Deficiencies in Food Safety Practices
Penalty
Summary
The facility failed to ensure that food was stored, prepared, distributed, and served in accordance with professional standards of food service safety. During the recertification survey, multiple instances were observed where staff did not wear appropriate hair and beard restraints in the kitchen. The Food Service Director, Dietary Aides, and a contracted pest control person were all observed without proper hair or beard nets, despite having noticeable facial hair. Interviews with the staff revealed that some were aware of the requirement but failed to comply due to discomfort or forgetfulness. Additionally, the facility's dry storage room was found to have an open box of instant food beverage thickening powder with a torn plastic bag and a paper cup inside. This box was observed on two separate occasions, indicating a lack of proper storage practices. The Dietary Aide responsible for checking the dry storage room admitted to not knowing who tore the bag and acknowledged that the food should be covered to prevent contamination. The Director of Food Services confirmed that the thickener should be stored in a container and not left open. The facility's dietary policies and procedures were found to be lacking in specific uniform requirements related to food handling. Although the policies outlined the need for safe and sanitary food preparation and handling, they did not explicitly mention the use of hair and beard nets. The facility's sanitation inspection and audit processes were also noted, but the observed deficiencies suggest that these measures were not effectively implemented or enforced.
Plan Of Correction
Plan of Correction: Approved January 10, 2025 Element 1 F812 Corrective Action: The Staff that were observed not wearing a beard net were immediately educated on wearing appropriate face beard covers inside the kitchen. All vendors will also be educated on the hair and beard coverings procedure. The open thickener box was removed, and the product was disposed of properly. A complete inspection of all dry storage areas was conducted to identify and remove any other improperly stored items. Element 2 Residents at Risk: All residents have the potential to be affected by this practice. All Dietary Staff were monitored to ensure compliance with beard and hair net coverings were in place. All dry storage areas were inspected to identify and remove any other improperly stored items. There were no issues that were identified. Element 3 Systemic Changes: Personal hygiene and protective equipment policies were reviewed to reflect strict enforcement of beard and hair nets. All dietary staff received mandatory in-service training on proper food safety protocols, including wearing hair and beard nets. Policies on food and dry storage were reviewed to ensure they included all food and beverages in dry storage that are labeled, and in approved containers. No revisions were required. Staff received training on proper storage requirements and food safety protocols. Audit tools are being developed to monitor compliance. Element 4 Monitoring of Corrective Action: Food Service Director will conduct daily spot checks to ensure compliance with personal protective equipment requirements. Non compliance will be documented and addressed with immediate corrective action. The Food Service director or designee will conduct daily inspections of storage area to ensure compliance with food safety protocols. Non compliance will result in retraining and possible disciplinary action. Monthly audits of kitchen and storage areas will be conducted, and results will be reviewed monthly with the administrator for a period of 6 months. On a quarterly basis, the results will be presented by the Food Service director to the QAPI committee. The QAPI Committee will decide if further action is required. Element 5 Completion date: (MONTH) 19, 2025 Person responsible: Food Service Director and Food Service Supervisor.