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A. Based on review of Hospital policy, Food Safety Product Labeling & Dating Guide, observation, and staff interview, it was determined that for 1 of 1 Dietary department, the Hospital failed to ensure proper storage and labeling of food products.

Findings include:

1. The Hospital policy titled, "Food Storage," revision date 12/2001, was reviewed on 10/4/11 at approximately 1:00 PM. The policy included, "1. ... foods are stored on shelving at least 6 inches off the floor ... 3. Stock is rotated so that old items are used first. Products are dated to assure that a first in first out procedure is followed....5. When opening cases, contents must be checked for condition (no dented, swollen or rusted cans)."

2. The "Food Safety Product Labeling & Dating Guide," revised 8/2009, was reviewed on 10/5/11 at 9:00 AM. The guide included, "Purchased, read-to-eat food removed from original container - Product storage label - Date of preparation and/or use-by-date..."

3. During a tour of the Dietary department on 10/4/11 between approximately 9:45 AM and 11:45 PM, the following was observed:

At 10:15 AM in the dry food storage area:
- One large kidney bean, two large tomato paste and two large pineapple tidbit cans were dented and on the shelf for use.
- all can products on the shelves were undated.
- a case of fresh bananas was stored on the floor

At 10:45 AM in the small floor freezer unit:
- undated and opened bags of hash browns, french fries and Tatar tots. The contents of the opened bags had spilled out into the freezer.
- undated, unopened and unlabeled bags of french fries and chicken patties

4. The above findings were confirmed with the Director of Dietary on 10/4/11 at approximately 10:45 AM, during an interview.

B. Based on review of Hospital policy, Dishwashing/Warewashing machine temperature log and staff interview, it was determined that for 1 of 1 dishwashing machine, the Hospital failed to ensure temperatures were monitored and recorded at all meals.

Findings include:

1. The Hospital policy titled, "Kitchen Temperature Taking and Record Keeping," revision date 9/2010, was reviewed on 10/5/11 at 8:30 AM. The policy included, "Dish Machine temperatures will be noted by all meal periods and recorded".

2. The" Dishwashing/Warewashing Machine Temperature Log" for July 2011-October 3, 2011 was reviewed on 10/4/11 at approximately 10:30 AM. The log lacked documentation of temperatures on the following dates:
- July 8th, 10th and 31st, dinner
- August 12th, 14th and 29th, dinner
- September 9th,and 15th, dinner
- October 2nd and 3rd, dinner
- October 3rd, lunch.

3. The above findings were confirmed with the Clinical Nutrition Manager on 10/4/11 at approximately 10:35 AM, during an interview.

A. Based on review of Hospital policy, clinical record review, observation, dietary order requisition, and staff interview, it was determined that in 1 of 4 (Pt #2) clinical records reviewed of patients on the 2 Medical Surgical Unit, the Hospital's Dietary Department failed to ensure patient's received their prescribed diets.

Findings include:

1. Hospital policy entitled, "Placing Patient Diet Orders," review date 12/2009, reviewed on survey date 10/5/11 at approximately 11:00 AM required, "Procedure:...2. Cerner Order Entry will ne used to transmit all patient information via FNS (Food & Nutrition Services), as follows: Diet Orders, Diet Changes...4. Diet Office staff will confirm diet order in Health Touch, the room service compute software.."

2. Hospital policy entitled, "Current Diet List Updates," effective date 8/2008, reviewed on 10/5/11 at approximately 11:00 AM required, "Purpose: To maintain updated diet information at assure patients' diets are accurately recorded at all times...Procedure:..3. All new orders and diet changes received via Cerner will be updated by the diet clerk on the diet list and in Health Touch room software..."

3. The clinical record of Pt #2 was reviewed on 10/5/11 at approximately 9:15 AM. Pt #1 was an 87 year old female admitted on 9/29/11 with diagnoses of Pneumonia and Urinary Tract Infection. The clinical record contained a physician's diet order dated 10/4/11 at 4:10 PM that required a :"low cholesterol, low fat, thickened liquids, honey consistency, purred, nectar thick liquids."

4. On 10/5/11 at approximately 9:30 AM Pt #2's diet was observed. The diet consisted of: a small banana, scrambled eggs, oatmeal, and pancakes.

5. On 10/5/11 at approximately 9:35 AM the dietician (E #1) was interviewed. The Dietician stated that after a diet order is placed in the Hospital's computer system an order is generated in the Dietary Department and it is then the responsibility of the Dietary Department to verify and ensure the order is correct. E #1 stated that in the Dietary Department, a second computer system is used by the Department to reenter the order.

6. The Dietary Order Requisition for Pt #2 was reviewed on 10/5/11 at approximately 9:365 AM. The requisition did not include the requirement for a purred diet.

7. The findings were verified by E #1 during an interview on 10/5/11 at approximately 9:45 AM. During the interview E #1 verified that the diet Pt #2 received was not a purred diet as ordered.