F0802

F

Failure to Ensure Competent Dietary Staff and Proper Dishwashing/Sanitizing Practices

Trenton, New Jersey Survey Completed on 02-06-2026

Penalty

No penalty information released

Summary

The deficiency involves the facility’s failure to ensure competent dietary staffing and proper sanitation practices in the food and nutrition service, particularly related to dishwashing and use of the three-compartment sink and dish machine. Surveyors observed that residents on multiple nursing units were being served meals on disposable dishware and utensils, while some residents still received meals on regular ceramic dishware and utensils. Used meal trays in the hallway contained a mix of disposable and reusable items. When the surveyor questioned staff, the acting Food Service Director (FSD) stated that the dish machine had not been functioning for one week and that disposable dishware was being used throughout the facility. The acting FSD also stated that insulated bowls and cups, which were non-disposable, had been washed in the non-functioning dish machine and that the LNHA was aware.

During kitchen observations, a dietary staff member was seen using the three-compartment sink incorrectly by scraping and washing pots and pans in the first compartment, skipping the rinse compartment, and then submerging them directly into the sanitizer compartment. This staff member stated he did not have to check anything and was unable to check the sanitizer concentration due to lack of test strips. The acting FSD could not provide a log or test strips for the three-compartment sink. When the surveyor requested information about the dish machine, the acting FSD could not operate it, could not locate the dish machine log, and could not identify who had checked the chemical sanitizer that morning. The LNHA also could not operate the dish machine, stated that the temperature did not need to be checked because it was a low-temperature machine, and could not locate test strips. The dish machine log that was eventually found showed the last entry dated more than a month prior to the survey.

Information from the dish machine vendor showed that the dish machine had been converted to a low-temperature, chemical-sanitizing process due to a non-functioning heat booster and roof exhaust issues, and that staff had been advised to check the chemical sanitizer regularly. The facility was unable to provide documentation that the sanitizer had been checked. On a subsequent observation, the surveyor found that the dish machine was not in use, disposable dishware was still being used, and non-disposable meal trays were submerged in the sanitizer compartment of the three-compartment sink. The sanitizer level in the sink did not meet the fill line, and when the acting FSD tested the solution with chlorine test strips, the strip did not change color and was used for an incorrect immersion time. The acting FSD stated the solution was “no good” and admitted unfamiliarity with the chemicals. A poster above the sink described a quaternary sanitizer process requiring different test strips and a specific concentration range, and when the correct quaternary test paper was used, the sanitizer registered between 200–400 ppm, but there was no thermometer to check water temperature and no log documenting concentrations. The facility’s policies addressed high- and low-temperature dishwashing and dish machine failure but did not address conversion to low-temperature chemical sanitization when the heat booster failed, and there was no documentation of staff competencies or consistent monitoring of sanitizer concentrations as required by the vendor’s instructions and the facility’s own policies.

The surveyor also reviewed the Safety Data Sheet for the low-temperature sanitizer attached to the dish machine, which described it as a hazardous chemical capable of causing eye and skin burns, respiratory irritation, and harm if swallowed. Despite this, there was no evidence that staff were consistently monitoring or documenting the sanitizer concentration in the dish machine or the three-compartment sink. The Food Service Director job description indicated responsibility for ensuring infection control and the highest sanitation standards in the dietary department, but the observations showed that dietary staff, including the acting FSD, were not competent in operating the dish machine, using appropriate test strips, following posted procedures for the three-compartment sink, or maintaining required logs. These actions and inactions resulted in a failure to maintain the kitchen in a sanitary manner and to ensure appropriate measures were in place to prevent potential foodborne illness or exposure to hazardous chemicals for all residents served by the dietary department.

The facility’s written policies on dishwasher temperature and dish machine failure specified required wash and rinse temperatures for high-temperature machines, required hypochlorite concentration for low-temperature machines, and the use of disposable products when the dishwasher was out of service. However, there was no policy guidance on converting to a low-temperature chemical sanitizing process when the heat booster failed, and no documentation that staff had been trained or deemed competent in this process. The LNHA acknowledged that staff had only been verbally instructed on how to use test strips and that there were no completed competencies. The combination of a non-functioning or improperly converted dish machine, lack of appropriate test strips and logs, incorrect use of the three-compartment sink, and staff unfamiliarity with chemical sanitizers and posted procedures led to the cited deficiency in providing sufficient, competent support personnel to safely and effectively carry out the functions of the food and nutrition service.

Residents throughout the facility were affected in that their meals were being served on a mix of disposable and reusable dishware without assurance that reusable items were being properly washed, rinsed, and sanitized. The report notes that this deficient practice had the potential to affect all residents, as the dietary department serves the entire resident population. No specific resident medical histories or conditions are described in the report, but the observations and interviews collectively demonstrate that the facility did not ensure dietary staff competency in maintaining kitchen sanitation and managing hazardous sanitizing chemicals in accordance with regulatory requirements and facility policies.