| 192 |
RIVER CITY NURSING AND REHABILITATION |
285058 |
7410 MERCY ROAD |
OMAHA |
NE |
68124 |
2019-09-12 |
812 |
L |
0 |
1 |
7GF911 |
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** LICENSURE REFERENCE 175 NAC ,[DATE].11E Based on observations, interviews, review of facility documents, and review of facility policies and procedures, the facility failed to ensure the staff used non-expired test strips to test the sanitizer level of the dishwashing machine, and failed to ensure the water temperature of the dishwashing machine was maintained within an acceptable range for the effective sanitization of kitchen and food-service dishware and utensils. This deficient practice created a likelihood for the occurrence of serious injury, harm, impairment, or death from foodborne illness and placed the 90 residents capable of oral intake in immediate jeopardy. The facility had a census of 93 residents on the first day of the survey. Findings include: During the initial tour of the kitchen, accompanied by the facility's Dietary Manager (DM), on [DATE] beginning at 8:38 AM, observation revealed, and the DM confirmed, that the facility used a low-temp dishwashing machine to clean and sanitize the facility's kitchen ware and food-service ware. At 8:40 AM, observation revealed Dietary Aide (DA)17 checked the water temperature of the dishwashing machine by visualizing the water temperature gauge on the front of the machine below a built-in water reservoir. DA17 reported the water temperature registered 115 degrees Fahrenheit (F). During the observation, the DM confirmed that the water temperature was below the acceptable range of 120 degrees F at the time the temperature was tested . DA17 then tested the level of sanitizer in the water by dipping a test strip into the sanitizing solution collected in the built-in water reservoir on the front of the machine. DA17 reported the sanitizer level as 100 parts per million. At that time, observation of the container of test strips just used by DA17 to test the sanitizer level, revealed the test strips had an expiration date of [DATE]. During an interview at that same time, both DA17 and the DM stated the test strips in the container had been supplied by the vendor that installed the new dishwasher on [DATE], and had been used exclusively since that date to test the sanitizer level of the dishwasher solution. A review of the Dish Machine Log - Low Temp forms posted next to the dishwasher revealed the forms were in a monthly format, and each day of the month was divided into three spaces labeled breakfast, lunch, and dinner. Each of the three daily timeslots had a place to log both the temperature of the water and the sanitizer level. Further review of the (MONTH) 2019 log entries from [DATE] through [DATE] revealed the following information: On [DATE] and [DATE]: No entries were logged for either the water temperatures or the sanitizer levels for any of the three meals on those two dates. On [DATE] and [DATE]: No entries were logged for either the water temperatures or the sanitizer levels for the breakfast and lunch meals on those dates. Supper water temperatures were logged as 100 degrees F, with sanitizer levels within normal limits. On [DATE]: Breakfast and lunch water temperatures were both logged as 100 degrees F, with no water temperature or sanitizer level entries logged for the supper meal. On ,[DATE] /19: Breakfast, lunch, and supper water temperatures were all logged as 100 degrees F, with sanitizer levels within normal limits. On [DATE]: No entries were logged for the breakfast and lunch water temperatures or sanitizer levels. The supper water temperature was logged as 100 degrees F, and the sanitizer level was within normal limits. On [DATE]: No entries were logged for the breakfast and lunch water temperatures or sanitizer levels. The supper water temperature was logged as 115 degrees F, with the sanitizer level within normal limits. On [DATE]: The breakfast water temperature of 115 degrees F, and the sanitizer level of 100 parts per million were logged post-breakfast at 8:50 AM that day. During an interview at the time of the observation, the DM stated he was responsible for ensuring the water temperature was tested prior to cleaning dishes and he failed to monitor the temperature logs for the dishwashing machine during the current month. During an interview with the Grounds Director (GD), the DM, and the Director of Procurement (DOP) on [DATE] at 9:30 AM, the GD stated the water in the building would only be heated to a maximum temperature of 119 degrees F and the dishwashing machine did not have a booster' to increase the temperature to acceptable