| 32 |
KETCHIKAN MED CTR NEW HORIZONS TRANSITIONAL CARE |
25010 |
3100 TONGASS AVENUE |
KETCHIKAN |
AK |
99901 |
2019-08-23 |
812 |
F |
1 |
1 |
0OWF11 |
> Based on observation, interview and record review the facility failed to ensure: 1) Food was stored, prepared and distributed in a safe and/or sanitary manner in accordance with professional standards and 2) the environment was maintained and monitored in a clean and sanitary condition. This failed practice placed all residents (based on a census of 21) at risk for foodborne illness. Findings: Food Storage/Cleanliness: During random observations on 8/19/19 of the central kitchen's dry storage area revealed: - 27 eight ounce cans of Nepro Supplement with best by dates of 8/1/19; - 1 case of Tostito's chips stored on the floor; - Shredded Sauerkraut (6 lbs 3 oz) with large dent located on the seal; - Sliced nacho jalapeno peppers with a 2 inch dent located just below the can's seal; and - 50 oz can of cream of mushroom with 1 inch dent located on the can's seal. During an interview on 8/19/19 at 2:00 pm the Dietary Manager stated the items identified in the dry storage should have been removed. Review of the U.S. Department of Health and Human Services (USDHHS) - Food and Drug Administration (FDA) Food Code, dated (YEAR), revealed Food shall be safe, unadulterated .dented cans may .present a serious potential hazard. During random observations on 8/19/19 of the central kitchen's walk-in cooler revealed a cracked and leaking plastic container of thawed pot roast. A leak of red tinged fluid that was dripping on the shelving unit and on the top of the plastic bin just below the pot roast. Review of the USDHHS - FDA Food Code, dated (YEAR), revealed food shall be protected from cross contamination by separating raw animal foods during storage. During an interview on 8/19/19 at 2:10 pm the Dietary Manager stated he/she was unaware of the leaking container and it should have been removed from service. During an observation on 8/19/19 of the central kitchen's walk-in freezer revealed a four pound package of salami slices that were open-to-air. The salami slices had frozen white crystals and appeared to be pale and green in color. Review of the USDHHS - FDA Food Code, dated (YEAR), revealed food packages shall be in good condition and protect the integrity of the contents so that the food is not exposed to adulterations or potential contaminants. During an observation on 8/19/19 of the central kitchen's cooking area revealed: - 27 eight ounce cans of Glucerna 1.2 cal with an expiration date of 8/1/19; - Dietary Aide Cooler in central kitchen contained approximately 1 inch of white frozen crystals on the interior back wall; and - Chef Fridge had large amounts of food debris located on the lower shelf behind stored boxes of food. Further observation revealed a 16 oz piping bag of whipped cream with the tip of the bag wrapped in a paper towel that was stuck to the tip by dried whipped cream. During an interview on 8/19/19 at 2:30 pm, the Dietary Manager stated he/she was not sure the last time the chef fridge and kitchen aide cooler were cleaned and/or defrosted. Random observations from 8/19-22/19 revealed food debris and dust build up in multiple kitchen drawers, under equipment and serving areas. During a second interview on 8/21/19 at 3:10 pm, the Dietary Manager stated he/she was unable to provide any documentation related to cleaning logs as the facility had not maintained the cleaning binder since (MONTH) of (YEAR). Review of the USDHHS - FDA Food Code, dated (YEAR), revealed the person in charge should have the ability to describe the relationship between the prevention of foodborne illness and the management and control of the facility in a clean condition. Further review revealed food packages shall be in good condition and protect the integrity of the contents so that the food is not exposed to adulterations or potential contaminants. Cleaning/Food Quality Duties: Review of the central kitchen's staff position descriptions, revision date 3/16/15, revealed the position #11 (Morning Cook) was to ensure daily that all items in chef cooler and freezer were labeled and dated; waste any outdated items and check cleaning binder. Further review revealed position #11 was to walk through the kitchen, dry storage, walk in coolers and freezers to check for any food safety or sanitation problems during each shift. Review of the central kitchen's employee schedule, dated 8/17-24/19 revealed position #11 was scheduled each day. Review of the central kitchen's staff position descriptions, revision date 3/16/15, revealed the position #13 (Morning Dietary Aide) was to ensure all items are labeled and dated and waste old items in the Diet Aide refrigerator and freezer daily. Review of the central kitchen's employee schedule, dated 8/17-24/19 revealed position #13 was scheduled each day. Review of the central kitchen's staff position descriptions, revision date 3/16/15, revealed the position #18 (Cook/Stocker/Support) was to pull out meats to thaw and place them in a bin to contain the juices; check cleaning binder to ensure dry storage, chef's freezer, walk-in freezer, and underside of grill and oven were cleaned. Review of the central kitchen's employee schedule, dated 8/17-24/19 revealed position #18 was scheduled each day. Review of the central kitchen's staff position descriptions, revision date 3/16/15, revealed the position #21 (Evening Cook) was to have cleaned the chef's freezer and fridge inside and out on Mondays; clean the plate warmer and grill area by pulling out the equipment; and clean out chef's refrigerator's on Saturday. Review of the central kitchen's employee schedule, dated 8/17-24/19 revealed position #21 was scheduled daily. Review of the central kitchen's staff position descriptions, revision date 3/16/15, revealed the position #23 (Evening Dietary Aide) was to ensure all items are labeled and dated and waste old items on Sundays in the cooler and refrigerator. Review of the central kitchen's employee schedule, dated 8/17-24/19 revealed position #23 was scheduled to be completed on 8/17/19. Review