§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 and employee breakroom.
Findings include:
Observation of the facility's main kitchen on February 13, 2024, at 9:30 AM with Employee 1, food service director revealed the following:
A large gray garbage can in the food preparation area across from the coolers was observed with visible dried food and dried liquid runs on the exterior of the lid and can, crumbs and debris were observed collected in the grooves of the handles.
The coating of shelves in the coolers by the floor mixer was peeled/worn off in several locations exposing rust colored metal.
Flooring throughout the kitchen under preparation tables, steam table, and coolers, along with the wall edges in corners and behind equipment was observed with significant debris and black buildup.
The lower shelf of the preparation table and steam table contained dried spills and splatter, and dried food debris. Pans and cooking equipment on the shelves also had dried food splatter.
A single door cooler containing juices had dried spills in the interior and on the vent on the front of the cooler.
A three-tier cart parked beside the juice cooler was covered in large brown stains on the top shelf, along with several dried brown spills throughout the cart.
A foot pedal garbage can located in the corner by the juice cooler was observed with a soiled exterior with dried food and dried liquid. Dried food was observed on the wall behind the garbage can.
The bottom shelf of the table holding the toaster was observed covered in crumbs and debris. A power strip running along the wall behind the toaster table contained a buildup of dust and dried food, which extended along the wall. The lower shelf of the steamer was covered in debris, dried food, and pots. The lids sitting on the shelf were covered in a dried white substance. The shelf was greasy and sticky to touch. Dried liquid spills/splatter were observed down the side of the stove directly beside the steamer.
The exhaust vent panels over the stove/cooktop area contained thick visible dust buildup throughout, the pipe of the fire suppression system directly above the cooktop/stove was covered in dust. The white wall behind the stove was covered in brown buildup.
The top of the convection ovens had visible dust and was sticky to touch. Employee 1 stated he had just wiped it off that morning.
Three large clear bins with lids were observed sitting on the lower shelf of a preparation table, one was filled with a white granular substance, another with a white powdery substance, and the third with a brown granular substance. None of the containers were labeled with the contents of the bin, when it was placed there, or when it expired. Employee 1 indicated the containers were white sugar, flour, and brown sugar.
Flooring throughout the dish room area under the machine and along the walls was observed with dirt and debris. Used bottles, lids, cups, pudding cup, and wrappers were observed scattered under the machine area. The pipes under the machine and wall area under the machine had dried splatter and dust. A metal panel covering the grease trap was dirty and appeared rusty. Tile grout surrounding the grease trap area was broken and crumbling along the wall behind the grease trap.
A meal tray/silverware/condiment cart was observed in the dish room with some plates on the top shelf and serving trays on the lower shelf. Employee 1 indicated they were clean. The shelves holding the plates and trays was covered in crumbs and dust. The tops had plastic containers covered in plastic bags stuck down in the holes on the top of the cart, which were holding various condiments such as salt, pepper, and sugar packets. The bags were sticky to touch. The bags were sticking to the metal holder when trying to remove the containers from the holes. Brown, sticky rings were observed around the holes where the containers covered in bags were removed.
A metal ceiling vent over the dish machine was rusted.
Flooring in the dry storage room was observed with debris throughout under the shelving units. The floor behind the door to the dry storage room, which was propped open upon entering was observed with a large pile of dirt, cereal pieces, and other debris behind the door.
The lower shelve in the dry storage area had various food products that contained dust and debris. One shelf was observed with a black apron sitting on the shelf behind food products covered in a white powdery substance.
Two ceiling vents in the dry storage room were observed with visible thick dust.
The chemical room was filled with boxes of paper products (plates, cups, etc.), stored directly on the floor. Employee 1 indicated there was no place to store the paper products when they ordered them for infection control outbreaks.
An observation of the facility ice machine located across from the kitchen in the employee break room on February 14, 2024, at 1:03 PM revealed a wet floor sign sitting in front of the ice machine. The floor under and extending out around the ice machine was saturated with water pooling under the ice machine. The floor under the machine was observed with a black build up, a piece of curled plastic resembling cove base material, as well as a pink plastic bin shoved up along the wall. Concurrently Employee 3, nurse aide, entered the room with a cooler on a cart. Employee 3 indicated the ice machine was used to obtain ice in the cooler carts for water pass on the units.
Employee 3 proceeded to lift the cooler off the top of the cart and dump water from the cooler in the sink in the area. A large gray plastic drainage bin was observed underneath where the cooler was removed from the cart with approximately one inch of water in the bin. A significant amount of white debris was observed floating in the water and settled on the bottom of the bin. A pink film was observed on the interior bottom of the bin extending to the sides. Employee 3 indicated the dietary staff were to clean the ice carts but was not sure when that happens.
The above findings were reviewed with the Nursing Home Administrator and Director of Nursing on February 14, 2024, at 3:24 PM.
483.60(i)(2) Store, prepare, food safe and sanitary Previously cited 7/13/23, 11/8/23
28 Pa. Code 201.14 (a) Responsibility of Licensee
| | Plan of Correction - To be completed: 04/02/2024
1-Cited: Garbage cans, kitchen floor and dry storage area floor, lower shelf of the preparation table and steam table, cooking equipment, coolers, vents, three-tier cart, kitchen walls, toaster area, power strip on wall, shelves, stove, the exhaust vent panels over the stove, cooktop area, the fire suppression system, the top of the convection ovens, the pipes under the dish machine and wall area under the machine, the grease trap area, the meal tray/silverware/condiment cart, shelves in dry storage area were cleaned. The black aprons were cleaned. The coating on the shelves in the coolers were repaired. The tile grout surrounding the grease trap was repaired. The metal ceiling vent over the dish machine was repaired. The bins holding the white sugar, flour, and brown sugar were labeled and dated. Used bottles, lids, cups, pudding cups, and wrappers were cleaned up from under the dish machine area. The paper products were stored in the lower level of the facility. The ice machine area in the employee breakroom was cleaned and plastic bin to retrieve ice is stored in bag. The cooler was cleaned. 2-Like: Facility sweep will occur to ensure ice coolers are sanitary. There is only one ice machine and one kitchen/dry storage area in the facility. Facility wide ceiling vents will be audited. 3-Educations: NHA/designee will educate the food service director on sanitary storage of kitchen (including equipment), dry storage, and the ice machine. NHA/designee will also educate staff of the routinely cleaning schedule of ice chests already in place, done weekly. 4-Audits: BOM/designee will audit the kitchen, dry storage area, and ice machine weekly x 4 weeks and monthly x 2 months. Results will be taken through QAPI.
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