HospitalInspections.org

Based on review of records and interview, the facility failed to ensure orders for patient diets were obtained on 4 (Patient #3, #5, #7, and #9) out of 7 patients reviewed for dietary orders.

Findings included:

Review of Patient #3's chart showed that she was admitted on 5-9-2019 and discharged on 5-15-2019, for a 6-day length of stay. Records indicated the patient was on a medication for insulin resistance. An order was written by the physician on 5-9-2019 for a dietary consult for starch and carbohydrate control. No order for a diet was written upon admission. The dietician met with the patient and completed a nutritional assessment. The assessment did not address the fact that the patient was taking an oral diabetic medication for insulin resistance. No diet was ever ordered throughout the patient's 6-day stay. Review of the Dietary Communication Form completed upon admission showed that the admission nurse completed the form for a regular diet and sent the form to the dietary department without a diet ordered.

Review of Patient #5's chart showed that she was admitted on 10-1-2019 and was a current patient on 10-10-2019. Review of orders showed that no diet had been ordered upon admission or at any time during the stay. Review of the Dietary Communication Form completed upon admission showed that the admission nurse completed the form for a regular diet and sent the form to the dietary department without a diet ordered.

Review of Patient #7's chart showed that she was admitted on 10-8-2019 and was a current patient on 10-10-2019. Review of orders showed that no diet had been ordered upon admission or at any time during the stay. Review of the Dietary Communication Form completed upon admission showed that the admission nurse completed the form for a regular diet and sent the form to the dietary department without a diet ordered.

Review of Patient #9's chart showed that she was admitted on 9-26-2019 and was a current patient on 10-10-2019 with an order to discharge on that day. Review of orders showed that no diet had been ordered upon admission or at any time during the stay. Review of the Dietary Communication Form completed upon admission showed that the admission nurse completed the form for a regular diet and sent the form to the dietary department without a diet ordered.

Interviews were conducted with Staff #2, Staff #9, and Staff #10. Staff #2 confirmed that the Dietary Communication Forms were being filled out in the admissions area by an admission nurse. Staff #9 confirmed that she was unable to find a diet order on all 4 patient charts. Staff #10 confirmed he was unable to find a diet order on Patient #3's chart.

Based on observation, review of documents, and interview, the facility failed to maintain a sanitary environment and monitor food in preparation/storage areas of the kitchen to ensure the prevention of food-borne illness. Food temperature logs did not contain the times that temperatures were taken on 8 out of the previous 11 days (9-29/30-2019 and 10-1/2/3/6/8/9-2019). Food and food items were stored in manners that allowed for contamination. Dead insects were found in 1 of 7 fresh fruit and vegetable bins observed. Food was stored without dates of receipt/preparation and/or use-by dates, allowing for the potential for expired foods to be served to patients. Cereal was observed to be expired and was found in the food preparation area, available to be served.

Findings included:

On the morning of 10-9-2019, a tour of the kitchen was made with Staff #9 and Staff #11 present. Upon entering the kitchen, it was noted that breakfast service was completed and all food had been removed from the service line. Review of the Food Management Group (FMG) form titled, FMG HACCP Daily Taste Panel Chart, showed the form contained the instruction that "Temperatures Should Be Taken At Least Every 2 Hours". The form contained blocks for the final cooking time and temperature, along with the service time and temperature. The form had hand written temperatures for the foods in the "Final Cooking Time" blocks and the "Final Cooking Temperature" blocks. The "Service Time" blocks and "Service Temperature" blocks were left blank. Without the documentation of times, it was impossible to determine the amount of time between the final food cooking time and the end of scheduled food service time to ensure that more than 2 had not elapsed between required temperature checks and end of service. The binder that the temperature log was contained in was observed to be dirty and visibly soiled with dried food spill, providing an environment for the potential growth of harmful bacteria.

Stainless steel food preparation tables were observed in the center of the kitchen. The tables had a table-top work surface with an open shelf underneath of the work surface. This design allowed for spilled food and liquids to drop onto items that were underneath the work surface. Paper and cardboard products could absorb spilled liquids and retain moisture, providing and environment for bacterial growth. Items stored underneath the food preparation work surfaces included:
1. Plastic containers without lids that contained paper bags, napkins, condiments, individual serving bags of chips, plastic eating utensils, paper napkins, and fresh fruit.
2. An assortment of cutting boards for food preparation.
3. Cardboard boxes that contained cooking oil, plastic bags, and plastic wrap.

The reach-in and walk-in refrigerators were observed to have unmarked food items in them. Without proper identifications of the item, when it was received or prepared, and the use-by date, there would be the potential for spoiled food to be served to patients. Undated food items included: one pan of cooked chicken and pasta, one bowl of pudding, four squirt-bottles of dressing and/or sauces, two containers of raw mushrooms, one plastic bin of individual servings of apple juice.

Two plastic containers of croutons were observed on a shelf. One container did not have any markings of when it was received or the use-by date. The other container was not marked with the use-by date. A plastic container of cereal was observed to have expired 3 days prior, on 10-6-2019, and was in the food preparation area of the kitchen, available for service to the patients.

An interview was conducted with Staff #11 at the time of the tour. Staff #11 confirmed the findings.