minimum required temperature for cleaning or rinsing dishes. In addition, the GD stated there had been no work orders submitted for repairs to the dishwashing machine. During an interview on [DATE] at 9:40 AM, the Administrator stated she had not been notified of any problems with the new dishwashing machine and there had been no work order submitted regarding problem with the safe operation of the machine. Review of a facility electronic mail (email) message titled, Dishwasher Replacement, dated [DATE], from the DM to the Administrator, the DOP, and the owners of the facility revealed the DM recommended a High Heat Washer be purchased to replace the facility's dishwasher. The reasons noted by the DM for this recommendation were noted as follows: 1) You wouldn't need a booster due to the machine heating the water which would solve our problem right now, 2) The facility would save money because, you wouldn't need to buy chemicals, and 3) it improves dry times on items washed. A follow-up interview was conducted with the DM on [DATE] at 11:00 AM. The DM confirmed he sent a message to the Administrator, the DOP, and the owners of the facility because there had been problems with inconsistent water temperatures with the facility dishwashing machine and plans were made to replace the machine. A review of a facility's Kitchen Audit, dated [DATE], and conducted by the Registered Dietician (RD) revealed the water temperature noted on the facility's dishwashing machine at the time of the audit was measured as 110 degrees. The audit guidelines noted a low temperature machine's water temperature should be equal to or greater than 120 degrees and should follow the manufacturer's guidelines. The RD's note on the audit reads, temp 110 - replacing dishwasher, An interview with the DOP was conducted on [DATE] at 12:30 PM. The DOP stated he was responsible for the purchase of the new dishwashing machine for the facility. The DOP confirmed he was aware of the recommendations made by the DM to purchase a high temperature dishwashing machine were made on [DATE]. In addition, the DOP confirmed he was aware the facility needed to purchase a new dishwashing machine due to problems with inconsistent water temperatures on the machine. The DOP stated he received a recommendation from a vendor to purchase a low temperature washer and the new dishwashing machine was installed on [DATE]. The DOP did not provide an explanation for why the recommendation to purchase a high temperature dishwashing machine from the DM was not considered and the DOP did not provide an explanation for why a booster was not purchased to increase the temperature of the new machine. An interview was conducted with the Administrator and Regional Administrator on [DATE] at 2:25 PM. The Administrator stated the DOP was responsible for the purchase of a new dishwashing machine for the facility kitchen. The Administrator confirmed she understood the facility needed to purchase a new dishwasher due to inconsistent water temperatures. In addition, the Administrator confirmed she was aware a low temperature dishwashing machine would need a booster to increase water temperatures because the hot water temperatures set in the building would only reach 119 degrees. The Administrator stated she had not been made aware of any problems with the new dishwashing machine and there had been no work orders submitted at the facility related to problems with the operation of the new dishwashing machine since the installation date of [DATE]. The Administrator stated the DOP was responsible for communicating with vendors related to the purchase and would have expected a booster to be purchased at the time the new machine was purchased but could not provide an explanation for the facility's failure to purchase a booster to increase the water temperature for safe operation of the new machine. Observation on [DATE] at 2:35 PM, revealed the manufacturer's guideline and the National Sanitary Foundation requirements were posted on the Data Plate on the front of the dishwasher and read, Wash Temp. - Minimum 120 degrees Fahrenheit, recommended 140 degrees Fahrenheit, Rinse Temp.- Minimum 120 degrees Fahrenheit, recommended 140 degrees Fahrenheit. A review of facility policy titled, Dish Machine Usage, dated ,[DATE], stated the purpose of the policy was, to ensure proper techniques when washing tableware (i.e., dishes, silverware, glasses and cups). The procedure outlined in the policy stated, Wash and rinse tanks should be filled with clear water. Check the temperature of the wash and rinse cycles, verifying that both meet the temperature posted on the dish machine. |
2020-09-01 |