Deficiencies in Dietary Sanitation Monitoring and Blood Glucose Device Competency
Penalty
Summary
The facility failed to ensure proper monitoring and documentation of dish machine temperatures in the dietary department, resulting in repeated instances where the rinse cycle did not reach the required sanitizing temperature of 180 degrees Fahrenheit. Observations and interviews revealed that staff were unclear about which gauges to use for monitoring, and there was confusion regarding the correct temperature requirements. Review of temperature logs for March, April, and May showed multiple days where the rinse temperature fell below the required level, and there were numerous instances of missing documentation. Staff did not consistently follow the policy to notify the dietary manager when temperatures were inadequate, and the dietary manager confirmed that she had not addressed these issues with staff. Additionally, competency documentation for dietary aides and cooks was lacking, with no evidence that staff had been trained or deemed competent in monitoring dish machine temperatures or reviewing relevant policies. In the area of blood glucose monitoring, a resident using a continuous glucose monitoring device (Freestyle Libre 3) was not assessed for knowledge or competency in using the device, including when to perform manual blood glucose checks or how to respond to device alarms. The resident reported that nursing staff relied on her to report her blood sugar readings and provided interventions such as snacks or juice for low readings, but she was not familiar with the device's alarm functions or manual testing procedures. Review of the resident's self-administration assessment showed no evidence of guidance or assessment regarding the use of the device. Manufacturer instructions require users to review all product instructions and complete tutorials, but this was not documented for the resident. Nursing staff, including RNs and the ADON, reported they had not received training or completed competencies on the use of the Freestyle Libre 3 device. Staff were unaware of the location of manufacturer instructions and had not been provided with a policy or process for using the device. The facility's assessment indicated that staff were to be trained and competent in diabetic management and the use of medical equipment, but there was no evidence that this had occurred for the continuous glucose monitoring device. The administrator confirmed the expectation that staff should be trained and competent in the use of any medical equipment used for resident care.