|§483.60(i) Food safety requirements.|
The facility must -
§483.60(i)(1) - Procure food from sources approved or considered satisfactory by federal, state or local authorities.
(i) This may include food items obtained directly from local producers, subject to applicable State and local laws or regulations.
(ii) This provision does not prohibit or prevent facilities from using produce grown in facility gardens, subject to compliance with applicable safe growing and food-handling practices.
(iii) This provision does not preclude residents from consuming foods not procured by the facility.
§483.60(i)(2) - Store, prepare, distribute and serve food in accordance with professional standards for food service safety.
Based on observation, facility documentation and policy review and staff interview, it was determined that the facility failed to store, prepare, distribute and serve food in accordance with professional standards for food service safety for the main kitchen, both bistro kitchens located on the nursing units and the nourishment/resident food refrigerators on both nursing units.
Review of a facility policy titled Outside Cleaning and dated as revised on November 1, 2007, revealed the exterior of the building and surrounding grounds are policed for cleanliness and overall appearance.
Review of a facility policy titled Machine Warewashing and Sanitizing and dated as revised on June 15, 2018, revealed that employees clean and sanitize all dishware after each use/meal.
Review of a facility policy titled Refrigerate/Frozen Storage and dated as revised on June 15, 2018, revealed that all foods are labeled with the name of product and the use by date once opened, prepared foods are labeled and dated with the name of the product, date opened and use by day and refrigeration units are kept clean and organized.
Review of a facility policy titled Department Maintenance and dated as revised on June 15, 2018, revealed that the food and nutrition services department is maintained in a good physical condition with equipment in working order.
Review of a facility policy titled Ice Machine Cleaning/Inspection and dated as revised on June 1, 2007, revealed all ice machines are inspected and cleaned quarterly to ensure proper operation and minimize equipment failure.
Review of a facility policy titled Food Brought in for Patients/Residents and effective November 28, 2017, revealed food items that require refrigeration must be labeled with the resident's name and the date the food was brought in.
Observation of the main kitchen on March 20, 2019, starting at 10:36 a.m. with Employee E8, Food Service Director (FSD), revealed the following observations:
Observation of the kitchen's waste disposal area in the parking lot revealed:
One circular trash can without a lid next to the trash compactor filled with water, dirty clinical gloves and food debris, and dirty clinical gloves, food waste, cigarette butts and other miscellaneous trash scattered around the base of the trash compactor.
Observation of the kitchen's receiving door hallway revealed:
18 cardboard boxes were placed directly on the floor of the hallway.
Observation of the kitchen's dirty dish area revealed:
Two large wooden-handled plungers laying directly on the floor;
Hundreds of small elliptically shaped black/dark brown substances along the perimeters of the room;
The presence of flies around and under the counters;
Grouting missing between approximately 40 floor tiles where water was pooling;
Grouting missing between baseboard tiles around the perimeter of the room, and
Dishwasher temperature logs for the heat-sanitizing dishwasher revealed the FSD had been documenting parts per million chemical concentrations even though the dish washer sanitized by heat, not chemicals.
Observation of the cereal storage area (not the dry food storage room) in the central kitchen area revealed:
Open frosted flakes and raisin bran both dated 2/7/19 - the FSD identified these as expired, and
Four bowels of cereal with loose fitting lids and no preparation dates.
Observation of the ice cream box revealed:
Two large panes of stained glass that slide to allow access to ice cream, and
A variety of brown colored food debris caught in all the grooves and handles of the ice cream box.
Observation of the stand mixer revealed:
Brown, yellow and white substances dried and stuck in a variety of places on the machine, including in the grooves.
Observation of the large toaster machine revealed:
A large accumulation of burned bread debris throughout the machine - the FSD identified that the machine had been cleaned since breakfast;
The control knobs along the front of the machine were covered in yellow sticky substances, and
The dust vents along the front underside of the machine were completely clogged with dust.
Observation of the microwave unit revealed:
The top exterior surface of the microwave was coated in a layer of a greasy substance that was embedded with dust particulates.
Observation of the juice concentrate to diluted drinkable juice machine revealed:
Large quantities of food-like debris wedged between various components of the machine, and
Dust accumulation in the level surfaces of the machine components.
Observation of the ice machine revealed:
A pipe used for cleaning had been placed directly under the flow of waste water from the ice machine, causing contaminated waste water to spew onto the kitchen floor tiles instead of entering directly into the waste water system, and
A black substance was observed to be dangling from the waste water pipe from the ice machine.
