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Based on tour/observation, staff interviews and review of hospital documents, the facility failed to to ensure that all food preparation equipment, surfaces and shelving were appropriately cleaned and that all food was labeled, stored/refrigerated and discarded appropriately, in accordance with their policies/procedures and standards of practice for food handling. The facility also failed to ensure that all food preparation equipment, surfaces and shelving were appropriately cleaned in accordance with their policies/procedures.


Findings:

1. Food Services Department Tours/Observations with Concurrent Staff Interviews:
On 09/05/13 at approximately 2:00 p.m., the dietary department was toured with the supervisor of Dietary Services, the Lead Dietician and the Quality/Regulatory Compliance Coordinator. Observations and concurrent interviews with the staff were conducted throughout the tour.

Observations in the Food Services Department:
During the tour in the kitchens, the cooks' walk-in refrigerator was observed. The following, unlabeled, expired and improperly covered food items were stored in the refrigerator:
- A storage container of vegetable sauce was labeled to expire on 09/03, which was two days prior to the tour.
- A large plastic vat of meat-based stock that was dated 8/23, with a 5 day expiration date of 8/28, which was 8 days prior to the tour.
- A second plastic vat of what also appeared to be stock, but was not labeled as to contents, and did not contain an initial preparation date or an expiration/discard date. The large vats of stock were not in compliance with the department ' s infection control policy, requiring that foods be stored in shallow pans to reduce the cooling time to prevent bacterial growth. On the eye level shelf below the vats, the wire shelving was very dirty and coated with a thick tan substance that was dried, but it appeared that the substance had been repeatedly dripping and then dried on the underside of the wire racks. The observation was confirmed with the facility staff who were present on the tour.

- A metal pan of cooked vegetables with no label as to contents did not contain an initial preparation date or an expiration/discard date.
- A metal pan of un-cooked cinnamon rolls not dated.
- A 3-pack of cinnamon rolls, not dated.
- Open pan of tomato sauce, dated 09/04 that was partially covered with plastic wrap and open to airborne contamination.
- A second large container of raw salad vegetables, with no label as to contents and did not contain an initial preparation date or an expiration/discard date.

During the tour of the cooks' walk-in refrigerator, the dietary supervisor stated that the identified foods listed above were not in compliance with the department's policies/procedures for safe handling and labeling of food. All of the identified foods were removed from the walk-in and discarded during the tour. The supervisor also acknowledged that the dirty shelving below the stock in the walk-in should have been cleaned promptly when the spills/drips occurred, or were detected.

In the cooks' preparation area, a large metal tray contained what appeared to be bread crumbs. The tray was covered with plastic wrap, but had no label as to contents, and did not contain an initial preparation date or an expiration/discard date.
The supervisor confirmed that the tray of bread crumbs were not dated or labeled as required and the tray was removed to be sicarded.

In the same area a plastic bin containing uncooked rice was sitting on the floor under a counter. The bin had a dirty lid and the sides that appeared to be a long term accumulation of dust and spills.
The supervisor confirmed that the bin appeared not to have been cleaned recently, which was not in compliance with the department's policies/procedures.

There was a dark greasy substance covering the tile and grout underneath the lower ovens and food warmers. The gap between the ovens and warmers was dirty all the way back to the wall and on the side outer walls of the ovens/warmers. There was a dark thick substance that appeared to be an accumulation of old kitchen grease drippings and dust/dirt. When the ovens/warmers were opened up, the inner wall, floor and doors of the appliances were covered with baked-on food splatters and drippings that appeared to have accumulated over a long period of time.

The supervisor confirmed the observation in the own/food warmer area and acknowledged that the area appeared dirty, but stated that it was difficult to clean in those areas, because the equipment was never moved for easy cleaning

During a tour of the stock room shelving, two open packages of crispy rice cereal were found in two separate locations. One package was dated 4/23 and per the nutrition supervisor, the expiration date was 3 months or 90 days later, which would have been 07/23. The second package was dated 04/18 with an expiration date of 7/18.

During the tour of the stock room, the supervisor confirmed that the discard dated for open packages of cereal was 90 days and that the identified open packages were out of compliance with the department policy for a discard date..


2. Dietary Policy/Procedure Review:
On 09/06/13, the facility food and dietary policies and procedures were reviewed.

a) Review of the facility policy/procedure "Storage of Foods" revealed the following, in part:
"PURPOSE: To ensure all supplies are stored in a manner to prevent spoilage and bacterial contamination.
SCOPE: Nutrition Services Department
POLICY:
1. All food shall be stored and handled in a manner necessary to provide optimum protection against any bacterial growth or spoilage. The standards shall fulfill all state requirements set forth by state law for restaurant operation.
PROCEDURE: Foods not in containers of origin.
- Dating of Food: Dating schema will be for (3) Three Days, (5) Five Days, (7) Seven Days and for Dry Bulk items (30) thirty to (90) ninety days based on manufacturer's recommendations.
- All leftover cold food for storage in refrigerator is put into storage containers and completely covered with plastic or foil wrap. These are marked with the name of the item, the date used, and the date of disposal.
- All leftover hot food for storage is refrigerated in shallow pans. The food is first cooled then covered, marked and dated.

b) Review of the facility policy/procedure "Infection Control" revealed the following, in part:
"PURPOSE:
To summarize sanitation and infection control policies for the Nutrition Services Department.
SCOPE: Nutrition Services, Infection Control.
POLICY: Equipment
2. Safe Food Handling:
d. Foods should be stored in the refrigerator in shallow pans to expedite cooling. In containers of 2-, 5-, or 10- gallon capacity, only the outer surfaces of food will cool rapidly; the center portion will remain for hours at a temperature that will allow bacterial growth.
f. Leftover foods that are to be kept should be refrigerated in shallow pans immediately. Foods that have stood for several hours at room temperature cannot be considered safe and free from contamination, and cannot be made so by refrigeration. Foods left over after a meal are put into clean containers, covered, labeled, and dated and placed into the refrigerator immediately.
5. The kitchen food prep areas will be disinfected/cleaned daily by Nutrition Services personnel."

c) Review of the facility policy/procedure "Sanitation & Cleaning in Dietary Department" revealed the following, in part:
"PURPOSE: To keep everything in the Dietary Department clean and sanitary.
To outline procedures so that each employee knows his/her responsibility and the method used for cleaning.
SCOPE: Nutrition Services
POLICY:
All counters, carts, stoves, ovens, refrigerators, and other equipment are to be kept clean and sanitary so that food will not be contaminated during preparation.
Refrigerators - Walk-In:
Daily: 1. Wipe up anything spilled. "

d) Review of the policy "Floor Maintenance Procedures," which described the procedures for immediate clean up of spills and the requirement need for daily mopping of the kitchen floors, revealed no instructions for cleaning around and under the ovens and food warmers, to maintain the overall cleanliness and sanitation of that food preparation area.