|§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 observations, interviews with staff, and a review of facility policies and documentation, it was determined that the facility did not ensure that food was stored, prepared, distributed, and served in accordance with professional standards for food service safety.
The undated "Food Storage" Policy # 4006, states, Leftover food is stored in covered containers or wrapped carefully and securely, clearly labeled, and dated before being refrigerated. Leftover food is used within 48 hours. (No single service containers are to be used to store food.) Scoops cannot be stored in the food containers but stored covered near the containers. Every refrigerator must be equipped with an inside thermometer. Rewrap packages of frozen foods which have been opened to prevent freezer burn and spoilage, re-label if original label has been removed.
An initial tour of the Food Service Department was conducted on February 4, 2019 at 9:30 AM with Employee E3, Acting Food Service Director, which revealed the following:
Observation in the receiving area outside the facility revealed that the food is delivered down a long sidewalk next to residential housing which includes open garbage cans and open recycling containers. Along this sidewalk are stacks of plastic bread racks, set of dollies with wheels for bread racks, stacks of empty milk crates and milk crates scattered along the sidewalk. During the tour of the outside of the facility the door was left propped open with a milk crate.
Observations in the walk-in freezer revealed no internal thermometer, two cases of beef steak fritters with broken boxes and left uncovered and open to the air, frozen cookie dough portions in an open plastic bag with no label or date and open to the air, a clear plastic bag of yellow eggs product in the shape of an omelet with no label or date and hamburger shaped meat patties in clear plastic packaging which were out of the master case with no label or date.
Observations in the dry storage room revealed a white container with a clear lid containing rice with a scoop left inside the container sitting directly in the rice. Further observations in the dry storage room revealed a crack in the wall in the corner near the door to the walk-in cooler, a brownish rust colored stain in the ceiling near above the crack in the wall and a heavy build-up of dust dirt and grime on the floor in the corner near the walk-in cooler door.
An observation in the walk-in cooler revealed no internal thermometer.
Observations in the kitchen revealed broken floor tiles on the step leading from the dry storage room down into the kitchen and more broken floor tiles in the main kitchen area. Further observation behind the cooks line revealed a floor drain which was recessed well below the floor surface and was located behind the steam table creating a tripping hazard, and broken floor tiles around the floor drain. Still further observation in the kitchen revealed that the plate warmer/lowerator had a build-up of yellowish substance on the exterior and interior surfaces, and that the bottom convection oven had a heavy build-up of black burned on substance on the inner surfaces of the oven including the glass door, and that the steamer had a build-up of dark substance on the bottom interior surface and the steamer door gasket had a coating of dark substance and was worn and torn, and the bottom of the gasket was almost completely missing and would not have effectively keep the steam from escaping from the bottom of the door creating a potential burn hazard. Observations of the floor and walls near the steamer revealed floor tiles missing grout and the space around the loose floor tiles was filled with stagnant water causing a slipping hazard and potential breeding ground for bacteria and pests, and a hole in the wall near the floor beside the steamer.
Observations of the three-door reach-in cooler revealed a stainless steel (ss) pan labeled "sauce" which was dated 1/23/19, a ss pan labeled "tomato soup" dated 1/20/19, a Styrofoam single service plate covered with plastic wrap containing two slices of meatloaf with no label or date, a stainless steel pan partially covered with torn plastic wrap contained a light colored meat in a hard, white fat with a label containing only a date of 1/30/19 and no food item name, and a stainless steel pan of a food which resembled applesauce which had only a date of 1/29/19 on the label but no food item name to identify the item. Further observation in the reach-in cooler revealed an open bottle of hot sauce and an open jar of grape jelly with no date when the items were opened.
Interview with Acting Food Service Director on February 4, 2019 at about 9:50 AM confirmed the above observations and indicated that the facility policy was to discard leftovers after 72 hours.