Observation of the meat slicer machine and associated food preparation counter revealed:
Dark pink and yellow dried substances, identified by the FSD as dried meat and dried fat, were caught between various hard to reach surfaces of the meat slicer machine, and
A plastic container of food thickener open to the air behind the meat slicer that was undated and unlabeled.
Observation of the three-door frozen vegetable box and surrounding area revealed:
All three doors had broken rubber gaskets that were discolored with black and yellow substances;
A bag of frozen cookies was open to the air;
Under the unit on the floor was a large accumulation of food waste including broccoli and a bread roll, and
The trash can adjacent to the vegetable box was not lined with a bag and had loose raw foods and dirty food preparation gloves.
Observation of the single-door refrigerator unit and surrounding area revealed:
The ceiling tiles directly above the unit were stained with yellow and brown substances, and
The air vent above the unit was dusty with large strings of dust and spider webs hanging down from the vents - the FSD identified that ceiling vents in the kitchen are not on a cleaning schedule with the maintenance department.
Observation of the frozen meat box revealed:
A tray of unlabeled undated cauliflower;
Beef used for cheese steaks in a bag open to the air and was placed inside an open box.
Observation of the food preparation table opposite the frozen meat box revealed:
One large metal tray containing uncooked bread rolls with a partial covering of plastic wrap that was undated and unlabeled.
Observation of the bread rack revealed:
Open packets of bread rolls, not sealed, unlabeled and undated, and
A plastic container, open to the air, with a dried yellow substance adhered to the bottom.
Observation of the four food trucks (enclosed shelves on wheels for delivering food trays to the nursing units) revealed:
All four trucks contained food debris, stains, sticky substances and dust. The carts were identified by the FSD as having been cleaned after breakfast, ready for lunch.
Observation in the dry food storage room revealed:
Two boxes stored within 18-inches of the ceiling (12.5" and 13" away from ceiling), away from the wall and in direct line of blocking the spray from fire sprinklers - interview with the Director of Maintenance on March 20, 2019, at 11:54 a.m. confirmed there were boxes too high to the ceiling in the dry food storage room that posed a fire hazard;
Two bulging ceiling tiles and two other stained ceiling tiles;
One hole in the baseboard as you enter the room to the back-left corner - estimated by the FSD to be one inch in diameter;
Multiple holes in the wall to the back-right of the room behind a cart on wheels, and
Marshmallows open and undated.
Observation in the janitor's closet revealed:
Multiple cardboard boxes stored directly on the floor, and
An accumulation of dirty food preparation gloves mixed with bread slice off-cuts in the waste water ceramic bin.
Observation of the tray line for lunch preparation revealed:
Dietary staff were observed to be plating resident food onto plates with brown and yellow substances adhered to the eating surface;
Observation of all 12 plates in a stack of clean plates revealed that all the plates were discolored with yellow and/or brown substances stuck to the plate that could be chipped off with the FSD's fingernails;
Further observation of all 10 bowls in a stack of clean bowls revealed the same problem as with the plates;
Throughout the lunch service a tray of raw chicken was defrosting open to the air on the table adjacent to the sandwich preparation table, Employee E15, Cook, touched the inside of the raw chicken pan, wrapped it, carried the raw chicken into the refrigerator and then left carrying containers of blue cheese, ham and salami, without first having performed hand hygiene. Employee E15 touched numerous surfaces with contaminated hands.
Observation in the walk-in refrigerator revealed:
The door handle latch was broken/missing so the door could not create a tight seal;
One large plastic container of mandarins in juice with plastic wrap on top and dated February 26, 2019 with a thick layer of white, black, green and blue mold as identified by the FSD layered across the top surface of the mandarins;
One orange coated in a white fluffy substance;
Cesar dressing decanted from a larger container into a smaller container dated as prepared on March 9, 2019 - the FSD identified this as expired;
Cabbage in a sealed bag dated March 4, 2019 - the FSD identified this as expired;
Sour cream dated February 28, 2019 - the FSD identified this as expired;
Unlabeled, undated and partially unwrapped meat-like substance, cooked poultry-like substance, cooked ham-like substance, liver wsubstance, cheese-like substance, three trays of uncooked bread roll-like substances and five containers of fruit juice;
Ham dated as opened on March 22, 2019 (two days in the future) and labeled, covered in plastic wrap that was open to the air;
Eight sour cream, 13 tartar sauce, 14 parmesan cheese and 5 Italian dressing cups all exposed to the air;
One gallon of whole milk opened but undated, and
Dill pickles in vinegar opened with illegible open date written on the container.
