Failure to Update Policy and Educate on Safe Food Handling
Summary
The facility failed to update its policy and procedures (P&P) regarding the handling of outside food brought in by visitors to meet state regulations. The existing P&P, last revised in September 2017, discouraged visitors from bringing potentially hazardous foods such as meats, fish, eggs, custards, and milk products. It stated that such foods should be consumed immediately and not shared with other residents, and that food items brought into the facility could not be reheated or stored. However, interviews with the Director of Staff Development (DSD) and the Director of Nursing (DON) revealed inconsistencies in the implementation of this policy. The DSD stated that visitors were encouraged to bring food, which must be consumed immediately or taken home if not consumed, and confirmed that the facility did not store or reheat outside food. In contrast, the DON mentioned that the facility labeled and stored food in the refrigerator for up to 72 hours, which contradicted the written P&P. Additionally, the facility failed to provide education to staff and visitors on safe food handling practices to prevent foodborne illnesses. The DSD confirmed that no education was provided to staff or visitors regarding safe food handling, despite the potential risk of foodborne illness from improperly handled outside food. This lack of education and the discrepancies between the stated policy and actual practices posed a risk to residents consuming food from outside sources. The findings were acknowledged by the DON, Administrator, Nurse Consultant, and Registered Dietitian (RD).
Penalty
Resources
Below are regulatory guidelines relevant to this citation:
A resident kept nine single-serve yogurts on an overbed table for three days after a friend brought them in, and staff did not intervene to ensure proper refrigeration. During observation and interviews, the IP confirmed the yogurts were unrefrigerated, stated they should have been stored in a refrigerator, and acknowledged that staff should have informed the resident that the yogurts required refrigeration. Review of the facility’s resident personal food storage policy showed that outside foods brought by visitors are to be monitored by staff for food safety and stored in a designated facility refrigerator, which did not occur in this situation.
Three residents had personal refrigerators filled with undated food items and no visible thermometers, with no clear staff responsibility for monitoring temperatures or cleanliness. Staff interviews revealed confusion about who was responsible for these tasks, and temperature logs showed potentially inaccurate readings despite the absence of thermometers. The facility's policy placed responsibility on residents and families, but lack of enforcement led to improper food storage and monitoring.
A resident's personal refrigerator was not consistently monitored according to facility policy, as daily temperature checks were not documented on several dates. Although the refrigerator was observed to be clean and within the appropriate temperature range, staff interviews confirmed that required documentation was not completed each day, resulting in a failure to follow established food safety procedures.
A resident with moderate cognitive impairment and multiple medical conditions had a personal refrigerator that was not consistently maintained at or below 41°F, and temperature documentation was incomplete for several days. The facility did not enforce its policy on safe food storage for items brought in by family or visitors.
Surveyors found that a refrigerator used for resident food storage contained outdated and unlabeled food items, including containers with old dates, take-out food, and opened ice cream with no open date. Some items were not marked with resident room numbers. The Dietary Manager stated monitoring had not been done recently, and facility policy required timely removal and proper labeling of food.
Surveyors found that the facility did not follow its unit refrigerator policy for labeling, storage, and expiration monitoring of foods brought in by families for two residents. In both cases, personal refrigerators contained multiple expired and unlabeled items, including visibly spoiled foods, while no temperature monitoring logs were present. CNAs, an LPN, the DON, and the housekeeping supervisor all described processes requiring labeling, daily checks, and housekeeping oversight of temperatures and food freshness, but their statements showed inconsistent practice and reliance on families who reported they had not been instructed to label items. Review of the written policy confirmed requirements for daily temperature checks, regular cleaning, removal of spoiled/expired food, and proper sealing and dating of perishable items, which were not consistently implemented.
