§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 observation and staff interview, it was determined the facility failed to store food and maintain food service equipment in accordance with professional standards for food service safety in the facility's main kitchen, dining area, and food storeroom.
Findings include:
Observation of the facility's main kitchen on February 27, 2024, at 9:20 AM with Employee 1, cook, revealed the following:
A large garbage can in the food preparation area across from the dishwasher was observed with visible dried food and dried liquid runs on the exterior of the can and the lid was not present. The lid was on top of the garbage can next to the handwashing sink.
The cook's refrigerator contained a plastic bag of sliced onions, that were not dated. Employee 1 indicated that nursing staff had leftovers and gave them to the kitchen in case they were needed but they were not used. Also in the refrigerator were the following food items that were not dated with a use-by date or expiration date: six slices of bread, two plastic squeeze bottles of Italian dressing, two sticky plastic squeeze bottles of sauce that was identified as barbeque sauce and two plastic squeeze bottles that was identified as liquid butter by Employee 1, two containers of mustard, two cartons of orange juice, and a partial pack of hamburger rolls. Employee 1 indicated that the items in the squeeze bottles were taken from the original containers to make it easier for resident use at the tables. In addition, in the refrigerator was an open container of beef broth that was not dated with the open date and the label indicated to use within 14 days of opening, a container of tomato sauce with a use-by date of February 25, 2024, a container of tapioca pudding with use-by date of February 26, 2024, a partial tray of yellow cake with chocolate icing that was dated as made on February 23, 2024, and a container of cheesy broccoli soup with use-by date of February 24, 2024. Employee 1 indicated that cooked food is good for three days after making.
The plastic shelving unit contained an open container of drink thickener with the expiration date of February 25, 2024, and a spray bottle labeled as a sanitizer that was stored with the food items.
The shelving unit near the coffee machine contained three bags of homemade cookies with no use-by date, a container of individual coffee creamers without a use-by date or expiration date, bins of single serve condiments (ketchup, mustard, honey, jelly, barbeque sauce, salad dressing, mayonnaise, and syrup) without expiration dates, and a bottle of coconut syrup that was labeled for staff use with a best-by date of December 14, 2023.
The cupboard on the bottom of the steam table housed single serve condiments without expirations dates.
The corner shelf next to the cook's refrigerator contained an open jar of peanut butter with the expiration date of November 6, 2023, a 22-pound container of chocolate icing with a use-by date of January 16, 2024, and a container of flour, two bags of cake mix, and a bag of rice pilaf that were not dated with expiration dates.
The drink refrigerator contained a pitcher of honey-thick lemonade with a use-by date of February 24, 2024, and an open container of Thick and Easy drink without a use-by date. The Thick and Easy label indicated to use the product within 10 days of opening.
Tour of the facility's food storage area was done after the tour of the main kitchen with Employee 2, dietary aide, and revealed the following:
The shelving unit contained the following food items without expiration dates: a bin of flour, a box of graham crackers, three boxes of cookies, and two boxes of oatmeal pies. In addition, a box of cookies was on the shelf with an expiration date of October 24, 2023.
Another shelving unit contained the following food items without expiration dates: brownie and cake mixes, chicken and beef bases, packs of rice pilaf, packs of potato pearls, and #10 cans of food.
The walk-in freezer contained bags of chicken and hamburger without any expiration dates.
The stand-up refrigerator contained the following items without expiration dates: 12 cartons of orange juice and seven packs of luncheon meat. A bag of lettuce that had browning and wilting had a use-by date of February 24, 2024.
The emergency food section contained numerous cans of evaporated milk with an expiration date of January 20, 2024. The canned goods were labeled with Julian dates (dates according to the Julian calendar, that represents the date the food as manufactured or packaged). Employee 2 did not know how to read the Julian dates and determine the use-by dates of the emergency canned food.
The surveyor reviewed the findings for the kitchen and storage area with Employee 3, dietary manager, on February 27, 2024, at 1:45 PM.
The surveyor reviewed the above findings with the Nursing Home Administrator on February 27, 2024, at 2:15 PM.
Observation on February 29, 2024, at 12:10 PM of the facility's ice machine that is in a room in the main dining room revealed there was no visible air gap from the ice machine between the indirect waste pipe and the flood level rim of the waste receptor as indicted in International Plumbing Code 802.3.1 and 802.3.2 of 2018.
