F0812 F812: Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
F

Food Items Stored Without Required Date Marking

St Francis HomeFond Du Lac, Wisconsin Survey Completed on 04-01-2026

Summary

The facility did not ensure food was stored and prepared in a safe and sanitary manner, with the deficiency centered on time/temperature control foods that were not labeled with open dates and/or use-by dates. During an initial kitchen tour with the Food and Nutrition Services Director (FNSD)-C, surveyors observed multiple dry storage items, coolers, and freezers containing food items that lacked required date markings. The facility’s own policy required refrigerated ready-to-eat time/temperature control for safety foods to be clearly marked with the date or day by which they must be consumed or discarded, and the FNSD-C stated the facility follows the Wisconsin Food Code as its standard of practice. In dry storage, surveyors observed items including salt, baking cocoa, sugar, flour, cracker crumbs, and instant cheese queso mix without use-by dates. In coolers, surveyors observed multiple items without use-by dates, including breaded chicken, baked cookies and cinnamon rolls, chicken thighs, Braunschweiger, breaded chicken patty, sloppy joe, an unlabeled container of yellow material marked open 3/26, cherry cheesecake, pork chops, and pork. In freezers, surveyors observed numerous unlabeled or undated items, including hot dogs, beef, smoth steak, beef tips, sl. beef, beef stroganoff, beef casserole, salisbury steak, lasagna sauce, riblettes, brat patties, BBQ pork, sausage patty, pulled pork, kielbasa, hamloaf, ham, pork in peach sauce, cod, pork, beef, turkey, quiche, squash, fish, soft pot, sweet pot, tavern fish, salmon, fish, turkey, and chx. During interview, FNSD-C stated bulk food items such as flour and sugar did not have use-by dates because they were used up quickly, but then verified the items should contain use-by dates. FNSD-C was unsure of the use-by dates for the dry storage items and stated the cracker crumbs should be thrown out. FNSD-C also did not know the use-by dates for the cheese mix and various items in the cooler and freezer, and confirmed the frozen items should have been labeled with use-by dates. The report states this practice had the potential to affect 74 of 74 residents residing in the facility.

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.

Resources

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Kitchen sanitation, food safety, and temperature monitoring failures
F
F0812 F812: Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
Short Summary

The facility failed to keep the kitchen hood clean, removed moldy cantaloupe from storage only after it was observed, allowed a staff drink to be stored in the kitchen freezer, and observed an employee washing hands for only four seconds with visible substance still on the arm before serving food. Food and refrigerator temperature logs were incomplete, and the activities refrigerator was found with condensation, black buildup, and temperatures above the safe range while the AD reported freezer temperatures were not being checked.

No penalty information released
tooltip icon
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.
Unsanitary Kitchen Food Storage and Handling
F
F0812 F812: Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
Short Summary

Unsanitary food handling and storage conditions were observed in the main kitchen. Food was stored under pipes with ice buildup dripping onto items, several meat packages were left unsealed, cereal drawers were open, a foam cleanser sat on a prep table with food, rotten bananas were present, melted butter was left uncovered, a bag of buns touched the floor, and the Dietary Supervisor entered without a hair restraint or beard guard.

No penalty information released
tooltip icon
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.
Food Storage and Ice Machine Sanitation Deficiencies
F
F0812 F812: Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
Short Summary

Food items in the walk-in cooler were found with expired use-by dates, missing labels or dates, and signs of spoilage, including discolored lettuce and opened cheese products left improperly stored. Surveyors also observed pink and brown substances on the kitchen ice machine baffle above the ice trough. The Head [NAME] acknowledged the storage issues and that the ice machine needed cleaning, while the DDM and Administrator stated that food labeling, dating, spoilage checks, and ice machine sanitation were expected.

No penalty information released
tooltip icon
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.
Dishwasher Temperatures Not Monitored
F
F0812 F812: Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
Short Summary

Dishwasher temperatures in the main kitchen were not monitored to required levels. The log showed repeated wash and final rinse temps below the required range, and during observation the dish machine again ran below spec, with the wash cycle reaching 143 degrees and then 141 degrees and the rinse cycle reaching 177 degrees before not registering. The dining supervisor and food service unit supervisor both stated staff had not notified them about the low temps, despite staff saying they were supposed to record the readings and report out-of-range temps.

No penalty information released
tooltip icon
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.
Dishwasher Rinse Cycle Failed to Reach Required Sanitizing Temperature
F
F0812 F812: Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
Short Summary

Dishwasher Rinse Cycle Failed to Reach Required Sanitizing Temperature: The facility failed to ensure 1 of 1 dishwasher reached the required high-temp rinse range. During observation, the wash cycle reached 153°F and the final rinse reached 150°F, below the posted 180-195°F requirement. The CD confirmed the machine should reach 180°F, and the temp log showed multiple rinse cycles below 180°F with no indication of correction.

No penalty information released
tooltip icon
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.
Kitchen Sanitation and Food Labeling Failures
E
F0812 F812: Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
Short Summary

Kitchen Sanitation and Food Labeling Failures: Surveyors observed a fryer, toaster oven, wall behind the dishwashing station, and hot holding trays/cookie sheets with heavy grease and grime buildup. Multiple canned goods, pantry snacks, prepared gravy, and prepared pureed chicken were also found without required use-by or expiration dates. Dietary staff and ADM stated staff were responsible for cleaning, labeling, and dating food items, but several items were left undated and the dietary mgr was unavailable.

No penalty information released
tooltip icon
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.
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