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Based on observation, staff interview, facility record review, and policy review, the facility failed to ensure that outdated medications would not be available for patient use for 1 of 2 sampled emergency carts and 1 of 1 sampled patient-use medication carts located in the Medical Services Unit (MSU).

The findings are:

An observation was conducted on 6/7/16 at approximately 11:45 AM of the patient medication cart. An audit of stock medications in the patient use medication cart revealed 2 expired vials of injectable furosemide 10 mg/mL (milligrams/ milliliter). Expiration dates on the two vials were 2/2016.

An observation was conducted on 6/8/2016 at approximately 8:45 AM of the emergency cart in MSU. Expired medications and Intravenous fluids were observed in the cart. The expired items included: 5 bottles of injectable Heparin 5000 units/mL which expired 5/2016, 2 single dose bottles of injectable Naloxone 0.4 mg which which expired 5/1/2016, 4 bottles of injectable adenosine 12 mg/4mL ,which expired 4/2016, 1 bottle of injectable solumedrol 125 mg per vial which expired 04/2016, and two 1,000 mL bags of 10% dextrose intravenous (IV) fluids which expired 3/2/2016.

On 6/7/2016 at approximately 1:30pm, an interview was conducted with employee Y, Registered Nurse (RN). The nurse confirmed the expired dates of the two vials of furosemide on the patient medication cart.

On 6/7/2016 at approximately 08:45AM, an interview was conducted with the employee Z, RN. The RN verified the indicated medications and IV fluids from the emergency cart were expired. The RN stated nightshift nurses check expiration dates of cart medications, fluids, and supplies each month per facility policy. She stated apparently the night shift had not been doing their job very well. The nurse confirmed that the crash cart log on the clipboard was the most recent log available.

On 6/8/2016 at approximately 08:45 AM, a review of the most recent MSU emergency crash cart log revealed dates of medications and supplies in the crash cart that were expired as of 6/7/2016. Items include: solumedrol (4/2016), IV start kits (4/2016), NTG ointment( 1/2016), Narcan (5/2016), aminophylline (5/2016), hemostats (3/2016), 7.5 millimeter cuffed endotracheal tube (3/2016), dextrose 10% 1,000 mL bag(3/2016), and Quik Combo (4/16 and 5/16).

A review of facility policy 'Emergency Medical Procedures' section 8 B revealed the emergency cart shall be checked monthly for contents' expiration dates and for replenishing supplies. A review of facility policy Guidelines for the 'Administration of Medication' Section II 10 revealed medications shall never be used that are expired and shall be returned to the pharmacy.

Based on observation and interview, the hospital failed to ensure proper operation and maintenance of dietetic equipment by failing to ensure that the primary outside freezer door was maintained or replaced to ensure proper functioning of the freezer and sanitary storage of food products for 1 of 2 freezers in the kitchen.

The findings are:

On 6/7/16 at approximately 2:00pm a tour of the facility's kitchen was conducted with the kitchen manager.

Observation of the facility's main freezer, located outside of the kitchen revealed that the door to the freezer was visibly warped and the rubber seal around the door was in severe disrepair. When the kitchen manager opened the door to the freezer by pulling outward, the door was heard scrubbing the cement floor. Once opened, the entry to the freezer was observed to be covered in a significant layer of icy slush. The freezer was rather large and contained a large amount of boxed, frozen foods. The ceiling of the freezer was observed with a large amount of condensation build-up. This condensation was observed to cover the entire freezer ceiling and was randomly dripping down on the boxes of food contained within the freezer to the extent that the drops would fall on you as you walked through the freezer. Most of the cardboard boxes had a significant amount of damage to them from the dripping water.

Observation of box contents revealed that some of the boxes contained food products packaged in plastic bags and had not been contaminated by the non-potable water dripping from the ceiling of the freezer. Other boxes contained within the freezer were observed to have bags of fries in them that were in brown paper type bags. These bags had also been saturated by the dripping water and the food product contained within was contaminated by the dripping non-potable water.

The freezer was also observed to contain several large chunks of ice under the fan unit. One large block of ice was observed to be sitting on top of a card board box labeled as containing food products.

Interview conducted with the kitchen manager on 6/7/16 at approximately 3:00pm revealed that the door to the freezer was causing the conditions within the freezer. She stated that the door had been worked on numerous times and that the facility was in the process of getting a new door.

