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METHODIST HOSPITAL 7700 FLOYD CURL DR SAN ANTONIO, TX 78229 Feb. 26, 2019
VIOLATION: ORGANIZATION Tag No: A0619
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**

Based on observation, interview, and record review, the facility failed to ensure that food and dietetic services organization requirements were met in accordance with the facility's infection control policy for Food Nutrition Services (FNS), and other procedures for maintaining safe temperatures for holding foods for service. Specifically, the facility and the FNS Managers failed to ensure:

1.) Safe Temperatures for Holding Food intended for patient service and consumption and,
2.) Temperature logs for foods being served included all the specific foods (meats) being held for service.

This deficient practice could place the Patients and employees at risk of obtaining food borne illnesses and/or infections.

Findings included:

Review of the Complaint Intake information for TX 637 dated 1/16/19 revealed an E-mail received by Patient #1/Complainant on 12/17/18 that indicated the following in part:
Patient #1 had been battling cancer and diagnosed with [DIAGNOSES REDACTED] Escherichia Coli (E. coli) based on the positive blood cultures. Patient #1 stated he had remembered receiving "contaminated breaded chicken strips and ate some of it" on 11/24/18 for lunch before he noticed the unsafe temperature issue and discoloration of the inconsistent cooked chicken he consumed. Patient #1 further indicated he spoke with the FNS Manager -B who explained the deep fried items such as the chicken strips needed to be stirred, flipped or rotated, and then immersed again to guarantee a full cooked process. Patient #1 indicated the FNS Manager-B mentioned to him that he believed the chicken Patient #1 received might have been undercooked.

Review of the Food Complaint Report Number 4820 documented that Patient #1 reported an alleged occurrence on 11/24/18 at 12:00 PM that he "ate undercooked chicken tender which made him sick. The patient was diagnosed with [DIAGNOSES REDACTED].
Food item product/supplier information: Chicken Tenders; uncooked southern style chicken.

Review of the hospital policy titled, "Infection Control Plan FNS," last revised "12/2017," stated in part:
Food Temperature-
The following are food temperature guidelines:
1. Hot foods should be served hot (above 135 degrees) Fahrenheit (F). Heated plates should be used and delivered immediately.
2. Serve cold food cold (below 41 degrees F). Bacteria multiplication proceeds most rapidly between 41 degrees F and 135 degrees F.
Service of Food: 5. Keep hot food at 135 degrees F. or above when placed on display for service

Observations of the FNS - Dietary Department was conducted on 02/25/19 beginning at 12:07 PM accompanied by the Contracted FNS Manager-A; the Vice President (VP) of Clinical Outcomes; the Manager of Regulatory Compliance; the Director of Facilities Manager; and the Assistant Chief Operations Officer; and revealed the following in part:
A temperature check of the chicken breast in natural gravy, and ground beef in the 2nd from the left section on the right hand side of Pod 2 at 12:24 PM by the FNS Manager - A revealed the temperature for both items was at 127 degrees F. The red light was off for that section that held the chicken breast and ground beef containers. The FNS Manager -A then ensured the foods were removed from service from this section of Pod 2.

Further observations of the lunch cart set for delivery to the oncology floor, "8W" revealed the documentation for this specific lunch cart had patient trays ready at 12:30 PM to be transported to patients. The metal transport cart was not temperature controlled. The cart left the kitchen at 12:41PM, and the last patient on the 8W floor received their tray at 12:56 PM (26 minutes after cart ready for delivery).

Review of the Daily Service & HACCP Record (Hazardous Analysis Critical Control Points) Temperature Checks for 2/25/19 at 12:30 PM during the observations revealed that temperatures were recorded on 02/25/19 at 6:00 AM and 10:00 AM for Pods 1, 2 and 3. There were no additional temperatures documented after 10:00 AM (2.5 hours had passed). The record included the following preprinted meats for the lunch meal: Chicken Nuggets, Classic Hamburger, Fried Chicken Tenders, Chicken Strips, and Pot Roast. There were not any records documented specifically for the Grilled Chicken Breasts, or Ground Beef.

Further review of the Daily Service & HACCP Record on page 2 indicated the HACCP Minimum Holding Temperature Requirements were: "HOLD HOT FOODS AT 140 [degrees] F OR ABOVE."

During an interview on 2/25/19 at 12:35 PM with the FNS Manager -A confirmed the temperature readings for the grilled chicken breast and ground beef were at 127 degrees F. The FNS confirmed the delivery/holding carts were not heated or refrigerated.
Further interview at 4:25 PM the FNS Manager A stated that the food service cooks did not use timers when deep frying chicken tenders; that the cook was to take the internal temperature of the chicken tender after waiting for it to cook; to ensure it reached the designated temperature according to the recipe or temperature on the boxed directions.

During an interview on 02/25/19 at 03:55 PM with the FNS Manager-B stated that holding foods should be at least 140 degrees F, and checked every 2 hours; if somethings is out of temperature for 2 hours, bacteria can grow.

Additional interview on 02/26/18 at 1:50 PM with FNS Manager -A was asked where the FNS staff document temperature checks on the temperature log for the ground beef and chicken breast. Per FNS Manager-A, the chicken breast was the "chicken strips," and further indicated the chicken tender is breaded. After reviewing the Daily Service Temperature Record, FNS Manager- A stated, "It is possible that the item is not listed here." The FNS Manager-A confirmed he could not find where the ground beef or chicken breast were listed on the temperature record, but indicated chicken breast was listed on the dinner temperature log records.