§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, review of facility policy, and interview 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 reach-in refrigerator, one of one walk-in refrigerator in the main kitchen; and one of one reach-in refrigerator in the Main Dining Room; and one of one nourishment pantry refrigerator in the nursing unit.
Findings include:
Review of the contract Foodservice Company's policy Maximum Storage Period of Dried Foods, revised December 2018, revealed that juices, and fruit drinks are good for up to 7 days once opened; and salad dressings once opened refer to the expiration date.
Review of the contract Foodservice Company's policy Use of Hair Restraints, revised December 2018, revealed "Hair nets, caps, chef hats and/or beard restraints must be worn when any employee is in the food production and kitchen area."
Observation in the reach-in refrigerator in the Main Dining Room on July 22, 2019, at approximately 9:05 AM revealed: One container of honey thickened milk open with no open or use by date; One container of honey thickened milk open with an open date of June 20th, use by date of June 27th was scribbled out then written September 15th; One container of nectar thickened orange juice open with no open or use by date; One container of nectar thickened apple juice, with no open or use by date; One container of nectar thickened water open with no open or use by date; Two containers of nectar thickened cranberry juice open with no open or use by date; 1 container of nectar thickened apple juice open with no open date, a use by date of Jan 12, 2019; One container of honey thickened orange Juice with no open or use by date; five of five shelves contained a black substance, that was able to be wiped off, on and underneath each shelf, and orange and red liquid on the inside floor of the refrigerator.
During an interview with the General Manager 1 (GM) 1 on July 22, 2019, at approximately 9:10 AM revealed that the facility has an expiration date check list, and the used by date for open juice/beverages is 7 days, it was also revealed that the shelves are on a cleaning schedule but should be cleaned as need.
During an interview with Nursing Home Administrator on July 25, 2019, at approximately 9:36 AM revealed that when beverages are opened they should be dated with an open or use by date. It was also revealed that if the refrigerator or shelves become dirty between the scheduled cleaning time they should be wiped down or cleaned as needed.
During an observation on July 22, 2019, at approximately 9:24 AM in the kitchen reach-in refrigerator three shelves contained a brown substance and a white substance that could be wiped off.
During an interview with the General Manager 1 (GM) 1 on July 22, 2019, at approximately 9:24 AM it was revealed that the shelves should be cleaned.
During an observation on July 22, 2019, at approximately 9:30 AM in the walk-in refrigerator in the kitchen there were 4 shelves, 2 on each side of the refrigerator, that contained a reddish-brown colored substance that didn't wipe off and an accumulation of dust and food residue that wiped off.
During an interview with the General Manager 1 (GM) 1 on July 22, 2019, at approximately 9:30 AM it was revealed that the refrigerator shelves are on a cleaning schedule. At that time it was also revealed that the shelves are worn and discolored, and they don't clean well.
On July 22, 2019, at approximately 9:30 AM in the walk-in refrigerator in the kitchen the following observations of salad dressings were made: One container of creamy Caesar salad dressing that was open with a sticker on container that revealed an open date of June 11, 2019, a use by date of November 11, 2019, and stamped on the container a manufacturer's date of April 3, 2019; One container of Italian salad dressing that was open with an open date of July 6, 2019, a use by date of August 10, 2019, and stamped on the container a manufacturer's date of April 3, 2019; One container of French salad dressing that was open with an open date of June 28, 2019, a use by date of July 28, 2019, and stamped on the container a manufacturer's date of May 7, 2019; One container of Blue Cheese salad dressing that was open with an open date of June 14, 2019, a use by date of December 14, 2019, and stamped on the container a manufacturer's date of December 14, 2019; One container of Honey Mustard salad dressing that was open with an open date of July 6, 2019, a use by date of December 10, 2019, and stamped on the container a manufacturer's date of May 7, 2019; One container of Honey Mustard salad dressing that was open, with no open or use by date.