Observation of the main nursing home kitchen on March 21, 2019, starting at 12:07 p.m. for a follow-up kitchen tour with Employee E8, Food Service Director (FSD), revealed the following observations in the walk-in refrigerator:
The door handle latch continued to be broken/missing so the door could not achieve a tight seal;
The moldy orange from the previous day had disintegrated over the other oranges in a mass of mold and moisture - the mold was identified by the FSD;
Two moldy apples, moldy cucumbers and zucchinis - the mold was identified by the RFSD;
Unlabeled, undated and partially or fully unwrapped three trays of uncooked bread roll-like substances (no change from previous day) and one container of fruit juice, and
One gallon of 2% milk opened but undated.
Observation of the second-floor bistro dining room on March 21, 2019, at 9:48 a.m. with the FSD revealed the following observations:
Undated and unlabeled open bread stored in the cupboards;
The microwave was soiled with yellow and brown sticky substances on the inside, and
Observation of the third-floor bistro dining room on March 21, 2019, at 9:58 a.m. with the FSD revealed the following observations:
The ice machine did not have an air gap between the waste-water outlet and the drainage pipe;
Undated and unlabeled open one-gallon whole milk, a cardboard lactose free milk and two bowls of cereal;
A lump of ice in the ice machine was contaminated with an unidentified yellow substance;
The cupboards were contaminated with brown substances, rust, food crumbs and the under cabinets were buckling and damaged on the inside;
The ice machine scoop was stored in water that was pooling in the wall mounted holder, and
Observation of the second-floor medication storage room nourishment refrigerator on March 22, 2019, at 9:58 a.m. with Employee E6, Registered Nurse (RN), Nurse Manager, revealed the following:
A large accumulation of discolored ice with purple and yellow colorations;
The thermometer was unreadable because it was frozen into the ice;
Sticky substances throughout the refrigerator;
Undated and unlabeled puddings, and
No refrigerator temperature logs.
Observation of the third-floor nourishment refrigerator for resident food on March 22, 2019, at 10:05 a.m. with the Director of Nursing revealed the following:
Unlabeled and undated two peanut butter cups, ice pops and ice cream containers, a moldy and malodorous food item belonging to Resident R69;
A lunch bag for Employee E16, licensed nurse;
A grey shopping bag that was undated and unlabeled containing a biohazard bag inside which were moldy crackers, cheese and pepperoni which smelled malodorous - the mold was identified by Employee E3, RN, Infection Control Nurse, and
Undated yoghurt and a baked breaded desert that was undated and unlabeled.
The facility failed to store, prepare, distribute and serve food in accordance with professional standards for food service safety for the main kitchen, both bistro kitchens located on the nursing units and the nourishment/resident food refrigerators on both nursing units.
28 Pa. Code 207.2(a) Administrator's responsibility
Previously cited 03/09/17
28 Pa. Code 211.6(b) Dietary services
| ||Plan of Correction - To be completed: 05/23/2019|
In the kitchen's waste disposal area in the parking lot, the circular trash can next to the compactor was emptied and the trash around the compactor was discarded.
In the kitchen's receiving door hallway, the 18 cardboard boxes were removed and Discarded.
In the kitchen's dish area, the 2 large wooden-handled plungers laying on the floor were discarded
The entire dish area was pressure washed. The drains were treated each night to reduce the presence of flies. Pest Control also treated the dish area.
The grouting will be replaced between 40 floor tiles and between baseboard tiles around the perimeter of the room.
The Dining Services Director is correctly documenting the dish-machine temperature logs.
The open frosted flakes cereal, raisin bran cereal, and 4 bowls of cereal with loose-fitting lids were discarded immediately.
On the ice cream box, the glass and grooves and handles of the box were cleaned to remove stains and debris
The standing mixer was cleaned to remove brown, yellow, and white substances.
The toaster, control knobs on the toaster, and the dust vents on the toaster were cleaned to remove bread debris and stains
The top exterior surface of the microwave was cleaned to remove the greasy substance.
The juice machine was cleaned to remove food-like debris and dust accumulation
The maintenance department repaired the ice machine in the kitchen so that the pipe has a 3" inch air gap from the drain
The waste water pipe from the ice machine was cleaned to remove the black substance.
The meat slicer was taken apart and cleared to remove the pink and yellow substances.
