An LPN assisted four residents with supper without performing hand hygiene between resident contacts, touching residents and their items while feeding and handing out utensils. In the kitchen, a cook with a beard was observed preparing raw chicken and other food without a hairnet covering his beard, despite staff stating that beard coverings were expected anytime food was being prepared.
Improper Hand Hygiene and Dish Sanitization: A cook did not fully submerge a cutting board in the hot water sanitation sink for the required 30 seconds, one cook wiped food from her hands on an anti-slip mat and handled food with bare hands without washing, and another cook touched items in a trash can after hand drying and then handled clean dishes without re-performing hand hygiene.
Rusty Walk-In Refrigerator Shelf Contaminated Raw Vegetables. A walk-in refrigerator had rust on metal wire shelves, and rust flakes were observed on the floor and on uncovered raw vegetables stored on the bottom shelf. The food service manager said he knew the shelves were rusting and that flakes could fall onto raw foods and potentially end up in residents' meals. The facility's food storage guidelines stated storage areas should be clean to prevent contamination and illness.
Improper Hand Hygiene During Food Prep: A cook wore gloves while handling cucumbers, touched a garbage can lid, and then continued handling food without removing the gloves or washing her hands. She later changed gloves and resumed cutting cucumbers, then removed the gloves and washed her hands. The DM and the cook both stated hand hygiene was expected before gloving and after glove removal.
Spoiled food was found in the main kitchen walk-in refrigerator when dietary staff observed moldy strawberries and moldy red bell peppers that had not been removed. A separate refrigerator on the Memory Care unit was also observed with a dried brown substance covering the bottom, and staff interviews showed confusion about who was responsible for cleaning and monitoring it. Facility policies required food storage areas to be clean and sanitary and for refrigerators to be routinely cleaned and monitored.
Dish Machines Used Before Reaching Required Temperatures: Two dish machines did not reach the required minimum wash and rinse temperatures before dishes were washed. A cook in the main kitchen ran dishes through a machine that reached only 142 degrees for wash and 164 degrees for rinse, and another cook in the second-floor kitchen used a machine that reached 147 degrees for wash and 177 degrees for rinse. Staff stated the machines needed to be run a couple of times to get up to temp, and the admin confirmed the required minimums were 150 degrees for wash and 180 degrees for rinse.
Unsanitary conditions were observed in two neighborhood pantries when dishwashers had thick biofilm and food particle buildup on the inner doors, one handwashing sink had grayish buildup, and a wall-mounted fan had visible dust buildup while blowing air toward the food service area. Staff stated the dishwasher and sinks were supposed to be cleaned daily, but the buildup was not known to the FSW-FA, CDM, or DSS, and there were no checklists showing when cleaning tasks were last completed.
Improper hand hygiene and glove use occurred during meal service when two cooks handled ready-to-eat foods with contaminated gloves, one cook discarded a glove into an unlidded trash container beside food items, a restorative therapy staff member did not wash her hands between feeding residents and eating her own meal, and a CNA/CMA handled a clean juice cup with soiled gloves before placing it in the refrigerator. The DON and administrator confirmed hand hygiene and glove changes were expected in these situations.
Failure to Maintain Hand Hygiene During Meal Prep: During lunch service, a cook dropped a butter container lid on the floor, picked it up, and continued plating food without hand hygiene. She also coughed into her hand while holding a resident plate, drank from her personal cup placed on a food transport cart, and kept preparing resident meals without washing or sanitizing her hands. The ADM and DM gave conflicting views on the beverage placement, but the DM stated the cart top was not a designated space for staff drinks.
A dietary aide failed to follow hand hygiene and food safety practices during meal service in the Central dining room. She touched her face, hair, pants, and a resident, then handled and served resident food without washing or sanitizing her hands, used bare hands to apply butter to a resident’s bread, washed her hands for only about 4 seconds, and put a milk lid back on a container after it fell on the floor. The DM confirmed the expected hand hygiene and food handling practices, and the facility policy required handwashing for at least 20 seconds before and after handling food and resident contact.
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