Observation on February 4, 2019, at approximately 10 AM in the pantry on the first-floor dining room revealed a refrigerator which contained three white plastic bags, two black plastic bags and one grey plastic bags all of which contained food items and none of the bags contained a label with a resident name or room number or a date when the bag containing perishable food was placed into the refrigerator. Further observation in the pantry refrigerator revealed a green container with a date of 12/25/18 and no label with identifying information about the food item or resident information. Still further observation in the first-floor pantry revealed a container of margarine portion cups with keep refrigerated on each individual cup which was found on the shelf in the cupboard above the counter and there was no date on the container indicating how long the margarine was in the cabinet at room temperature.
Observation on February 4, 2019, at approximately 10:10 AM in the pantry on the second floor dining room revealed a refrigerator which contained a single service Styrofoam cup with a straw in the lid containing liquid but had no label or date, a yellow plastic bag containing food with no label or date, a blue cloth lunch bag and a striped insulated lunch bag each containing food with no label, date or resident name or room number. Further observation in the second-floor pantry revealed the stainless steel shelf under the counter was dusty and contained food particles and crumbs and the shelf under the steam table had a build-up of yellowish substance along with dust and dirt. Still further observation revealed a hole in the wall near the floor by the steamer.
Interview with the Acting Food Service Director on February 4, 2019 at about 10:15 AM confirmed the above observations and indicated that the pantry refrigerators were for resident food which should be labeled and dated and that most of the food in the bags belonged to staff and that the margarine should not be stored at room temperature. Interview with second floor Unit Manager confirmed that the staff should not keep their lunches in the pantry refrigerators.
Observations in the dish room on February 7, 2019 at approximately 11:30 AM revealed many missing and some broken floor tiles near the dish machine, and a heavy black build-up of dust, dirt and grime on the walls and pipes under the dish tables.
An interview with the Acting Food Service Director on February 7, 2019 at about 10:40 AM confirmed the missing floor tiles and lack of sanitation in the dish room.
The facility failed to store, prepare and serve food in accordance with professional standards for food service safety.
28 Pa. Code 201.14(a) Responsibility of licensee
Previously cited 9/20/18, 3/30/18
28 Pa. Code 201.18(b)(3) Management
Previously cited 3/30/18
28 PA. Code: 207.2(a) Administrator's responsibility
| ||Plan of Correction - To be completed: 03/07/2019|
All unlabeled/undated/outdated/spoiled items and open boxes in any fridge, freezer, or food storage area was discarded immediately. Thermometers were placed in all freezers and refrigerators where resident food is kept. Food delivery pathway has been changed to a location that avoids the residential housing garbage cans and recycling containers. The steamer was thoroughly cleaned and the The ovens were thoroughly cleaned.
Residents receiving meals have the potential to be affected.
Dietary Manager will reeducate dietary staff on ensuring that food is stored prepared, distributed, and served with professional standards for food service safety. Education will include cleaning schedules and audits of food prep and storage areas, food delivery, food storage temperature audits, notification of maintenance services when maintenance issues are identified, and adhering to food storage policy.
The crack in the wall in the corner near the door to the walk in cooler and brownish discolored area on the ceiling in the dry food storage area will be repaired through the roofer repairing the drain line and maintenance staff replacing the damaged wall and repairing the ceiling. Housekeeping staff will thoroughly clean the floor in the dry food storage area. The floor in the dry storage area will be cleaned. The broken tile in the kitchen and the dish machine will be replaced. The plate warmer/lowerator, convection oven, and steamer will be cleaned both interior/exterior surfaces. The drain will be raised to the level of the floor to prevent a trip hazard. The other drain which is capped that contained the stagnant water will also be raised to the level of the floor to prevent water from pooling. Hole in wall by the steamer will be repaired. Both Pantry areas were cleaned. Gasket for the steamer will be replaced.
Dietary Manager or designee will review cleaning schedules and audits of food prep and storage areas, food delivery, food storage temperature audits, notification of maintenance services when maintenance issues are identified, and adhering to food storage policy daily for 1 month and weekly with the Administrator for 3 months.
Findings of the audit will be submitted to the QAPI for additional review/recommendations.
Date of Compliance: 3/7/19