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.

BEHAVIORAL HOSPITAL OF LONGVIEW 22 BERMUDA LANE LONGVIEW, TX Jan. 16, 2014
VIOLATION: THERAPEUTIC DIET MANUAL Tag No: A0631
Based on observation and interviews, the facility failed to provide a current and updated diet manual approved by the Dietician. The diet manual was found to exceeded 5 years.

During a tour of the kitchen on 1/15/2014 the diet manual was found covered in dust, above the sink. The diet manual was dated 1/21/08.

Interview with staff #6, #3, and #1 on 1/16/2014 confirmed the diet manual had expired.
VIOLATION: INFECTION CONTROL Tag No: A0747
Based upon observation and interview, the facility failed to provide a sanitary environment in the dietary department (food storage, preparation, and dining areas). Potential for cross-contamination due to unsanitary food handling, unsanitary cooking implement storage, unsanitary food service items (pots, pans, and serving carts) storage and use, unsanitary food storage, and poor general sanitation practices was found throughout the dietary department.

A tour was done of the Dietary Department on 1/15/2014, at approximately 11:20 am with staff #1, and staff #6. Findings were as follows:

Below the serving line, on the bottom shelves, seven plastic containers were found with condiments. The lids of the containers were soiled with dirt and dried food. On 1/16/2014, staff #7 was observed opening the containers and laying the dirty lids on top of the serving line. The lids were put back on the containers and stored under the serving line. Lack of proper cleaning had the likelihood to cause contamination of food and food preparation area.

The lunch food for 1/16/2014, was placed in the steamer table at 11:20 AM. Patients and staff were being served until 1:00PM. The steam table did not have a themometer to ensure the food was staying at the appropriate temperatures.

On top of the cold side of the serving line seven bottles of salad dressing were found in unmarked bottles. There were no dates visible on the opening or expiration of the contents. The server would not be able to establish the expiration date which could cause a food borne illness.

Inside the dry food storage room multiple shipping boxes were found on the shelves. The shelves were dusty and the floor was dirty with food particles and dust. The lack of proper cleaning and storage of shipping boxes created a possibility for cross- contamination and insect infestation.

Inside the walk-in freezer, multiple shipping boxes were found. The storage of shipping boxes leaves a possibility for cross- contamination and insect infestation.

Inside the walk-in refrigerator, a serving cart had four trays of uncovered food as follows;
- The first and second tray contained 8 pieces of cake unwrapped with no preparation dates.
- The third tray had 11 bowls of peaches with whipped cream uncovered with no preparation dates.
- The fourth tray contained 13 bowls of strawberries and grapes uncovered with no preparation dates.
Placing the food back into the refrigerator uncovered with no preparation dates allows for bacterial food borne illnesses, cross- contamination, and the possibilities of the food re-served to the patient population.

Interview with staff #6 reported that the above items were snacks and desserts offered the day before and was put back into the refrigerator. Staff #6 confirmed that the items were not covered. Staff #6 stated, "They should have been thrown out but they were put back in here. We are not going to serve them."

A large covered trash can, with wheels, was found sitting next to the sink and under the refrigerator doors. The wall area under the refrigerator door and behind the trash can had dried food, dried liquid substances, and dirt from the upper door to the floor.

The large trash can was rolled from the kitchen area and taken to the dumpster area daily. The trash can was brought back through the kitchen preparation area and placed beside the sink and food preparation areas. The wheels had a black sticky substance on them. The trash can barrel was soiled with dirt and dried liquid substances. There was no other visible trash can in the kitchen area. The trash can leaving the kitchen area and not being properly cleaned allows for cross- contamination.

The ice machine has a filter named, "Ice O Matic" hanging on the wall above the machine. The filter is for reducing rust, dirt, and sediment. The date to be changed was 12-27-2013(observation date 1/15/14). The filter was expired and could cause an increase in sediment deposits in the ice.

Above the fryer and food prep area was a red fire suppression system box and a white pipe with gas shut off valve. The box, pipe, and the wall behind them were covered in a greasy substance mixed with dust.
The fryer had a front panel door that opens to the mechanical workings of the fryer. The inside of the fryer floor was thick with old grease. Hair and what appear to be food particles were mixed into the grease. The un-clean fryer was not only a fire hazard but could contribute to food borne illnesses.

The convection oven was soiled with grease and dried food particles. The oven had a stainless steel door with a glass front that was stained with grease and a sticky substance.

