HospitalInspections.org

Based on review of facility documents, observation and staff interview (EMP), it was determined the facility failed to ensure food for patient consumption was not expired in the dietary department and on the patient care units.

Findings include:

Review on July 15, 2021, of the facility's "Proper Labeling of Food" policy, last replaced October 16, 2020, revealed "Policy Statement: All foods must be properly labeled to keep items safe and prevent food borne illnesses. Purpose: To establish a written policy and procedure for the proper labeling of food which is vital for the safety and well-being of our patients and employees ...Procedure: ... Do not use any food past the expiration or use by date."

Review on July 15, 2021, of the facility's "Expiration Dates of Food Items" policy, last replaced July 20, 2020, revealed "Policy: All food items prepared and served are to represent the highest food quality standards regarding nutrition and patient acceptability. Purpose: To ensure that all food items are within the expiration dates. Procedure: 1. Expiration dates of food items will be identified and monitored by the Food Services Supervisor assigned to each kitchen area. ... 2. Any item found to have expired will be disposed of immediately. 3. The supervisor will notify and confer with the food manager on a timely basis to ensure preparations and services are not compromised if a food item has expired. ..."

Review on July 15, 2021, of the facility's "Purchasing, Receiving and Storage" policy, last replaced September 1, 2019, revealed "Policy: ... Food will be properly stored to preserve flavor, nutritive value, appearance and safety. ... Procedures: ... 2. ...b. All food items will be stored with first in/first out compliance. ..."

Review on July 15, 2021, of the facility's "HACCP Policy," last replaced October 1, 2019, revealed "Policy: All food purchased, prepared and served will be protected from physical, chemical and biological hazards. ...Definitions: HACCP (Hazard Analysis Critical Control Point) is a food safety system that focuses on the flow of food in a food service operation to reduce the risk of foodborne outbreaks. ... Purpose: ... Food Storage Procedure: 1. All food will be stored under safe, sanitary conditions, first in/first out in place, temperature/humidity will be monitored and recorded. ..."

1. Observation on July 15, 2021, of the dietary department revealed nine loaves of bread on the food service line. Four of these loaves of bread expired on July 5, 2021, and five of these loaves of bread expired on July 7, 2021.

Interview with EMP2 on July 15, 2021, at the time of the observation confirmed the four loaves of bread which expired on July 5, 2021, and the five loaves of bread which expired on July 7, 2021, on the food service line in the dietary department. EMP2 confirmed these loaves of bread were for distribution to patients.

Observation on July 15, 2021, of the walk-in refrigerator in the dietary department revealed a storage rack of bread. This storage rack had 12 loaves of bread with an expiration date of July 11, 2021. These loaves of bread were stored alongside four open and partially used loaves of bread with expiration dates of July 21, 2021.

Interview with EMP2 on July 15, 2021, at the time of the observation confirmed the walk-in refrigerator in the dietary department had a storage rack of bread which contained 12 loaves of bread which expired on July 11, 2021 and the four open and partially used loaves of bread with expiration dates of July 21, 2021. EMP2 confirmed the loaves of bread with the expiration date of July 11, 2021 were stored alongside the loaves of bread with the expiration date of July 21, 2021. EMP2 confirmed the facility was not following its established policy regarding first in and first out product usage.

2. Interview with EMP2 and EMP4 on July 15, 2021, at approximately 10:15 a.m. revealed perishable patient snacks, including milk, are stored in the refrigerator in the staff lounge on patient care unit 4.

Observation of the refrigerator in the staff lounge on patient care unit 4 on July 15, 2021, revealed an open and partially used container of milk which had an expiration date of July 13, 2021.

Interview with EMP2 and EMP4 on July 15, 2021, at the time of the observation confirmed the open and partially used container of milk with the expiration date of July 13, 2021.

3. Interview with EMP2 and EMP5 on July 15, 2021, at approximately 10:45 a.m. revealed perishable patient snacks, including milk, are stored in the refrigerator in the staff lounge on patient care unit 7.

Observation of the freezer section of the refrigerator in the staff lounge on patient care unit 7 on July 15, 2021, revealed two sandwich bags containing two slices of frozen bread in each sandwich bag. There was no date on these sandwich bags indicating when the bread was placed in the freezer and there was no date indicating when to discard the bread if it was not consumed. There was also a frozen container of milk with an expiration date of June 8, 2021.

Interview with EMP2 and EMP5 on July 15, 2021, at the time of the observation confirmed the freezer section of the refrigerator in the staff lounge on patient care unit 7 had two sandwich bags containing two slices of frozen bread each; there was no date indicating when the bread was placed in the freezer; there was no date when to discard this bread if it was not consumed and a frozen container of milk with an expiration date of June 8, 2021.