HospitalInspections.org

Based upon observation, record review and interview, the facility failed to ensure adequate direction and staffing of dietary services. The facility also failed to ensure dietary staff were following acceptable standards of dietary practice regarding food handling and sanitation.

An interview was conducted with the Administrator on 10/12/10 at 9:30 am in the conference room. The Administrator reported the Food Service Director was terminated on 9/1/10 and there has not been another Director hired as of this date. Three other dietary staff's employment was discontinued; one on 8/27/10, one on 10/1/10, and one on 10/2/10. These terminations left dietary services with one full time employee working twelve hours/day and preparing 3 meals per day for 20-30 people. The Administrator reported attempts had been made to hire dietary staff but applicants unable to pass drug screens and/or criminal history backgrounds.

An observation tour of the dietary department was conducted on 10/13/10 at 10:00 am with the Director of Quality Management. There was one dietary staff person (#5) working in dietary on this date. The following observations were made during the tour: 1.) The glass cover over the serving table had crumbs and stains from spills, 2.) Water was standing on the top shelf under the ice table where ice had melted , 3.) The floor in the serving area was dirty, 4.) The large boxes of juice concentrate that connected to a drink machine had leaked onto the floor leaving sticky juice concentrate residue on the floor, 5.) The shelves under the serving table were dirty with crumbs and dust, 6.) The steam table had 3 compartments with pans of boiling water for placing pans of food on top for keeping food warm/hot. The pans of boiling water had a rust colored substance in the bottom of the pan that was loose on the edges and breaking off and floating in the water. This surveyor was unable to determine what the rust colored substance was in the pan. The lids that covered the pans of boiling rust colored water creating steam on the lids, were the same lids that covered the pans of food while on the steam table, 7.) The top of the deep fryer was grease laden, 8.) The wall behind the stove/oven had dark grease streaks running down the wall, 9.) The bottom shelves under the food prep table contained large containers (approximately 2 gallon containers) of loose corn meal, flour, and sugar that were not labeled with dates products were put in containers, 10.) The shelf above the food prep area had approximately 24 large bottles of Seasonings and Spices and (1) partial gallon can of chives. The bottles and labels were discolored and sticky from grease residue. Four (4) bottles had a date of December 18 but no year written on the bottle as the date it was opened and the can of chives had the date of September 23 but no year written on the can. Staff #5 was present during the tour and reported the bottles of spices all needed to go in the trash because they had been there for several years and staff #5 reported she did not use them; 11.) The following refrigerated food items were inspected as follows: Partial Gallon Dill Pickle Relish - Expiration date 2/10/09, Partial Gallon Sweet Pickle relish - No date opened, Partial Gallon of Vanilla Extract - No date opened, Partial pan of Chicken Lasagna covered with foil with a hole torn in the foil - date prepared 10/3/10, Three (3) unopened 1 lb. packages of lunch meat - no label of what it was and no expiration date, One unopened 1lb. bag of cole slaw dressing - expiration date 10/7/10, Loaf (2lb.)of cream cheese with a date of 5/28/10 on the side but not identified as expiration date, Two cases of eggs (approximately 28 dozen) with the only date on the side of the case of 8/31/10 but date not identified as the expiration date, Four packages of 12 count flour tortillas - Expiration date 7/10, Grapes - 1 1/2 cases with no purchase date or pull date.

Review of menus and special diet menus revealed the provision for regular diets as well as diabetic diets, no added sugar, no added salt, low fat, low cholesterol, and low carbohydrates that had been approved by the facility's dietitian. Review of the temperature logs revealed the temperatures for the food items prepared for any given day. Comparison of the food items that were listed on the temperature log did not match the food items listed on the menu. When questioned about this discrepancy, staff #5 reported that she changes the menu frequently when a food item was not available and that sometimes the whole menu was changed out due to not having certain food items. Staff #5 reported she does not obtain approval from the dietitian for these changes.

Review of the policy and procedure #FOS-6:000 titled Planning Patient Menus revealed "All menus including modified diets are planned by the Food Service Director and approved by the Clinical Nutritionist (registered dietitian) for nutritional adequacy."

An interview was conducted with staff #5 on 10/13/10 at 10:30 am in the kitchen food prep area. Staff #5 reported for the last two (2) weekends there has not been any dietary staff. Staff #5 reported that on the weekend of 10/2/10 - 10/3/10, the food service staff scheduled did not report to work. Staff #5 reported that the Assistant Director of Nurses was called and arrangements were made for meals for those 2 days. On 10/9/10 - 10/10/10, staff #5 reported that she came in and prepared breakfast and after serving breakfast, she prepared lunch and dinner and put the meals in styrofoam containers and placed them in the refrigerator of the patient care units and unit staff were responsible for re-heating the meals. Staff #5 reported she had been working 12 hour days and had to have some time off. Staff #5 reported there was no record of temperatures when unit staff re-heated the meals and it was not know what sanitary practices were used by the unit staff when heating and serving the meals. Staff #5 reported the temperatures on the temperature log were the temperatures when food was prepared prior to being put in warming pans in the steam table and prior to being put in the styrofoam containers. Staff #5 reported that was the only time she checked temperatures because of lack of time.

An interview was conducted with staff #4 on 10/13/10 at 11:30 am in the conference room. Staff #4 reported that he was the Administrator on Call for the weekend of 10/2/10 - 10/3/10 and he received a call that no kitchen staff reported to work on these days. Staff #4 reported that patients were provided cereal and toast for breakfast on both days. He also reported that on 10/2/10, lunch was catered in by a local restaurant and unit staff served the food and staff #4 went to the store and purchased the food and grilled hamburgers and hotdogs on the facility patio. On 10/3/10, lunch and dinner was brought in from a local restaurant. Unit staff served the food. No special diets or substitutions were provided and no temperatures were taken of the food items served.

On 10/13/10 at 2:00 pm, an interview was conducted with the Executive Director and the Administrator in the conference room. A review of these findings were discussed and due to the potential for harm to patients whose food was prepared and served in unsanitary conditions, menus being changed without Dietitian approval, and inadequate dietary staff, an immediate jeopardy existed. Facility staff was instructed to develop a plan of correction to alleviate the potential for immediate harm. An acceptable plan of correction was provided by the facility to close the kitchen on 10/16/10 - 10/17/10 for a thorough cleaning, organization of food and supplies, and hiring of additional staff. The facility has arranged for a local restaurant to provide lunch and dinner on these dates and the facility would provide a continental breakfast on these dates. Based upon this plan, the Immediate Jeopardy was removed, but the deficient practice remained until plan was fully implemented.