The stove had a grate under the burners. The grate was soiled and covered in dust. Below the burners was aluminum foil placed to catch food particles. The foil was heavily soiled with a greasy substance. The door to the oven below the stove had what appeared to be caked up dried food particles and grease in the knobs and handle.

On a rack, in the food prep area, a pan of rolls was sitting exposed to a dirty fan and next to shipping boxes. The rolls were uncovered and scheduled to be served that day for dinner. The rack was soiled with dried food particles and grease.

A large, free standing, mixer was covered with a black trash bag. Staff #6 had confirmed it was covered because it was clean. The trash bag was removed and the mixer was found to have multiple dried, crusty yellow substances on the base, and top of the mixer.

The food processor was found on a wire rack next to the mixer. The food processor was confirmed as "clean" from staff #6. The base of the food processor was covered in a sticky greasy substance.

The muffin pans were stacked upside down on the top of a 6 ft. wire rack. The pans were coated in carbon buildup and grease. This does not allow the pans to be cleaned properly causing possible food born illnesses.

The floors of the storage and main food prep areas, and the dining room were soiled with greasy substances and build up of dried food particles. The dining area had dirt and hair build up around all the thresholds and baseboards.

The p-trap and pipe under the sink was not enclosed. The pipes were covered in a sticky black substance. The black substance had hair and what appeared to be food particles built up on it. A soiled red rag was found stuffed in the old sewage line under the sink. A large hole surrounded the pipe exposing the kitchen to possible rodent or bacterial substances from behind the wall. No proper seal was on the sewage line which could possibly contaminate food and the food prep area with sewage contamination.

Staff #7 was observed rolling an open plastic cart from the outside hallway into the kitchen and past the food preparation area. The cart was soiled with liquids and dried food particles. It was confirmed by staff #6 that the cart is the only one and goes to the floors and back to the kitchen area.

Staff #6 confirmed that the dirty cart was brought through the preparation area and had not been cleaned.

Staff #1 and #6 confirmed the findings listed above.

The following issues were found in the dining room:
-Four tables were found to have rusted legs.
- Eleven out of twenty chairs were found to have rips and significant tears in the seat covers exposing the foam.
- The chairs were soiled with dried food particles and dried liquid substances found on the seats, frames, and down the legs.
- Hair and dirt build up was found down the base boards all along the floor.
-Windows were open to allow outside air to come in but the window ledge had a buildup of dried bugs and dirt. This allowed the wind to blow these particles into the food sitting on the serving line.
-Paint was missing from the doors and the frames coming into the dining room. The frames have visible rust that does not allow for proper cleaning.
- One of the tables was unbalanced. A stack of paper napkins had been placed between the floor and the table leg. It was confirmed by staff #6 that it had been that way for several days. This area would not be able to be properly mopped causing contamination.

Staff #1 and #6 confirmed the findings listed above.

Staff #1 reported that enviromental rounds had been done in the kitchen with the infection control nurse. Staff #1 reported that the last time he was in the kitchen preparation area was the first of December 2013. There was no infection/enviromental reports for the kitchen for December 2013 or January 2014.

Policy and procedures "Preparation and Handling" states,
"all foods should be kept covered between time of preparation and time of serving.
A. Hot food should be held at a temperature of 135 degree F to 145. (60 degree C.) or more.
B. Cold food at 41 degree F.(7 degree C.) or less.
Refrigerators designed for food should be used for food and food products only. All foods should be dated with expiration dates and discarded on that day.
Insulation or protection from pipes, heaters, compressors, condensing units, and heat- producing equipment is provided.
All openings to the outside shall be rodent-and insect-proof.

Policy and procedures "Storage of Perishable Items" states, "It is the responsibility of the CEO and or designee to implement this policy and procedure. It is the responsibility of the food service director to disseminate this information to employees under their direction.
Procedure:
- All leftover foods are placed in appropriate containers, which are covered, and labeled. The label must include the name of the item and the date or preparation.
- Never mix leftover foods with fresh foods."
VIOLATION: FOOD AND DIETETIC SERVICES Tag No: A0618
Based upon record review, observation, and interviews, the facility failed to provide a sanitary environment in the dietary department (food storage, preparation, and dining areas). Potential for cross-contamination due to unsanitary food handling, unsanitary cooking implement storage, unsanitary food service items (pots, pans, and serving carts) storage and use, unsanitary food storage, and poor general sanitation practices was found throughout the dietary department.The facility failed to provide menus that met the therapeutic dietary needs of all patients. The dietary director failed to follow therapeutic menus, provide food substitutions, and identify patients to provide the prescribed diet, and an updated diet manual.

