of the other pans.

* In the walk-in refrigerator, 3 5-lb bags of ground beef were sitting in a sheet pan, thawing on the bottom shelf of the refrigerator. Kitchen towels had been placed on the sheet pan under the bags and were soaked with blood. When asked why the towels were bloody, staff #15 stated that one of the bags must have a hole in it. A hole in a bag of ground beef would allow a portal of entry for bacteria and other contaminants.

* During a tour of the walk-in refrigerator, a clamshell container of lettuce bore an expiration date of 2-7-19 but was still available for use.

* During a tour of the walk-in refrigerator, the following items were noted: a 51-quart tub of undated, wilted leaf lettuce; 2 heads of cabbage with brown leaves; several stalks of celery with dirty, brown ends; a plastic tub containing 2 bags of red grapes sitting in a wet, sticky substance at the bottom of the bin. None of the items listed above bore a date indicating when they had been received into the facility or how long they could be safely consumed.

* During a tour of the walk-in refrigerator, 6 external shipping boxes were noted.

* During a tour of the walk-in refrigerator, a half-gallon of half & half had been opened but had not been opened to indicate the date on which it had been opened.

* During a tour of the walk-in refrigerator, 4 cans of expired biscuits were found. 1 can had expired on 11-18-18 and the other 3 cans had expired on 12-9-18.

* During a tour of the walk-in refrigerator, a zippered bag containing a thick, creamy, white substance was found. The bag was not labeled as to its contents and was dated 1-18. In an interview with staff #15, staff #15 stated that the bag contained mayonnaise.

* During a tour of the walk-in refrigerator, a plastic container was found, covered in plastic wrap. On the plastic wrap was written "shrimp sauce". There was no indication as to the date the sauce had been more or on what date it needed to be discarded.

* During a tour of the walk-in refrigerator, the floor was noted to be covered in a sticky substance. In an interview with staff #15, staff #15 stated that the floor in the walk-in refrigerator was mopped weekly. Staff #15 stated that something must have been spilled on the floor since it was most recently mopped.

* During a tour of the walk-in refrigerator, a metal container was found, covered in plastic wrap. The container appeared to contain a tomato-based product. On the plastic wrap was written "hot sauce" with the dates 2-11-19 and 2-23-19. When asked how long a tomato-based product should be kept before discarding it, staff #15 stated "about 7 days".

* During a tour of the general dietary area, 4 skillets were being stored under the hot food serving line. 1 skillet measured 12 ½" across and the other 3 skillets measured 14 ½" across. All 4 skillets were coated in a thick, greasy substance. The area under the hot food serving line contained visible crumbs and other debris.

* During a tour of the general dietary area, the drawer under the microwave shelf contained a thick coating of crumbs and other food debris in the drawer tracks.

* During a tour of the general dietary area, 2 of 2 "front" ovens were soiled inside and contained caked-on debris.

* During a tour of the general dietary area, the underside and whisk attachment of the "little mixer" contained hardened spots of substance that appeared to be splattered food.

* During a tour of the general dietary area, the underside of the "big mixer" contained hardened spots of substance that appeared to be splattered food.

* During a tour of the general dietary area, the exterior of the "robot coupe" blender/food processor contained hardened spots of substance that appeared to be splattered food.

* During a tour of the general dietary area, 1 of 2 of the handles on the Cambro® insulated food cart was broken. A length of rubber tubing had been tied to form a band and the band was looped around both doors to keep the broken door closed. Without the doors closing and properly latching, food cannot be delivered at the proper temperature and thereby encouraging bacterial growth.

* During a tour of the general dietary area, an approximate 4" gap around a "chase" was observed in the ceiling, allowing a portal of entry for dust, insects and vermin. The chase was located over a food preparation/cooking area.