The plastic container of food thickener that was open to the air behind the meat slicer was discarded
On the 3-door frozen vegetable box, the maintenance department repaired the broken rubber gaskets.
In the 3-door frozen vegetable box, the bag of frozen cookies open to the air was discarded
Under the 3-door frozen vegetable box, the broccoli and bread roll were discarded
The trash can adjacent to the vegetable box was emptied, power washed, and a new liner was placed in the can
Above the single-door refrigerator unit, the ceiling tiles were replaced
The air vent above the single-door refrigerator unit was cleaned and added to a cleaning schedule
In the frozen meat box, the tray of unlabeled, undated cauliflower, the beef used for cheesesteaks open to the air, and the uncooked bread rolls that were unlabeled and undated were discarded
On the bread rack, the open packets of bread rolls were discarded
On the bread rack, the plastic container, open to the air was removed and cleaned to remove the dried yellow substance
All four food trucks were power washed to remove debris stains, sticky substances, and dust
In the dry food storage, the two boxes stored within 18-inches of the ceiling were removed and the maintenance department added an indicator on the wall to identify 18-inches from the ceiling
The 2 bulging ceiling tiles and two stained tiles in the dry storage area were replaced
The hole in the baseboard and multiple holes in the walls of the dry storage area were repaired and patched by the maintenance department
The marshmallows that were open and undated in the dry storage area were discarded
In the janitor's closet, multiple cardboard boxes stored directly on the floor were discarded
In the janitor's closet, the accumulation of dirty food preparation gloves mixed with bread slice cut-offs in the waste-water ceramic bin were discarded
The plates and bowls utilized for the tray line for lunch preparation were removed from the tray line, and cleaned and sanitized to remove stains and substances
The tray of raw chicken that was defrosting open to the air on the table adjacent to the sandwich preparation table, the blue cheese, ham, and salami were discarded
In the walk-in refrigerator, the door handle latch was repaired by the maintenance department so that it could properly create a tight seal
In the walk-in refrigerator, the one large plastic container of mandarin oranges, an orange coated in a white fluffy substance, caesar dressing that was expired, cabbage that was expired, the unlabeled, undated, and partially unwrapped meat-like substance, cooked poultry-like substance, cooked ham-like substance, liver substance, cheese-like substance, 3 trays of uncooked bread roll-like substances and five containers of fruit juice were discarded immediately
In the walk-in refrigerator, the ham the eight sour cream, 13 tartar sauce, 14 parmesan cheese, and 5 italian dressing cups that were open to the air were discarded
In the walk-in refrigerator, the gallon of whole milk undated and the dill pickles with illegible date were discarded
In the walk-in refrigerator, the 2 moldy apples, moldy zucchinis and moldy cucumbers were discarded
In the 2nd floor dining room, the undated and unlabeled bread stored in the cupboards was discarded
In the 2nd floor dining room, the microwave was cleaned to remove the yellow and brown substances
In the 3rd floor dining room, the maintenance department repaired the drainage pipe on the ice machine to create a 3-inch air gap between the waste-water outlet and the draining pipe
In the 3rd floor dining room, the undated and unlabeled one gallon of whole milk, lactose-free milk, and 2 bowls of cereal were discarded
In the 3rd floor dining room, the lump of ice with the yellow substance was removed as well as all of the ice, the ice machine was cleaned
In the 3rd floor dining room, the cupboards were cleaned and repaired of the damage
In the 3rd floor dining room, the ice machine scoop holder was replaced to ensure that water would not pool
In the 2nd floor medication room, the nourishment refrigerator was defrosted and cleaned to remove the large accumulation of ice and thaw the thermometer
In the nourishment refrigerator in the 2nd floor medication room, the undated and unlabeled puddings were discarded
Temperature logs were added to the nourishment refrigerator in the 2nd floor medication room
In the 3rd floor medication room, in the nourishment refrigerator, the unlabeled and undated peanut butter cups, ice pops, and ice cream containers, the grey shopping bag of unlabeled and undated employee food, and the undated yogurt and baked breaded dessert were discarded
Dining Services District Manager or designee to re-educate dining services staff on how to store, prepare, distribute, and serve food in accordance with professional standards for food service safety
Dining Services Director or designee to conduct weekly audits x 3 months to ensure that the dining services department is storing, preparing, distributing, and serving food in accordance with professional standards for food service safety
Center Executive Director will review audit findings at the monthly QAPI meeting x 3 months