During an interview with the General Manager 1 (GM) 1 on July 22, 2019, at approximately 9:35 AM it was revealed that the Food Service company's guideline for use by date of salad dressing once opened is the product expiration date. It was also revealed that the manufacturer's date is not the expiration date, and that the GM 1 wasn't sure what the expiration date is for the aforementioned items, and that it wasn't displayed on the aforementioned containers.
Interview with Nursing Home Administrator on July 25, 2019, at approximately 9:36 AM revealed that when food items are opened they should be dated with an open or use by date. It was also revealed that if the refrigerator and or shelves become dirty between the scheduled cleaning time they should be wiped down or cleaned as needed.
Observation on July 25, 2019, at approximately 11:03 AM revealed the accumulation of dust and food residue was removed, the reddish-brown substance remained on the front trim and side poles of the shelves.
During an interview with the GM 1 on July 25, 2019, at approximately 11:03 AM revealed that the shelves were cleaned, however the shelves the reddish-brown substance didn't come off. It was revealed that the per the manufacture's guideline the salad dressing is good for 14 days once opened
Observation on July 22, 2019, at approximately 9:55 AM in nursing unit nourishment pantry refrigerator the following supplement, and juice containers were open, and didn't contain an open and/or a use by date: Three containers of nutritional supplement 2.0 (a liquid nutritional supplement use to provide added calories and nutritive value); One container of honey thickened water; Two containers of nectar thickened orange juice; One container nectar thickened cranberry juice; One container honey thickened cranberry juice; and 1 container honey thickened orange juice.
During an interview with the GM 1 on July 22, 2019, at approximately 9:57 AM it was revealed when a container is opened it should be dated with an open date, and that it is good for 7 days.
During an interview with the Nursing Home Administrator on July 25, 2019, at approximately 9:36 AM it was revealed that when beverages are opened they should be dated with an open or use by date.
During an observation of trayline service in the kitchen on July 22, 2019, at approximately 11:30 AM it was revealed that Assistant General Manager 1 was in the food preparation area and behind the steam table, and he had a short beard and mustache, and wasn't wearing a beard net. Further observation made at 11:35 AM in the same area revealed GM 1 with a short beard and mustache, and wasn't wearing a beard net.
During an interview with the Nursing Home Administrator on July 25, 2019, at approximately 9:36 AM it was revealed that a beard restraint should be worn by any staff member with a beard or mustache in the food production area.
During an interview with GM on July 25, 2019, at approximately 11:06 AM it was revealed that beard nets should have been worn by staff members with a beard and/or mustache while in the food production area.
28 Pa Code 211.6(b)(d) Dietary Services
| | Plan of Correction - To be completed: 09/09/2019
At the time of the survey GM/district manager audited refrigerators and removed any products that did not have dating and labeling according to (standard).
At the time of the survey on July 22, 2019 the dining assistant was in the middle of completing the cleaning schedule in the main refrigerator when the surveyor noticed the black and red and orange substance. The dining assistant immediately wiped down the shelves and removed the white, brown and black substance.
At the time of the survey GM and dining team members immediately wore beard nets when in the food production or kitchen areas.
At the time of the survey GM/district manager audited refrigerators and removed any products that did not have labels.
A deep clean of the walk in refrigerator and cleaning of shelving and floors will be completed. The shelving that had the brown-reddish substance or could not be wiped off will be replaced.
Dining team members will be re-educated to wear beard nets immediately.
Re-education to dining and nursing team members on the dating and labeling process.
New stickers will be utilized to include open and used by date.
Food and sanitation audit will include proper label and dating.
Re-education to dining team members of the cleaning schedule which includes shelves, floor, and post. Dining team members will be re-educated that in between the cleaning schedules if refrigerator, floor or equipment appears dirty it must be cleaned.
Re-education to dining team members on Use of Hair Restraints Policy.
GM/designee will audit the refrigerators weekly times 3 and weekly x 8 to ensure cleanliness, and dating and labeling process is being followed. Findings of the audits will be brought to QAPI for further recommendation.
GM/designee will audit team members 3 times a week x four weeks and then weekly times 8 to ensure beard nets are being worn. Findings of the audits will be brought to QAPI for further recommendations.
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