An interview was conducted with the kitchen manager both during and after the initial tour of the kitchen on 6/7/16 between approximately 2:00pm and 3:15pm. She confirmed that the freezer had been in a state of disrepair and that there had been numerous work orders submitted for its repair. She stated that maintenance had been done on the freezer door; however, at that point the plan was to purchase a new freezer door but stated she was not sure when that would occur. She also confirmed that an audit of the freezer would be conducted the following morning and all contaminated products would be disposed of so that they were not available for use.

Based on observation and interview, the dietetic department failed to store and prepare food in a sanitary manner during 1 of 2 kitchen observations.

The findings are:

On 6/7/16 at approximately 2:00pm a tour of the facility's kitchen was conducted with the kitchen manager. The kitchen is immense with multiple sections designated for various kitchen operations. During the tour, observations showed that one of the staff handwashing sinks in the dishwashing area did not have a trash container for disposal of paper napkins used for staff to dry their hands. Another handwashing sink in one of the food preparation areas was observed with a foot pedal operated lid that was not functioning and the trash container was unable to be opened without using your hands to open the trash container's lid which would lead to recontamination.

Observation of tray line services was also conducted and revealed a cart parked next to the tray line conveyor belt that held multiple food items for tray service. Trays were being assembled for the breakfast meal. On the cart were several small round plastic containers. Some of the containers had lids on them and some of the containers were open and food items within were exposed. The staff member in charge of the cart stated that the open containers were from a previous meal and were not for use, but had not been disposed of.

In the rear of the kitchen, there was a large area used for baked goods. The area was not in use at the time of the observation; however, there was a large fan observed standing on a stand to the side of the food preparation area that had a significant amount of dust observed on the cage that encloses the fan blades.

Observations were also conducted of the kitchens numerous coolers and freezers.

Cart Cooler: this refrigerated area was located off to the side of the food production area where food is placed on trays and trays are loaded onto carts that once full are pushed into this cooler for storage until ready to send to the units. There was a small area at the front of this cooler that the kitchen manager stated was the snack holding area. On one of the shelves in this snack holding area, there was a tray of bread observed with another tray stacked on top of it that was holding a fully cooked turkey breast wrapped in plastic that was defrosted and had dripped some water onto the bags of bread below it.

Bakery Cooler: There were two fans observed to be installed towards the ceiling inside of the refrigerated area. These fans had visible dust and dirt particles on them and the fans were blowing air through the cooler. There was food (cooked and raw) stored in the cooler.

Outside Freezer: The door to the freezer was visibly warped and the rubber seal around the door was in severe disrepair. When the kitchen manager opened the door to the freezer by pulling outward, the door was heard scrubbing the cement floor. Once opened, the entry to the freezer was observed to be covered in a significant layer of icy slush. The freezer was rather large and contained a large amount of boxed, frozen foods. The ceiling of the freezer was observed with a large amount of condensation build-up. This condensation was observed to cover the entire freezer ceiling and was randomly dripping down on the boxes of food contained within the freezer to the extent that the drops would fall on you as you walked through the freezer. Most of the card board boxes had a significant amount of damage to them from the dripping water. Observation of box contents revealed that some of the boxes contained food products packaged in plastic bags and had not been contaminated by the non-potable water dripping from the ceiling of the freezer. Other boxes contained within the freezer were observed to have bags of fries in them that were in brown paper type bags. These bags had also been saturated by the dripping water and the food product contained within was contaminated by the dripping non-potable water.

The freezer was also observed to contain several large chunks of ice under the fan unit. One large block of ice was observed to be sitting on top of a card board box labeled as containing food products.

Interview conducted with the kitchen manager on 6/7/16 at approximately 3:00pm revealed that the door to the freezer was causing the conditions within the freezer. She stated that the door had been worked on numerous times and that the facility was in the process of getting a new door.

An interview was conducted with the kitchen manager both during and after the initial tour of the kitchen on 6/7/16 between approximately 2:00pm and 3:15pm. The kitchen manager acknowledged that one of the employee handwashing sinks was missing a trash container for disposal of paper napkins and confirmed that the other trash container observed was in fact not functional. She further stated that she was not sure why the food items not being used for the meal that was currently being assembled would be on a serving cart that she stated was the entrée station and stated that the containers should have been disposed of and not left on the cart. She stated that the dusty fan observed at the back of the kitchen in the bakery area was not used during food preparation and was only allowed to be turned on during the clean-up process but did acknowledge that the fan was dusty. She also confirmed all findings within the facility coolers and outside freezer. She stated that she would have all issues corrected and would dispose of all contaminated food products within the outside freezer