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F0812
F

Multiple Food Safety and Sanitation Deficiencies Identified

Grand Rapids, Michigan Survey Completed on 04-16-2025

Penalty

No penalty information released
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The penalty, as released by CMS, applies to the entire inspection this citation is part of, covering all citations and f-tags issued, not just this specific f-tag. For the complete original report, please refer to the 'Details' section.

Summary

Surveyors identified multiple failures in food safety practices within the facility's kitchen and food service areas. During observations, several food items, including milk, soy milk, grape jelly, vinaigrette dressing, artichoke hearts, and ranch dressing, were found opened and stored without proper labeling of opened or discard dates. Additionally, resident food items in the pantry were not discarded within the facility's stated 72-hour rule. These actions were inconsistent with the 2022 FDA Food Code requirements for date marking and disposition of ready-to-eat, time/temperature control for safety foods. Review of the facility's food cooling logs revealed that staff did not consistently monitor or document food temperatures during the cooling process as required by policy. Multiple entries showed that foods did not reach the required temperature of 70°F within two hours, and there was no documentation that these foods were reheated to 165°F and re-cooled, as mandated. In some cases, there were no recorded temperature checks after the initial cooking, indicating a lack of adherence to both facility policy and FDA Food Code standards for cooling potentially hazardous foods. Additional deficiencies were observed in equipment sanitation and maintenance. Sheet pans were found stacked with water trapped between them, indicating they were not air-dried as required. The juice machine spouts had visible sticky debris, and the large floor mixer had dried food residue, both of which are violations of cleanliness standards for food-contact surfaces. Furthermore, the dish machine was operating at a rinse pressure above the manufacturer's specified range, and staff were unaware of the need to monitor this parameter, contrary to FDA Food Code requirements for mechanical warewashing equipment.

Plan Of Correction

Element 1: All residents/patients can be affected by deficient practice of food procurement, storing/labeling/preparing/sanitizing. 2% milk, organic soy milk, grape jelly, artichokes, container of ranch dressing and vinaigrette and patient food from home were discarded immediately. All wet nested pans were rewashed and air dried thoroughly. Drink machine spouts and mixer were cleaned and sanitized immediately. All open and prepped food in coolers and dry storage areas and in pantry refrigerators were checked for proper labeling and dating and were addressed appropriately. All food on cooling logs that were still in use but not cooled properly were discarded immediately. All clean dishes were inspected to ensure there was no water or food debris left on them. All small equipment was also inspected for signs of food debris. Element 2: All residents/patients have the potential to be affected by deficient practice of food procurement, storing/labeling/preparing/sanitizing. Element 3: Staff will be educated on labeling/dating food in kitchen and in pantries and on proper method to air dry dishes. Staff will be trained. Chefs and cooks will be educated on properly filling out cooling logs and how to cool food properly and in proper cleaning of small equipment. Trayline staff and supervisors will be educated on proper cleaning of juice machine and all its parts. Maintenance ticket submitted to identify and fix root cause of dish machine pressure. Element 4: The dining services manager or designee(s) will complete an audit 5 times a week for 12 weeks to check for properly labeled, stored and dated foods in coolers in kitchen and in pantry refrigerators. Food will be discarded after 72 hours of initial date. The cooling log and food cooling procedure to proper temperatures will be audited 5 times a week for 12 weeks. Small equipment, including mixer and juice machines will be audited for cleanliness and to ensure no wet nesting of clean dishes 5 times a week for 12 weeks. The dishwasher pressure will be audited 5 times a week for 12 weeks to ensure pressure is in recommended range. All audit findings will be submitted to Quality Assurance Process Improvement committee monthly and the Administrator is responsible for compliance.

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