Facility policy titled "Food Sanitation" states, in part:
"Food is essential in promoting and maintaining health. If proper precautions are not taken, food may also serve as a carrier for disease-producing organisms, bacterial poisons, or poisonous chemicals.
...
G. Dry Storage:
1. The dry storage area should be equipped for the orderly arrangement of stored items; it should be protected from dirt, dust, insects, and rodents, as well as sewage backflow and drippage.
Transportation
A. All potentially hazardous food shall be kept at 41 degrees F[ahrenheit], or below, or 140 degrees F[ahrenheit], or above, during transportation."

Facility policy titled "Housekeeping and Sanitation" states, in part:
"Policy: The Dietary Manager will be responsible for preparing daily and weekly cleaning schedules, and for ordering and maintaining cleaning supplies and tools. Routine care of the floor in the cafeteria and the entire kitchen area, as well as light fixtures, will be under the direction of the Dietary Manager.
Purpose: To ensure that the kitchen is clean and sanitary.
Procedure:
1. Dietary Manager will prepare daily and weekly cleaning schedules.
...
4. Dietary personnel will be responsible for the care of the floor in the cafeteria and the kitchen area, as well as the light fixtures.
...
Equipment:
Cutting Boards, Containers, Utensils, Grinders, Mixers, Other Appliances:
...
3. Food grinder, chopper, mixer, slicer, blender and other appliances shall be disassembled, cleaned, rinsed and sanitized, dried and reassembled after each use.
Dishwasher:
...
3. Shall maintain a final sanitation rinse of 125 degrees F[ahrenheit] and wash water of 125 degrees F[ahrenheit] or more Sanitizer is injected automatically into the final rinse at a dilution of 50 ppm-100 ppm.
Refrigeration:
1. Shall be kept in a clean and sanitary condition through regular cleaning.
...
4. All foods that have been prepared for service shall be covered, dated and discarded after three (3), if not used.
Non-food contact surfaces of equipment:
a. Clean on a regular basis to keep surfaces free of accumulation of dust, dirt, lint food particles and other debris.
Floors:
a. Wet-mop daily and as required per housekeeping policy.
Storage areas for food:
a. Clean on a regular basis.
Mixers, blenders, grinders, slicers:
a. Clean after each use. Disasemble as necessary, wash with pots and pans and sanitize, dry [and] reassemble.
Ovens:
a. Weekly or as needed. Clean inside surfaces using oven cleaner designated; following manufacturer's directions rinse."

Facility policy titled "Infection Control Practices" states, in part:
...
3. Storage areas shall be adequate, cleaned and sanitized thoroughly weekly. Adequate ventilation shall be provided in all storage areas.
4. All refrigeration units shall be cleaned and sanitized thoroughly weekly. Spills will be cleaned up immediately.
5. At this facility, the ware washer equipment uses the chemical sanitizer function. Wash and rinse temperature maintained at 125 degrees F[ahrenheit].
...
7 ...Food stored in opened original containers must be covered and dated."

Facility policy titled "Washing of Dishes and Utensils" states, in part:
"Policy: Dishes and utensils shall be washed in a manner which will remove food particles and reduce bacterial count, some of which may be disease organisms.
Purpose: Infection control
Procedure:
1. Follow manufacturer's directions for operation and care of dish machine. Water pressure will be strong enough to thoroughly clean dishes. Wash and rinse water temperatures shall be maintained at least 125 degrees throughout operation.
...
4. ...The Sanitizing solution must be able to sanitize dishes at a minimum temperature of 125 degrees."

Facility policy titled "Storage of Utensils and Dishes" states, in part:
"Procedure:
1. Cleaned and sanitized utensils and equipment shall be stored at least 6 inches above the floor in a clean, dry location in a way that protects them from contamination by splash, dust and other means."
Facility policy titled "Food Storage" states, in part:
"At all times, food shall be protected from potential contamination including, but not limited to dust, insects, rodents, flooding, drainage, overhead leakage or condensation. Proper temperatures will be maintained in all areas."

The above was confirmed in an interview with the CEO and other administrative staff on the evening of 2-13-19.