The above findings were reviewed with the Nursing Home Administrator on February 29, 2024, at 12:15 PM.
28 Pa. Code 201.14 (a) Responsibility of Licensee
| | Plan of Correction - To be completed: 04/16/2024
1-A large garbage can in the food preparation area across from the dishwasher was observed with visible dried food and showed no lid--LID was placed on garbage can and garbage can will be cleaned.Refrigerators will be audited ensuring open date is on items along with expiration dates. The plastic shelving unit contained an open container of drink thickener with the expiration date of February 25, 2024,-This was tossed out. Audit of food items will be completed ensuring dates are on items and any expired items are tossed out.Food items will be audited to ensure food items are stocked and organized with food items only and not mixed with other items.
The shelving unit near the coffee machine contained three bags of homemade cookies with no use-by date, a container of individual coffee creamers without a use-by date or expiration date, bins of single serve condiments (ketchup, mustard, honey, jelly, barbeque sauce, salad dressing, mayonnaise, and syrup) without expiration dates, and a bottle of coconut syrup that was labeled for staff use with a best-by date of December 14, 2023.-ITEMS will be audited and ensured that there is a use date and or expiration date. expired items were tossed out. The cupboard on the bottom of the steam table housed single serve condiments without expirations dates.-Use date and or expiration date will be added. The corner shelf next to the cook's refrigerator contained an open jar of peanut butter with the expiration date of November 6, 2023, a 22-pound container of chocolate icing with a use-by date of January 16, 2024, and a container of flour, two bags of cake mix, and a bag of rice pilaf that were not dated with expiration dates. -Expired items were tossed out. Dates will be added to to food items. The drink refrigerator contained a pitcher of honey-thick lemonade with a use-by date of February 24, 2024, and an open container of Thick and Easy drink without a use-by date. The Thick and Easy label indicated to use the product within 10 days of opening.-Expired items were tossed out. Items were labeled with a use date and or expiration date. Storage area-The shelving unit contained the following food items without expiration dates: a bin of flour, a box of graham crackers, three boxes of cookies, and two boxes of oatmeal pies. In addition, a box of cookies was on the shelf with an expiration date of October 24, 2023.-Items that are expired will be tossed out. Items will have a use date and or expiration date added. Another shelving unit contained the following food items without expiration dates: brownie and cake mixes, chicken and beef bases, packs of rice pilaf, packs of potato pearls, and #10 cans of food.-Items that are expired will be tossed out. Items will have a use date and or expiration date added. The walk-in freezer contained bags of chicken and hamburger without any expiration dates.-ITEMS will be reviewed and expired items will be tossed out other items will be reviewed and audited to ensure a use by date and or expiration date is labeled on food item. All items when opened will have a open date added as well. The stand-up refrigerator contained the following items without expiration dates: 12 cartons of orange juice and seven packs of luncheon meat. A bag of lettuce that had browning and wilting had a use-by date of February 24, 2024.-ITEMS will be reviewed and items that are expired will be tossed out. The emergency food section contained numerous cans of evaporated milk with an expiration date of January 20, 2024. The canned goods were labeled with Julian dates (dates according to the Julian calendar, that represents the date the food as manufactured or packaged). Employee 2 did not know how to read the Julian dates and determine the use-by dates of the emergency canned food.-ITMES will be converted over and kitchen staff will be educated on Julian calendar dates.
2-Full kitchen audit of all refrigerators and storage areas will be audited to ensure an open date is labeled on item if open along with a use by and or expiration date.
3-Dietary manager will be educated by NHA to ensure that the Kitchen staff are educated on facilities daily and weekly kitchen audit schedules that are to be completed ensuring compliance with storing and labeling. Julian calendar dates and understanding will be gone over with the kitchen staff.
4-NHA/Designee will audit weekly refrigerators and storage areas ensuring that the facility is using daily kitchen audits and ensuring open dates are placed on items along with having used by date and or expiration date. NHA/Designee will also audit to ensure there are no expired items in storage area/refrigerators as well as audit to ensure kitchen garbage cans are clean and have lids. Audits will be completed randomly weekly x 4 weeks than monthly x 2 months results will be reviewed in QAPI.
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