A tour was done of the Dietary Department on 1/15/2014, at approximately 11:20 am, with staff #1 and staff #6. Findings were as follows:
Below the serving line, on the bottom shelves, seven plastic containers were found with condiments. The lids of the containers were soiled with dirt and dried food. On 1/16/2014, staff #7 was observed opening the containers and laying the dirty lids on top of the serving line. The lids were put back on the containers and stored under the serving line. Lack of proper cleaning had the likelihood to cause contamination of food and food preparation area.

The lunch food for 1/16/2014, was placed in the steamer table at 11:20 AM. Patients and staff were being served until 1:00PM. The food was not covered with a lid. The steam table did not have a themometer to ensure the food was staying at the appropriate temperatures.

On top of the cold side of the serving line, seven bottles of salad dressing were found in unmarked bottles. There were no dates visible on the opening or expiration of the contents. The server would not be able to establish the expiration date which could cause a food borne illness.

Inside the dry food storage room, multiple shipping boxes were found on the shelves. The shelves were dusty and the floor was dirty with food particles and dust. The lack of proper cleaning and storage of shipping boxes leaves a possibility for cross- contamination and insect infestation.

Inside the walk-in freezer, multiple shipping boxes were found. The storage of shipping boxes leaves a possibility for cross-contamination and insect infestation.

Inside the walk-in refrigerator, a serving cart had four trays of uncovered food as follows;
- The first and second tray contained 8 pieces of cake unwrapped with no preparation dates.
- The third tray had 11 bowls of peaches with whipped cream uncovered with no preparation dates.
- The fourth tray contained 13 bowls of strawberries and grapes uncovered with no preparation dates.
Placing the food back into the refrigerator uncovered with no preparation dates allows for bacterial food borne illnesses, cross- contamination, and the possibilities of the food re-served to the patient population.

Interview with staff #6 reported that the above items were snacks and desserts offered the day before and was put back into the refrigerator. Staff #6 confirmed that the items were not covered. Staff #6 stated, "They should have been thrown out but they were put back in here."

A large covered trash can, with wheels, was found sitting next to the sink and under the refrigerator doors. The wall area under the refrigerator door and behind the trash can had dried food, dried liquid substances, and dirt from the upper door to the floor. The large trash can left the kitchen area and was taken to the dumpster area daily. The trash can was brought back through the kitchen preparation area and placed beside the sink and food prep areas. The wheels had a black sticky substance on them. The trash can barrel was soiled with dirt and dried liquid substances. There was no other visible trash can in the kitchen area. The trash can leaving the kitchen area and not being properly cleaned allows for cross- contamination.

The ice machine had a filter named, "Ice O Matic" hanging on the wall above the machine. The filter is for reducing rust, dirt, and sediment. The date to be changed was 12-27-2013(observation made 1/15/14). The filter was expired and could cause an increase in sediment deposits in the ice.

Above the fryer and food prep area was a red fire suppression system box and a white pipe with gas shut off valve. The box, pipe, and the wall behind them were covered in a greasy substance mixed with dust.
The fryer has a front panel door that opens to the mechanical workings of the fryer. The inside of the fryer floor and was thick with old grease. Hair and what appear to be food particles were mixed into the grease. The un-cleaned fryer was not only a fire hazard but could contribute to food borne illnesses.

The convection oven was soiled with grease and dried food particles. The oven had a stainless steel door with a glass front that was stained with grease and a sticky substance.

The stove had a grate under the burners. The grate was soiled and covered in dust. Below the burners was a sheet of aluminum foil placed to catch food particles. The foil was heavily soiled with a greasy substance. The door to the oven below the stove had what appeared to be caked up dried food particles and grease in the knobs and handle.

On a rack, in the food prep area, a pan of rolls was sitting exposed to a dirty fan and next to shipping boxes. The rolls were uncovered and scheduled to be served that day for dinner. The rack was soiled with dried food particles and grease.

A large, free standing, mixer was covered with a black trash bag. Staff #6 had confirmed it was covered because it was clean. The trash bag was removed and the mixer was found to have multiple dried, crusty yellow substances on the base, and top of the mixer.

The food processor was found on a wire rack next to the mixer. The food processor was confirmed as "clean" from staff #6. The base of the food processor was covered in a sticky greasy substance.