Failure to Safely Store Visitor-Provided Yogurt for a Resident
Penalty
Summary
Surveyors identified a deficiency in the facility’s handling and storage of food brought in by visitors when a resident had nine single-serve yogurts left on the overbed table for three days. During observation and interview in the resident’s room, the resident reported that a friend had brought the yogurts three days earlier, and the yogurts remained unrefrigerated on the overbed table. In a concurrent interview, the Infection Preventionist confirmed the presence of the nine single-serve yogurts, stated they should have been refrigerated, and explained that staff should have informed the resident that the yogurts required refrigeration. The Infection Preventionist further stated that the yogurts could cause foodborne illness when left at room temperature and could make the resident sick. Review of the facility’s “Resident Personal Food Storage” policy showed that food or beverages brought from outside sources are to be monitored by designated staff for food safety and that outside foods brought in by visitors are to be stored in a facility refrigerator designated for resident use, which did not occur in this case. This failure to follow the facility’s food storage policy and to ensure proper refrigeration of visitor-provided food resulted in a deficiency related to safe storage of resident food items.
Failure to Monitor and Maintain Safe Storage of Resident Food in Personal Refrigerators
Penalty
Summary
The facility failed to implement and enforce a policy regarding the use and storage of foods brought to residents by family and other visitors, specifically in relation to the monitoring and maintenance of personal refrigerators in resident rooms. Observations revealed that three residents had personal refrigerators that were packed with undated food items and lacked visible thermometers. Interviews with these residents indicated that they were either unsure of who was responsible for checking the refrigerator temperatures or believed that no one was regularly monitoring them. Review of temperature logs showed consistent, possibly inaccurate temperature recordings, despite the absence of thermometers in the refrigerators during the survey period. Staff interviews demonstrated confusion and lack of clarity regarding responsibility for monitoring and maintaining the cleanliness and temperature of residents' personal refrigerators. Various staff members, including LVNs, maintenance, housekeeping, and CNAs, provided conflicting statements about who was responsible for these tasks. The housekeeping supervisor mentioned keeping a temperature log and attempting to clean the refrigerators but noted that residents sometimes refused access. The administrator and DON both acknowledged the importance of monitoring refrigerator temperatures but also indicated uncertainty about which staff were assigned to this duty. A review of the facility's Food and Nutrition Services policy revealed that the responsibility for monitoring the interior temperature of personal refrigerators was assigned to residents and/or their family members, with a requirement to keep food at 40 degrees Fahrenheit or less and to discard perishable foods within seven days. However, the lack of enforcement and oversight of this policy led to the deficiency, as evidenced by the absence of thermometers, undated food items, and inconsistent temperature monitoring in the residents' personal refrigerators.
Failure to Document Daily Temperature Checks for Resident Refrigerator
Penalty
Summary
The facility failed to consistently document daily temperature checks for a resident's personal refrigerator, as required by facility policy. During observations, the refrigerator was found to be clean, organized, and set to an appropriate temperature; however, the daily temperature log was missing entries for several dates in December. Interviews with the resident and staff confirmed that while the temperature was verbally checked and maintained within the expected range, documentation was not consistently completed. The resident reported a previous incident where the refrigerator was not plugged in, resulting in spoiled food, and expressed concern that staff do not always record the temperature as required. Staff interviews revealed that housekeeping is responsible for monitoring, cleaning, and documenting the temperature of personal refrigerators daily, with an expected range of 35-40 degrees Fahrenheit. Both nursing and housekeeping staff acknowledged the importance of daily documentation to ensure food safety, as outlined in facility policies. Despite these expectations, the lack of consistent documentation on the temperature log constituted a failure to follow established procedures for monitoring food safety in resident refrigerators.
