The information below comes from the statement of deficiencies compiled by health inspectors and provided to AHCJ by the Centers for Medicare and Medicaid Services. It does not include the steps the hospital plans to take to fix the problem, known as a plan of correction. For that information, you should contact the hospital, your state health department or CMS. Accessing the document may require you to file a Freedom of Information Request. Information on doing so is available here.

EMERSON HOSPITAL - 133 OLD ROAD TO 9 ACRE CORNER W CONCORD, MA 01742 May 12, 2014
VIOLATION: DIRECTOR OF DIETARY SERVICES Tag No: A0620
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**

Based on observations, record review and interviews the Director of Food Service failed to ensure the that on 3/25/14, the Hospital's dishwasher machine operated with soap.

Findings include:

1.) According to the United States, Public Health Service Food Code, 2013, Chapter 4 indicated the following: a warewashing machine (dishwasher machine) shall effectively wash items to remove or completely loosens soils by using the manual or mechanical means necessary, such as the application of detergents.

2.) According to ServSafe Manual, a dishwasher machine should be operated according to manufacturer instructions. The general procedures included to make sure detergent and sanitizer dispensers associated with the dishwasher machines are properly filled. The sanitizing rinse must be at least 180 degrees Fahrenheit (F).

3.) The Director of Food Service was interviewed at 8:00 A.M. on 5/12/14. The Director of Food Service said a few months ago the dishwasher washer machine was run for a few hours without soap. The Director of Food Service said running the dishwasher without soap was okay, as long as the water temperature reached 180 degrees. When the Surveyor asked what standard he was referring to, the Food Service Director said it was just something he knew from his years of experience. The Director of Food Service said he did not have the manufactures recommendation for the operation of the Hospital's dishwasher.

4.) The Surveyor tour the Main Kitchen at 8:00 A.M. on 5/12/14 with the Risk Manager and the Director of Food Service. The Surveyor observed a functioning, [AGE] year old dishwasher, that washed dishes with soap and sanitized the dishwasher items with water reaching 185 degrees (F).

5.) The Operations Manager was interviewed at 9:30 A.M. on 5/12/14. The Operations Manager said the dishwasher machine uses 4-5 cases of soap a week, which was a lot of soap. There were no invoices available, dated March 2014 for dishwasher soap.

6.) Tray Passer/Dishwasher #1 was interviewed at 9:00 A.M. on 5/12/14. Tray Passer/Dishwasher #1 said the dishwasher machine on occasion runs out of soap. Tray Passer/Dishwasher #1 said when the dispenser runs out, she would notify the Manager and soap would be added to the dispenser. Tray Passer/Dishwasher #1 said she remembered one occasion when the dishwasher machine was run without soap.

7.) The Vice President for Operations was interviewed at 11:05 A.M. on 5/12/14. The Vice President for Operations reviewed with the Surveyor a Capital purchase Order to replace the Hospital's dishwasher machine. The Vice President for Operations said the target date for installation of the Hospital's new dishwasher machine was for July 2014.