Nursing Investigation Results -

Pennsylvania Department of Health
Patient Care Inspection Results

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Inspection Results For:

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GARDENS AT ORANGEVILLE, THE - Inspection Results Scope of Citation
Number of Residents Affected
By Deficient Practice
Initial comments:

Based on an abbreviated complaint survey completed on January 2, 2020, it was determined that The Gardens at Orangeville was not in compliance with the following requirements of 42 CFR Part 483, Subpart B, Requirements for Long Term Care and the 28 PA Code, Commonwealth of Pennsylvania Long Term Care Licensure Regulations.

 Plan of Correction:

483.60(i)(1)(2) REQUIREMENT Food Procurement,Store/Prepare/Serve-Sanitary:This is a less serious (but not lowest level) deficiency and affects more than a limited number of residents, staff, or occurrences. This deficiency is one that results in minimal discomfort to the resident or has the potential (not yet realized) to negatively affect the resident's ability to achieve his/her highest functional status. This deficiency was not found to be throughout this facility.
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 of the nutritional service department and interview with the Food Service Manager it was revealed that the facility failed to consistently adhere to acceptable food safety practices for warewashing (term used to describe the act of collecting and washing any kitchen ware used in the preparation, serving, or storing food. Although not an exhaustive list, this mainly refers to the pots and pans, cutlery, flatware, glasses, kitchenware, serving pans, and trays).

Findings include:

Food safety and inspection standards for safe food handling indicate that everything that comes in contact with food must be kept clean and food that is mishandled can lead to foodborne illness. Safe steps in food handling, cooking, and storage are essential in preventing foodborne illness. You cannot always see, smell, or taste harmful bacteria that may cause illness according to the USDA (The United States Department of Agriculture, also known as the Agriculture Department, is the U.S. federal executive department responsible for developing and executing federal laws related to food).

A review of the facility policy for "Dish Machine Temperatures (Low Temperature Machine)and Sanitizer Testing" last revised by the facility June 2014 and observations conducted on January 2, 2020, revealed that the facility utilized a chemical low temperature dish machine
(a low temp machine, both washes and rinses at temperatures between 120 and 140 degrees Fahrenheit. Because these temperatures are not high enough to sanitize by themselves, low temperature commercial dishwashers must use chemical sanitizing agents with the water).

According to this policy the wash and rinse temperatures were to be obtained and recorded during each meal to assure they met or exceeded the goal temperature, which was to be in excess of 120 degrees fahrenheit.

A review of the facility's dishwasher temperature log for December 2019, revealed that staff had not obtained the dish machine temperatures on December 1, 2, 30, 2019, for the evening meal. The documented temperatures and sanitizer check for December 18, 2019 were "crossed out" for the morning and afternoon meals.

Interview with the Food Service Manager and the Environmental Services Director on January 2, 2020 at 2:30 p.m., revealed that these staff members were unable to provide a copy of the manufacturer's guidelines for the use of the facility's dish machine.

Observations in the nutritional service department on January 2, 2020, at 2:17 p.m. revealed that the dietary staff was in the process of washing of dishware and utensils used at the afternoon lunch meal. Continued observations revealed that the wash chemicals required for this process (utilized to remove food particles as the first of three chemical steps in the warewashing process) was extremely low in supply with only a thin layer of chemical on the bottom of the dispenser.

When interviewed at the time of the observation the Food Service Manager estimated that the facility would likely have enough wash chemical remaining to complete the wash process for the evening meal and possibly also the breakfast meal the next morning. However, the Food Service Manager was unable to to state with any certainly how long the minimal amount of chemical washing agent would last.

Observation of the facility's chemical storage area revealed that other types of cleaning chemicals had been delivered to the facility that day, but the chemical specified for the wash cycle was not among the products delivered to the facility when observed on January 2, 2020, at approximately 2:30 PM.

Continued interview with the Food Service Manager at that time revealed that she had been "having difficulty" obtaining this wash chemical, with issues arising during the last two deliveries to the facility. She stated that she had to borrow her last supply for another area facility. There was no evidence that the facility had established par levels (system determines the minimum level of inventory necessary to be on hand for a specific period and requires automatic replenishment if the level of inventory falls below that level) of necessary chemicals for the dishmachine to prevent the potential of running out of the required chemical agents for effective washing and sanitization of dishware.

The facility failed to assure that necessary supplies were consistently available, in sufficient quantities, for use in the routine operation of the facility's warewashing and on an emergency basis. The facility further failed to consistently monitor dish machine temperatures, and sanitizer dispensing, during meals to ensure consistent maintenance of wash and rinse temperatures necessary for effective sanitization.

28 Pa. Code 207.2(a) Administrator Responsibility.

28 Pa. Code 211.6(c)(d) Dietary Services.


 Plan of Correction - To be completed: 01/20/2020

The chemical washing agent was obtained on 1/2/2020 from sister facility. Chemical washing agent was delivered to facility from provider on 1/3/2020. Par level for emergency backup of 1 - 5-gallon container of each of the detergent, sanitizer and rinse has been established.
Dietary staff re-educated on obtaining and recording the dish machine temperatures for each meal to assure it meets or exceeds which is to be 120 degrees Fahrenheit.
Audit of dish machine temperature will be completed daily x5 days, then three times per week x4, then weekly x4. Audit of dish washing agents to be completed weekly to ensure adequate supply with par levels.
Audits to QA for review and recommendations.

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