§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.
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Observations:
Based on facility policy reviews, observations, and staff interviews, it was determined that the facility failed to store food, beverages, and nutritional supplements in accordance with professional standards for food service safety in the main kitchen, four of four nourishment areas, and two of three medication storage areas. Findings include: Review of facility policy, titled "Food Product Shelf-Life Guidelines", last revised January 28, 2022, revealed, "Manufacturer/supplier code dates, use by dates, use thru dates, or expires on dates should always be considered the first level of control ...products with a 'Sell By', Best By or (Before) or 'Use-By': Adhere to that date for quality reasons."
Further review of the aforementioned policy revealed that butter should be kept refrigerated or frozen. Review of facility policy, titled "Labeling and Dating Guide," last revised June 17, 2017, revealed, all juices have a use by date of three days or by expiration date. Observation of the walk-in refrigerator on January 8, 2024, at 9:53 AM, revealed: one bag of shredded red cabbage not dated; and four packs of margarine not dated.
Observation in walk-in freezer on January 8, 2024, at 9:56 AM, revealed: three bags of onion rings not dated; one bag of sausage links not dated; and one piping bag of whipped topping not dated. Observation during initial tour of the Colonial Park pantry area refrigerator on January 8, 2024, at 10:12 AM, revealed: one container of apple juice, red colored beverage, orange juice, and cranberry juice all not labeled or dated; and one container of thickened cranberry juice labeled with a use by date of January 5, 2024.
Further observation of the Colonial Park pantry area on January 8, 2024, at 10:15 AM, revealed: one open pack of hot dog buns not dated; four packs of English muffins not dated; one shelf of individual boxed cereals all not labeled with use by dates; one bin of individual jelly packets labeled use by January 6, 2024; one bin of oatmeal packets labeled use by January 4, 2024; and one bin of individual butter packets not dated and left out at room temperature.
Observation during initial tour of the Oak Lane pantry area refrigerator on January 8, 2024, at 10:21 AM, revealed one bin of individual creamer packets not dated.
Further observation of the Oak Lane pantry area on January 8, 2024, at 10:23 AM, revealed: four packs of individual cookies labeled use by January 4, 2024.
Observation during initial tour of the Oak Terrace pantry area refrigerator on January 8, 2024, at 10:26 AM, revealed one container of apple juice, red colored beverage, orange juice, and cranberry juice all not labeled or dated.
Observation during initial tour of the Oak View pantry area on January 8, 2024, at 10:28 AM, revealed: one bin of individual butter packets not dated and left out at room temperature; one bin of individual jellies not dated; and one bin of individual crackers not dated.
Interview with the Employee 1 (Food Service Director) on January 8, 2024, at 10:32 AM, revealed it is his expectation that expired items are discarded, food and beverages are labeled and dated per facility policy, and food items are stored in accordance with professional standards.
Interview with the Nursing Home Administrator (NHA) on January 9, 2024, at 10:41 AM, revealed it is the facility's expectation that expired items are discarded, foods items are labeled and dated per facility policy, and food items are stored in accordance with professional standards.
Observation of the Oak View/Oak Place medication room refrigerator on January 10, 2024, at 11:09 AM, revealed: 23 cartons of Ensure Plus protein supplement dated January 1, 2024.
Observation of the Oak Lane medication room refrigerator on January 10, 2024, at 11:16 AM, revealed: two cartons of Ensure Clear therapeutic nutrition supplement dated January 1, 2023; and one opened container of thickened lemon water with a best by date of July 12, 2023.
Email correspondence with the NHA on January 11, 2024, at 9:06 AM, revealed that he spoke with the manufacturer and the dates on the packaging are use by dates. He further revealed, "we have posted the attached [document] and updated the stockroom manager and nurses for awareness. Ensure has been difficult to get nationally and in short supply but we should not be holding on to it."
During a follow-up interview with the NHA on January 11, 2024, at 10:35 AM, he revealed the guidelines for stocking supplements have been posted and staff has been educated.
28 Pa. Code 211.6(f) Dietary services
| | Plan of Correction - To be completed: 02/29/2024
The kitchen and pantry food items discovered to be unlabeled and out of date were immediately discarded.
The medication room items (Ensure) identified in the nurse medication rooms as being outdated were also immediately discarded at time of discovery by the Director of Nursing. A daily walk through of the pantries, refrigerators and freezers is being conducted by the Food Services Director or designee to ensure that all food items are labeled and dated, with any outdated foods and unlabeled or undated foods discarded.
Education was provided to the Storeroom Clerk on January 11, 2024 by the Nursing Home Administrator and the Director of Nursing regarding the need to check dates on supplements and food items stored in the facility medication rooms. Moving forward these items will be checked routinely for date upon entering each area for weekly restocking activities, with any outdated items removed and disposed of. A daily walk-through of the pantries, refrigerators and freezers for outdated or unlabeled or undated food items will be completed by the Food Service Director or designee. Items that are out-of-date will be discarded and unlabeled foods will be labeled and dated if storage date is known or if not will be discarded. Documentation of unlabeled or outdated items will be completed to determine if additional action is required.
All dining staff will be in-serviced on the proper labeling and dating of foods and storage requirements, with training completed by January 31, 2024.
The Director of Nursing, Nursing Home Administrator or designee will conduct a weekly audit of all supplements and foods stored in medication rooms. Any outdated item will be discarded, and re-education of staff will be provided as needed when any items are found to be out of compliance.
A weekly audit of outdated/unlabeled food items from the daily walk through of refrigeration and freezer units will be completed by the Food Service Director or designee. If findings indicate that there continue to be outdated or unlabeled food items, staff will be re-in-serviced on proper storage of leftovers and labeling and dating procedures. Audits will be completed monthly with action plan developed if any non-compliance with labeling and dating concerns continue to exist.
Food service safety requirements related to unlabeled or outdated items will be presented as a standing agenda item as part of the facility's 2024 Quality Assurance and Performance Improvement meetings, for review and approval.
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