The muffin pans were stacked upside down on the top of a 6 ft. wire rack. The pans were coated in carbon buildup and grease. This does not allow the pans to be cleaned properly causing possible food born illnesses.

The floors of the storage and main food prep areas and the dining room were soiled with greasy substances and build up of dried food particles. The dining area had dirt and hair build up around all the thresholds and baseboards.

The p-trap and pipe under the sink is not enclosed. The pipes were covered in a sticky black substance. The black substance had hair and what appears to be food particles built up on it. A soiled red rag was found stuffed in the old sewage line under the sink. A large hole surrounded the pipe exposing the kitchen to possible rodent or bacterial substances from behind the wall. No proper seal was on the sewage line which could possibly contaminate food and the food prep area with sewage contamination.

Staff #7 was observed rolling an open plastic cart from the outside hallway into the kitchen and past the food preparation area. The cart was soiled with liquids and dried food particles. It was confirmed by staff #6 that the cart is the only one and goes to the floors and back to the kitchen area.

Staff #6 confirmed that the dirty cart was brought through the preparation area and had not been cleaned.

Staff #1 and #6 confirmed the findings listed above.

The following issues were found in the dining room:
-Four tables were found to have rusted legs.
- Eleven out of twenty chairs were found to have rips and significant tears in the seat covers exposing the foam.
- The chairs were soiled with dried food particles and dried liquid substances found on the seats, frames, and down the legs.
- Hair and dirt build up was found down the base boards all along the floor.
-Windows were open to allow outside air to come in but the window ledge had a buildup of dried bugs and dirt. This allowed the wind to blow these particles into the uncovered food sitting on the serving line.
-Paint is missing from the doors and the frames coming into the dining room. The frames had visible rust that did not allow for proper cleaning.
- One of the tables was unbalanced. A stack of paper napkins had been placed between the floor and the table leg. It was confirmed by staff #6 that it had been that way for several days. This area would not be able to be properly mopped causing contamination.
Staff #1 and #6 confirmed the findings listed above.

Policy and procedures "Preparation and Handling" stated, "all foods should be kept covered between time of preparation and time of serving.
A. Hot food should be held at a temperature of 135 degree F to 145. (60 degree C.) or more.
B. Cold food at 41 degree F.(7 degree C.) or less.
Refrigerators designed for food should be used for food and food products only. All foods should be dated with expiration dates and discard on that day.
Insulation or protection from pipes, heaters, compressors, condensing units, and heat- producing equipment is provided.
All openings to the outside shall be rodent-and insect-proof."

Policy and procedures "Storage of Perishable Items" stated,
"It is the responsibility of the CEO and or designee to implement this policy and procedure. It is the responsibility of the food service director to disseminate this information to employees under their direction.
Procedure:
- All leftover foods are placed in appropriate containers, which are covered, and labeled. The label must include the name of the item and the date or preparation.
- Never mix leftover foods with fresh foods."


Refer to Tags 0628
Refer to Tags 0631
VIOLATION: GOVERNING BODY Tag No: A0043
Based upon record review, observation, and interviews the Governing Body(GB) failed to ensure a sanitary environment in the dietary department (food storage, preparation, and dining areas). Potential for cross-contamination due to unsanitary food handling, unsanitary cooking implement storage, unsanitary food service items (pots, pans, and serving carts) storage and use, unsanitary food storage, and poor general sanitation practices was found throughout the dietary department. The Governing Body(GB) failed to ensure menus that met the therapeutic dietary needs of all patients, identify patients to provide the prescribed diet, and an updated diet manual.


Based upon the review of policy and procedures, observation, and interviews, the facility failed to provide menus that met the therapeutic dietary needs of all patients. The dietary director failed to follow therapeutic menus, provide food substitutions, and identify patients to provide the prescribed diet.

Refer to Tag A0628


Based on observation and interviews, the facility failed to provide a current and updated diet manual approved by the Dietician. The diet manual was found to exceeded 5 years.

Refer to Tag A0631


Based upon observation and interview, the facility failed to provide a sanitary environment in the dietary department (food storage, preparation, and dining areas). Potential for cross-contamination due to unsanitary food handling, unsanitary cooking implement storage, unsanitary food service items (pots, pans, and serving carts) storage and use, unsanitary food storage, and poor general sanitation practices was found throughout the dietary department.
Refer to Tag A0747