Failure to Maintain and Document Safe Refrigerator Temperatures for Resident Food Storage
Penalty
Summary
The facility failed to implement and enforce a policy regarding the use and storage of foods brought in by family and other visitors for residents. Specifically, the facility did not ensure that a resident's personal refrigerator maintained a temperature at or below 41 degrees Fahrenheit, as required by facility policy. Temperature logs showed that for several days, the refrigerator was above the recommended temperature, and for a subsequent period, temperatures were not documented at all. This lapse was identified through observation, interview, and record review. The resident involved was an older adult with a history of constipation, protein-calorie malnutrition, and nausea, and had moderate cognitive impairment as indicated by a BIMS score of 12 out of 15. Despite the resident reporting no illness from consuming food stored in her refrigerator, the facility's failure to monitor and document refrigerator temperatures as per policy constituted a deficiency in ensuring safe and sanitary food storage for residents.
Outdated and Unlabeled Food Items Found in Resident Refrigerator
Penalty
Summary
The facility failed to ensure that the resident food refrigerator was free of outdated food items. During an observation, the refrigerator contained food containers with dates from over a month prior, take-out food with similarly old dates, and a jar of soup with no date. The freezer section also had two opened and partially used ice cream containers with no open date. Some food containers did not have resident room numbers identified. The Dietary Manager acknowledged responsibility for monitoring the refrigerator but admitted it had not been done recently. Facility policy required foods to be removed after three days unless unopened and unexpired, and all items should be marked with resident room numbers. The Director of Nursing Services confirmed that staff should be marking foods with the room number of the resident.
Failure to Follow Unit Refrigerator Policy for Labeling and Expired Food Monitoring
Penalty
Summary
The deficiency involves the facility’s failure to follow its policy on unit refrigerators regarding labeling, storage, and monitoring of expiration dates for foods brought in by families for residents. For one resident, an older female with multiple diagnoses including fractures, diabetes, osteoarthritis, acute cystitis, hypertensive heart disease, and dysphagia, surveyors inspected her personal refrigerator and found no temperature monitoring log despite a thermometer reading of 40°F. Multiple food items were expired or unlabeled, including hard candy with past expiration dates, a smoothie snack with a past expiration date, unlabeled containers of pound cake, soup, kimchi, and Korean kangjam, discolored and visibly spoiled boiled purple yam in a ziplock bag, and a piece of pound cake with brownish-black raised texture suggestive of spoilage. Additional items included cans of peach juice and orange pineapple juice with printed expiration dates, very soft and mushy black plums in an unlabeled ziplock bag, and high-calcium black soy milk packs without expiration dates on the packaging. For a male resident with diagnoses including diabetes, end stage renal disease, cerebral infarction, dysphasia, hypertensive heart disease, speech and language deficit, arthritis, and seizure, his personal refrigerator was inspected with a CNA present. Items found included yogurt with an expiration date that had passed, organic roasted chestnut with a past expiration date, and several unlabeled items such as dried fish, boiled purple potatoes, grapes, cherry tomatoes, and boiled corn in ziplock bags. The CNA stated that housekeeping maintains the personal refrigerator log and acknowledged that food brought in by families should be checked for expiration and labeled, and that consuming expired food is not safe. Interviews with staff revealed inconsistent implementation of the facility’s policies. A CNA reported that she labels food when she receives it but was unsure if others do the same, and confirmed that all foods need labels and should be checked to ensure they are still fresh. An LPN stated that CNAs and housekeeping must check food in personal refrigerators daily and that housekeeping maintains temperature logs, and she personally identified spoiled and expired items in one resident’s refrigerator when they were pointed out. The DON stated that staff are responsible for labeling and dating food brought by families and that housekeeping checks food for freshness and expiration, while also noting that sometimes CNAs ask families to write dates on items. The housekeeping supervisor reported that housekeeping is responsible for daily temperature checks and inspection of food for freshness and expiration, that all food should be labeled and opened items kept no more than 72 hours, but also stated that sometimes they have no control over what families bring. The resident’s family later reported they had not been advised by the facility to label food they bring. Review of the written policy on Unit Refrigerators showed requirements for daily temperature checks, cleaning every three days by housekeeping, and removal of spoiled or expired food, as well as resident/caregiver responsibility to seal, date, and promptly store perishable items, which were not consistently followed in these cases.
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