HospitalInspections.org

20021

REPEAT DEFICIENCIES

Based on staff interview, document review and observations made during a tour of the kitchen, it was determined that the facility failed to ensure compliance with the New Jersey State Sanitation Code: "Sanitation in Retail Food Establishments and Food and Beverage Vending Machines (Chapter 24)" of the New Jersey State Sanitary Code N.A.A.C.P. 8:24 and failed to ensure management of dietary services was provided in accordance with the job descriptions of both the Director of Food and Nutrition Services and the Food and Nutrition Services Assistant Director of Clinical & Patient Services.

Findings include:

Reference #1: The Director of Food and Nutrition Services job description states, "Plans and directs the activities of the department to assure quality service of food to patients, staff, and visitors...Maintains a sanitary, safe and efficient operation in accordance with federal, state, and local health regulations, and all standards as set forth, by The Joint Commission(TJC)...Reviews and revises departmental policies and procedures, and ensures compliance with established policies and procedures."

Reference #2: The Food and Nutrition Services Assistant Director - Clinical & Patient Services job description states, "Plans, directs the activities for menu processing, meal assembly, distribution and delivery to ensure quality service of food to all patients at all stages of the meal delivery process. Develops, coordinates and revises the nutritionally balanced patient menu cycle as necessary to enhance patient satisfaction...Plans, coordinates, implements and manages the delivery of Clinical Nutrition Services to all Inpatient Units,..and maintains a sanitary, safe and efficient operation of inpatient and ambulatory nutrition services in accordance with Federal, State, & Local health regulations... "

Reference #3: NJAC 8:24-3.3(c) states, "Separation, packaging and segregation requirements for packaged and un packaged food include the following: Food shall be protected from cross contamination by Separating raw animal foods from any ready-to-eat foods during storage, preparation, holding..."

Reference #4: NJAC 8:24-3.3(d) states, "Working containers holding food or food ingredients that are removed from their original packages for use in the retail food establishment, such as cooking oils, flour, herbs...shall be identified with the common name of the food, except that containers holding food that can be readily and unmistakably recognized..."

Reference #5: NJAC 8:24-4.6(c) states, "Non food-contact surfaces of equipment shall be kept free of an accumulation of dust, dirt, food residue and other debris."

Reference #6: NJAC 8:24-6.2(a) states, "The floors, floor coverings, walls, wall coverings and ceilings shall be designed, constructed and installed so that they are smooth and easily cleanable..."

Reference #7: NJAC 8:24-6.5(a) states, "The physical facilities shall be maintained in good repair."

Reference #8: The Menu Modification policy and procedure states, "Procedure: Diet prescriptions are faxed down from each nursing unit to the diet Office. Faxed information is then transcribed into each patients electronic card file utilizing CBOARD's designated abbreviations. A menu will be printed for each patient (except for those on pediatric formula, liquid, mechanical soft, pureed, NPO and tube feeding/supplements only diets). Menus will be delivered during the breakfast meal service. Patients will make their menu selections for lunch and dinner for that day and breakfast for the following day. Menus will be retrieved by the assigned Nutrition Care Assistant, Diet Control Assistant and/or Food Service Worker and selections will then be entered into electronic card files as assigned.

Reference #9: The Nonspecific Diet Orders policy and procedure states, "Policy: Diet Orders containing relative or general descriptions of the diet will be interpreted and processed by the Food and Nutrition Services Department until more specific orders are written by the physician. The Registered Dietitian will contact the physician within 24 hours to write a specific Diet Order. ...Procedure: ...3. The dietitian will contact the physician within 24 hours to clarify the specific diet prescription for nonspecific order."

1. During a tour of the main food services kitchen, on 9/29/11 from 11:15 AM to 11:50 AM, in the presence of Staff #9, Staff #10 and Staff #11, and a tour of the patient care unit on 9/29/11 from 12:20 PM to 12:45 PM in the presence of Staff #9 the following observations were made:

a. In the mechanical ware washing room located in the main food services kitchen, there was a broken tile located adjacent to the mechanical ware washer creating an uneven surface. The floor was not maintained as required in Reference #6 and #7.

i. There was a ceiling tile missing directly above the mechanical ware washer and above the end of the mechanical ware washer rack holder. Also, there was a ceiling tile with a brown stain above the mechanical ware washer. The ceiling tiles were not maintained as required in Reference #6 and #7.

b. There were four large trays of raw chicken, each tray partially covered with a piece of parchment paper. The raw chicken was open and unprotected on all sides of the trays. The raw chicken was not protected from cross contamination, as required in Reference #3.

c. There was a brown colored liquid in a container in the main kitchen walk-in refrigerator that had no label to identify the contents as required in Reference #4.

i. Upon request on 9/29/11 at 11:50 AM, Staff #9 was unable to show evidence of a policy and procedure related to the storage of food items and the identification of food items not being stored in the original container. Refer to Reference #3 and Reference #4.

d. On 9/29/11 at 11:25 AM, it was observed on the 'Bally Walk-In' refrigerator located in the main kitchen area, on the right side of the wall was a pipe that had a build-up of condensation, and white and black residue on the outer surface of the taped pipe. The pipe that had black tape wrapped around it was not maintained as required in Reference #5.

f. Upon review of Medical Record #10 in the presence of Staff #9 on 9/29/11, the initial nutrition assessment dated 9/27/11 did not address the non-specific prescriber's diet order dated 9/24/11 "low phosph diet" and 9/25/11 "low phosphorus diet." There was no evidence that the dietitian contacted the physician within 24 hours to clarify the low phosphorus diet order as required in Reference #9.

i. On 9/29/11 at 12:35 PM during lunch meal observations in Room #217, the meal ticket on the lunch tray for Patient #10 showed no evidence that low phosphorus was included in the dietary restrictions. Staff #9 stated that the meal had been modified to include a low phosphorus diet. Upon request Staff #9 was unable to show evidence that the lunch meal had been modified to include a low phosphorus dietary restriction for Patient #10. Refer to Reference #8 and #9.

ii. Upon review, the facility "NONSPECIFIC DIET ORDERS" policy did not include an interpretation of a low phosphorus diet.

g. On 9/29/11 at 12:20 PM during lunch meal observations in Room #210, it was printed and circled on the lunch meal ticket for Patient #12 that the 1.8 GRAM SODIUM, LOW CHOLESTEROL lunch meal was to include a macaroni salad. However, the lunch meal tray did not include macaroni salad and there was no reason noted on the lunch meal ticket as to why this item was not included on the lunch tray. There was no evidence that the lunch meal was provided to Patient #12 in accordance with Reference #8.