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Based on observation, policy review, sanitation inspection review and interview, it was determined the facility failed to ensure the Food and Dietetic Service requirements for kitchen sanitation and integration of the kitchen into the hospital wide Infection Control Program were met. The failed practice had the potential to affect all patients receiving food or nutritional supplements from the kitchen. Evidence follows:

A. At 1000 on 11/10/10, a tour of the cafeteria and patient food service kitchen was conducted with the Executive Director of Nutritional Services and the Director of Accreditation and Regulatory Compliance. A sugar scoop was setting on top of a dirty sugar container. The coke refrigerator by the milk box had a paper cup behind it. The paper cup contained liquid with a dead bug floating in it. Food and used paper products were also observed behind the coke refrigerator. The door tracks for the sliding door on the counter behind the salad bar were filled with food crumbs and a sticky substance. The condiment board on the salad bar was badly chipped and could not be sanitized. The posts on the food bar were covered at the bottom with dust and food buildup. Behind the cafeteria, a heavy metal door was off the hinges, barring the area from being cleaned. Food and dirt were observed on the floor behind the door. In the same area, refrigerator racks were lying on the floor.

The dirty dish area contained clean dish cloths stored under the dirty dish area. The dish cloths had food crumbs on them. A huge amount of grease, food and dirt covered the entire outside of the garbage disposal. In an area between the food preparation and dirty dish area, a rusty broiler rack, fryer pans, an old rubber tube and clean plastic bags were observed stored together.

Clean cookie sheets were stored on a cart at the end of the dirty dish area with dirty cookie sheets stacked on top of them. Five racks of clean dishes, food containers, pots and pans were stored immediately behind the dirty dish area. The separation between the areas was low enough for splashing of dirty water and food onto the clean dishes. Observation of the clean dishes and pans revealed food crumbs and dirty water on dishes and/or pans on each of the five racks.

Two old black, moldy banana peels and food crumbs were observed behind the air duct. All sugar, flour and meal bins in the kitchen were covered with food and grime. A black piece of food, which looked like a piece of potato, was observed inside a flour bin which was left uncovered. Cornbread mix and breading mix were stored unsealed in the kitchen. A dirty rubber mat was observed lying on top of a flour bin. Mildew or mold was observed on the ceiling in the cooking area.

In the patient nourishment area, paint was observed peeling off the ceiling and clean linens were stored uncovered. A dead roach was observed on the floor. A box of Ensure nutritional supplement was stored on top of a trash can. An employee coat was stored in the nourishment room.

The back door to the dock would not close completely. There was a two-inch opening between the doors for rodents and pests to enter.

An overflow room next to the back door had boxes stored all over the floor and several ceiling tiles were missing, providing entry for pests and rodents. Peeling paint, an un-flushed toilet and an uncovered overflowing trashcan were observed in the women's restroom by the back door.

Men's and women's restrooms were observed in an alcove just off the kitchen. In the men's restroom, a towel dispenser was on the floor, the trash was overflowing and there were dirt and food crumbs in the threshold of the door. In the women's restroom the towel dispenser was hanging open and a large amount of dust and grime was observed on the inside of the dispenser. The alcove between the restrooms was adjacent to the kitchen. The overhead light was out and the area contained two dirty trash cans and a mouse trap.

B. Review of Food Service Policies and Procedures revealed the entire section for Infection Control Policies was missing.

C. Review of the Sanitation Inspections Policy, revised 03/99, revealed Supervisors were responsible for verifying cleaning tasks were completed and signed off daily. The Supervisors were to conduct daily 21-step sanitation inspections in the cafeteria and the kitchen. Managers were to conduct weekly sanitation inspections. Copies of the sanitation checklists were to be stored in a binder and kept for one year.

Cafeteria and kitchen sanitation checklists for the previous three months were requested. Four days of cafeteria sanitation checklists and zero kitchen sanitation checklists were provided. The Director of Nutritional Services confirmed at 1245 on 11/10/10 there were no more sanitation checklists.

D. The Executive Director of Nutrition Services stated during interview at 0850 on 11/10/10 a cleaning company came in once a week for deep cleaning, but agreed they were not doing their job. He stated they came at night and an employee let them in, but there was no one present when the cleaning company finished and left. The hospital failed to provide evidence the work done by the cleaning company was monitored.

E. The hospital failed to provide evidence the food service was integrated into the hospital-wide Infection Control Program. This was confirmed by the Director of Nutrition Services during interview at 1245 on 11/10/10.