The hospital must have a full-time employee who-
(i) Serves as director of the food and dietetic services;
(ii) Is responsible for daily management of the dietary services; and
(iii) Is qualified by experience or training.
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Observations:
Based on observations, review of facility policy and procedures and interviews with staff (EMP), it was determined the facility failed to adhere to established facility policies regarding the safe handling of patient food. Observation tour of dietary department on December 4, 2023, at 12:25 PM in the walk in refrigerator off of main food preparation area revealed, eight vacuum sealed bags of what appeared to be beef loins with one tray labeled only with the date "December 10, 2023" on the label. Review on December 5, 2023, of facility policy, "Food Handling Practices" , dated July 15, 2023, revealed, "...4 ...All items must be stored off the floor, and must be properly covered, labeled, and dated ..." Interview on December 4, 2023, at approximately 1:00PM with EMP9 confirmed the beef was only labeled with the date December 10, 2023. Interview on December 5, 2023, at 1:34 PM with EMP8 confirmed the labels on the beef did not follow facility policy regarding food handling practices. ______________________________________________________________________ Based on observations, review of facility policy and procedures and interviews with staff (EMP), it was determined the facility failed to adhere to established facility policies regarding the safe handling of patient food. Observation tour of dietary department on December 4, 2023, at 1:34 PM in the patient snack preparation area, inside the stand alone refrigerator revealed, single serve clear containers with lids marked with the contents of the cups. Further observation revealed: four (4) egg salad cups with no date label, seven (7) chicken salad cups with no date label, one (1) ham salad cup with no date label, and five (5) tuna cups with no date label. Review on December 5, 2023, of facility policy, "Food Handling Practices", dated July 15, 2023, revealed, "...4 ...All items must be stored off the floor, and must be properly covered, labeled, and dated ..." Interview on December 4, 2023, at approximately 1:37 PM with EMP9 confirmed the single serve containers were not labeled with a date. Interview on December 5, 2023, at 1:41 PM with EMP8 confirmed the labels on the single serve cups did not follow facility policy regarding food handling practices.
| | Plan of Correction - To be completed: 01/03/2024
Dietary's Food Handling Practices Policy states: "All items must be stored off the floor, and must be properly covered labeled, and dated. Two instances were observed during the CMS tour where food items were not properly dated. Immediately following the tour, staff members involved were interviewed and stated they missed dating the food items. Both staff members were counseled for the infraction and reminded of the policy that all food items must be properly covered, labeled, and dated. On January 3, 2024, all department staff were in-serviced on the Food Handling Practices Policy.
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