of the central kitchen's staff position descriptions, revision date 3/16/15, revealed position #'s 13; 16 (Food Preparation); and 23 were to ensure all items were within date and discard any dented cans. Review of the central kitchen's employee schedule, dated 8/16-24/19 revealed position #s 13; and 23 were scheduled daily. Further review revealed position #16 was scheduled Monday through Friday. Review of the facility's food service policy Cleaning, review date of 8/20/19, revealed the staff were to have clean all kitchen equipment on a regular schedule and utilize the cleaning checklist to insure periodic cleaning of all non-food contact surfaces. Food Handling: During an observation on 8/20/19 at 11:45 am Dietary Staff (DS) #2 was plating food for residents of the long term care unit. During the observation DS #2 used right gloved hand and a scoop to obtain a serving of ground chicken. Next, DS #2 used the left gloved hand to push ready-to-eat ground chicken into the scoop and continued to use the left hand to cover the scoop as it was transported to the plate. This was repeated for two resident's lunch meals. During the lunch observation, DS #2 was observed using the unchanged left gloved hand to obtain various items around the kitchen such as blenders, open containers and plates in between plating meals and touching the meat directly. No hand hygiene or glove change was conducted during the observation. During an observation on 8/21/19 at 11:45 am DS #1 directly handled carrots with gloved hand after touching handles of serving utensils. DS #1 would next wipe gloved hand on washcloth which was resting on the left side of the counter, then continued to plate food. After using a knife to cut food items, DS #1 wiped off the knife with the same washcloth used to wipe gloved hands, touched bread with same gloved hand, then wiped off counter with same washcloth. When soiled, DS #1 then rinsed the washcloth in the sink located next to the serving line, which had an open bag of thawing chicken under continuously running water. During an observation on 8/21/19 at 11:55 am DS #1 grabbed ready to eat chicken with gloved hand and plated the meat. Next, DS #1 grabbed other utensils and continued plating the meat. DS #1 proceeded to wipe the knife with a wet washcloth located on the left side of the counter and continued to directly plate meat with unchanged gloved hand. This process was repeated multiple times during the lunch observation. No hand hygiene or glove change was conducted during the observation. Review of the USDHHS - FDA Food Code, dated (YEAR), revealed when utilizing single-use gloves they shall be used for only one task such as working with ready-to-eat foods and used for no other purpose, and discarded when damaged or soiled, or when interruptions occur in the operation. During an interview on 8/21/19 at 12:00 pm, DS #1 stated the washcloths he/she was using was to wipe gloved hands, and knife. When asked if the washcloth was rinsed in the sink with thawing chicken, DS #1 stated yes. Review of the facility's Food Service policy Food Handling, last review date of 8/20/19, revealed .compliance reduces the risk of food contamination .Food handling is at all times in compliance with federal, state, and local sanitation and safety laws and regulations. During an interview on 8/22/19 at 9:11 am, the Infection Preventions stated that potentially contaminated gloves should be discarded when completing different task. Sanitation During an observation on 8/20/19 at 11:40 am DS #1 prepared a sanitation compartment of the three-sink method (alternative method to manually wash kitchen utensils and cutlery). DS #1 turned the hot and cold valves to an open position. Next, DS #1 turn a knob on box labeled ECOLAB APEX Solid Quat Broad Range Sanitizer which mixed the sanitizer and the water supplied by the faucet. During an interview on 8/20/19 at 11:40 am DS #1 was asked to explain the sanitation process. DS #1 stated that he/she would test the sanitation/water mix. During a secondary observation on 8/20/19 at 11:42 am DS #1 obtained a cylinder container of test strips to test the solution. As DS #1 was obtaining a strip, the Dietary Manager stopped DS #1 and instructed him/her that the strips were not the correct type to test the sanitation. The Dietary Manger proceeded to obtain a roll of orange test strip paper to test the solution. Next, DS #1 proceeded to take a three inch piece of the orange test paper from a product entitled Hydrion QT-10 and swirled the test paper though out the soapy foam floating on top of the sanitation solution for approximately 1-2 seconds. During an interview on 8/20/19 at 11:45 am, DS #1 was asked if there were parameters for testing the solution at certain temperatures. DS #1 was not aware of any temperature parameters. When asked to obtain the temperature of the water, DS #1 and the Dietary Manager obtained a facility kitchen thermometer and tested the solution at 85 degrees Fahrenheit. Review of the Hydrion QT-10 Testing Strips instructions, undated, revealed Dip paper in quat solution, NOT FOAM SURFACE, for 10 seconds .Testing solution should be between 65-75(degrees Fahrenheit) .FOLLOW MANUFACTURER'S DILUTION INSTRUCTIONS CAREFULLY. During an interview on 8/21/19 at 1:14 pm, the Dietary Manager stated DS #1 incorrectly tested the sanitation solution. When asked for any training records or in-services related to the sanitation solutions, the Dietary Manager stated the staff had not received training on sanitation solutions. Review of the facility's policy Sanitation Monitoring, effective date 7/6/17 and a review date of 8/20/19, revealed an evaluation of sanitation guidelines compliance shall be conducted by the Dietary Manager and deficiencies and violations will be addressed and corrected and an in-service with dietary staff will be conducted. Review of the facility's policy Personnel Management - Food Service Policy, last reviewed 9/16/18, revealed that qualified employees who have met pre-established criteria and competency and performance expectations shall staff the Food Service departments. |
2020-09-01 |