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Based on record review and staff interviews during the recertification survey the facility failed to ensure that the patient or the patient representative received the standardized Medicare Notice within two (2) days of admission or the advanced discharge notification for five (5) of fifteen (15) discharged records reviewed (Patients #20, #21, #25, #32 and #44).

Findings:

Review of the medical records for Patients #20, #21, #25 and #44 revealed the patients' "An Important Message (IM) from Medicare" form was not signed by the patient or patient representative and there are no signatures for the advanced "Notice of Discharge."

Review of the medical record for Patient #32 revealed the IM was signed by the patient's daughter on admission, but there was no signature on the Notice of Discharge.

This was confirmed with facility's staff during the onsite visit.
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Based on observations and interviews the facility'sDirector of Food Services did not ensure that kitchen sanitation standards were adhered to at all times.

Findings:

a) Food contact surfaces on dietary equipment were not maintained clean. On 5/24/10 at 10:30AM, a heavy build up of pink colored slime was noted on the food contact surface (i.e., ice chute) of an ice machine in the kitchen dry goods storage room. Concurrent interview with the Director of Food Services indicated the machine would be immediately cleaned.

b) Non-food contact surfaces of dietary equipment were not maintained clean. On 5/24/10 at 10:23AM, a heavy build up of dust was noted on the ceiling of the "Ramp-up" walk-in cooler. Concurrent interview with the Director of Food Services indicated the walk-in cooler would be immediately cleaned.

c) Food that was displayed in the Cafeteria was not always protected from possible contamination. On two (2) occasions (i.e., 5/25/10 during lunch service and on 5/27/10 at 7:40AM) food items (i.e., chicken strips & pasta on 5/25 and hash browns on 5/27) were noted displayed in an open front unprotected service container.

d) Hand washing stations used by food service personnel were not properly equipped. On the morning of 5/24/10, it was noted that three (3) of three (3) hand washing lavatories in the kitchen area (e.g., vicinity dietary office, designated male toilet room) were not provided with a nailbrush.

Food and Drug Administration (FDA) Food Code