|§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, review of facility policies, and interviews it was determined that the facility failed to store and serve food/beverages in accordance with professional standards for food safety for one of one dry storeroom, one of two walk-in refrigerators, five of eight unit nourishment pantries; two of two wall fans to the right of the dishwashing machine; and one of one wall fan to the left of the three compartment sink.
Review of the facilities Food Receiving and Storage policy, no initiated or revised date noted, revealed that "all foods stored in the refrigerator or freezer will be covered, labeled and dated("use by" date). "All foods belonging to residents must be labeled with the resident's name, the items and the "use by" date." The policy also revealed "beverages must be dated when opened and discarded after twenty-four hours."
During an observation in the dry storage room on September 30, 2019, at approximately 9:16 AM it was observed 2 squeeze bottles of chocolate topping (food enhancement product used for decorating a plate), 1 squeeze bottle of caramel topping (food enhancement product used for decorating a plate), 1 squeeze bottle of raspberry topping (food enhancement product used for decorating a plate), 1 squeeze bottle of vanilla topping (food enhancement product used for decorating a plate) were uncovered, didn't contain an open or use by date, and were not refrigerated after opening. The bottle of the aforementioned product contained "it is recommended to refrigerate this product after opening."
During an interview on September 30, 2019, at approximately 9:16 AM with Food Service Director 1 (FSD) 1 it was revealed that the aforementioned items should have been covered, dated with an open date, and refrigerated after opening.
During an observation in the walk-in refrigerator in the preparation area of the kitchen on September 30, 2019, at approximately 9:40 AM it was revealed that 3 trays with a total of 26 servings of chocolate cream pie in individual dishes, wrapped, that didn't contain a date. Review of the facilities cycle menu revealed that pie was on the menu for the previous weeks menu Friday for lunch.
During an interview on September 30, 2019, at approximately 9:40 AM with FSD 1 it was revealed that the aforementioned pie should have contained a date.
During an observation on October 1, 2019, at approximately 9:24 AM revealed two wall fans on the "clean" side of the dishwashing machine (the wall fan closest to the clean end of the dishwashing machine was turned on), and one wall fan on the clean side of the 3 compartment sink contained an excessive amount of a dark brown fuzzy substance.
During an interview with the FSD 1 on October 1, 2019, at approximately 9:25 AM revealed that maintenance is responsible for cleaning the fans.
During an interview on October 2, 2019, at approximately 9:54 AM with the Maintenance Director 1 (Main) 1 it was acknowledged that the fans need to be cleaned, it was also revealed that a contract company comes in annually to clean the fans, he was not sure the last time the fans were cleaned, stated that the company was called, but not sure when they are scheduled to come in.
During an observation in the McBride 1 st floor pantry on September 30, 2019, at approximately 10:23 AM revealed one cup of orange Italian ice without a resident name or room number, or a date.
During an interview on September 30, 2019, at approximately 10:23 AM with Registered Dietitian 1 (RD) 1 revealed that the Italian ice should contain a resident name and date.
During an observation in the McBride 3rd floor pantry on October 2, 2019, at approximately 9:36 AM revealed one gallon of red fruit punch open without an open or use by date.
During an interview on October 2, 2019, at approximately 9:36 AM with Licensed Practical Nurse 2 (LPN 2) it was revealed the fruit punch should be dated once opened.
During an observation in the McBride 4th floor pantry on October 1, 2019, at approximately 10:27 AM revealed 3 bags of vanilla wafers opened, not securely closed, and without an open or use by date.
During an interview on October 1, 2019, at approximately 10:27 AM with Licensed Practical Nurse 3 (LPN 3) it was revealed that the bags should be closed, and dated once opened.
During an observation in the South 3rd floor pantry on October 1, 2019, at approximately 9:37 AM revealed 1 carton of thawed chocolate and 1 carton of thawed vanilla mighty shake, without a thawed or use by date, 1 opened container of butter pecan med pass 2.0 ( nutrient dense nutritional supplement) without an open or use by date, 1 gallon of zero calorie ice tea without an open or use by date.
During an interview with Registered Nurse 1 (RN) 1 on October 1, 2019, at approximately 9:43 AM it was revealed that nurses pull the mighty shakes from the freezer and have been instructed to use thawed mighty shakes within 14 days. It was also revealed that items should be dated when opened, and to use nutritional supplements within 4 days after opening.
During an interview with FSD 1 on October 2, 2019, at approximately 1:23 PM it was revealed that when an item is opened it should be dated, and resident food should marked with a room number or name.
During an interview with the Nursing Home Administrator on October 2, 2019, at approximately 2:30 PM it was revealed that all items in the pantry refrigerators should contain a resident or a staff name and should contain a date the item was brought into the facility and/or an open date.
28 Pa Code 211.6(b)(d) Dietary Services
Previously cited: 9/20/18, 4/20/17, 1/12/17
| ||Plan of Correction - To be completed: 12/02/2019|
1. There were no residents affected with negative outcomes related to the condition of the kitchen wall fans or the identified foods not properly labeled and dated in the main kitchen and on the Nursing Units.
2. All food items not dated or properly labeled were discarded upon discovery on 9/30, 10/1 and 10/2/2019. The wall fans were removed from the main kitchen.
3. The Director of Culinary Services/Designee will educate the Culinary Service Staff regarding facility policy for FOOD RECEIVING AND STORAGE. Foods delivered to the Nursing units from Culinary Services will be properly labeled and dated upon delivery. Staff Development/Designee will educate the Nursing Staff (Nurse Manages, CNAs, Licensed Nurses), and Management Team regarding food receiving and storage as it pertains to supplements, snacks, beverages and personal resident foods on the nursing units. A written guideline for providing and storing personal resident foods will be included in the Admissions process and communicated to the Resident Council. Foods belonging to the residents will be labeled and dated by the staff member receiving that food product.
4. All kitchen storage areas, dry and refrigerated, will be inspected on a routine basis by a Culinary Services Manager to ensure proper food storage. The Director of Culinary Services/Designee will conduct Food Storage audits in the Main Kitchen 3 times per week X 4 weeks then 2 X per week for 2 months. All nursing unit pantry areas will be inspected for safe food storage on a routine basis by the Director of Culinary Service/Designee. The Director of Culinary Service/Designee will conduct food storage audits on their unit 3 X per week X 4 weeks then 2 X per week for 2 months. The findings will be reviewed at the monthly Quality Assurance meetings to identify need for further revisions and/or recommendations.