F000
A COVID-19 Focused Infection Control Survey was conducted by the Oregon State Survey Agency on 12/1/20 to 12/3/20.
A deficiency was cited.
Total residents: 72
Abbreviations possibly used in this document:
ADL: activities of daily living
bid: twice a day
BIMS: Brief Interview for Mental Status
CAA: Care Area Assessment
CBG: capillary blood glucose or
blood sugar
cm: centimeter
CMA: Certified Medication Aide
CNA: Certified Nursing Assistant
CPR: Cardiopulmonary Resuscitation
DNS: Director of Nursing Services
F: Fahrenheit
FRI: Facility Reported Incident
HS or hs: hour of sleep
LPN: Licensed Practical Nurse
MAR: Medication Administration
Record
mcg: microgram
MDS: Minimum Data Set
mg: milligram
ml: milliliters
O2 sats: oxygen saturation in the
blood
OT: Occupational Therapist
PCP: Primary Care Physician
PO: by mouth, orally
PRN: as needed
PT: Physical Therapist
RA: Restorative Aide
RAI: Resident Assessment
Instrument
RD: Registered Dietician
ROM: range of motion
RN: Registered Nurse
RNCM: Registered Nurse Care
Manager
SLP: Speech Language
Pathologist
TAR: Treatment Administration
Record
tid: three times a day
UA: Urinary Analysis
UTI: urinary tract infection
A COVID-19 Focused Infection Control Revisit Survey was conducted by the Oregon State Survey Agency on 1/26/21.
The facility was found to be in compliance with 42 CFR ยง483.80.
Total residents: 77
Based on observation, interview and record review, it was determined the facility failed to ensure dishes were sanitized according to professional standards for 1 of 1 sampled kitchens. This placed residents at risk for food contamination and food-borne illness. Findings include:
On 12/1/20 at 1:00 PM, manufacturer instructions for the dishwashing machine were observed posted above the machine in the kitchen. The instructions indicated the machine could function as a high-temperature washer or a chemical sanitizing dishwasher. For high-temperature washing the machine was required to be at 160 degrees F or more for the wash cycle and 180 degrees F or more for the rinse cycle.
On 12/1/20 at 1:00 PM, Staff 1 (Dietary Manager) stated the current method for sanitizing dishes was using the hot water method. Staff 1 stated that the previously used method at the last (survey) visit had been chemical sanitizing.
On 12/1/20 at 1:00 PM, three cycles for dishwashing were observed. The water temperature for the wash cycle was observed to be 155 degrees F for both the wash and rinse cycle (5 degrees low for the wash and 25 degrees low for the rinse cycle). At 1:04 PM the water temperature for the wash cycle was 165 degrees F and 168 degrees F (12 degrees low) for the rinse cycle. At 1:08 PM, the water temperature for the wash cycle was 160 degrees F and 162 degrees F for the rinse cycle (18 degrees low). At 1:22 PM, the water temperature for the wash cycle was 160 degrees F and 172 degrees F (8 degrees low) for the rinse cycle.
On 12/1/20 at 1:25 PM, Staff 1 stated she would switch from the hot water sanitizing method to the use of chemicals for the rinse cycle and began adding the chemical sanitizer into the dish washing machine. Immediately after, Staff 1 placed chemical test strips into the disinfectant three times on three different machine cycles. The results for the chemical concentrations did not register to an acceptable limit of 200-400 parts per million (PPM) and registered at 100 PPM or less.
On 12/1/20 at 1:35 PM, Staff 1 was asked to demonstrate what the disinfecting methods using the three sink method, which was also being used for cleaning. Staff 1 stated (quaternary) sanitizing chemicals were used in the third sink for the final step. The chemical instructions for the quaternary sanitizer were as follows: 1.) Remove 1.5 strip of clean, dry test paper 2.) Dip paper into clean fresh room temperature sanitizer solution. Hold solution for time required on test paper container. 3.) Compare on chart to test paper immediately - do not exceed recommended limits.
When the solution was tested, the PPM exceeded the manufacturer's instructions of 200 PPM and measured 400 PPM three separate times, possibly contaminating the cleaned dishes.
On 12/1/20 at 2:20 PM, Staff 1 acknowledged it was an expectation that dish machine temperatures reach manufacturer's recommended temperatures and sanitizing solution reach the appropriate concentrations per manufacturer's instructions.
On 12/1/20 at 1:25 PM, Staff 2 (Registered Dietitian) stated she performed monthly sanitation audits and would forward information received from the audits to management or to the regional level. Staff 2 acknowledged the dishwashing machine temperatures had been an ongoing issue and the facility needed to "redo" the entire process.
On 12/1/20 at 1:45 PM, Staff 3 (Administrator) stated the facility had a service person out recently and the machine had been repaired two or three times.
Staff 3 stated the plan for dinner service would be to serve all meals in disposable containers, use disposable cups and cutlery. The repair service would be notified, a service request would be made immediately and until the machine was repaired, disposable containers would be utilized.
Staff 3 confirmed it was an expectation the dish machine temperatures reach manufacturer's recommended temperatures and sanitizing solution reach the appropriate concentrations per manufacturer's instructions.
On 12/1/20 at 1:57 PM, Staff 4 (DNS) confirmed it was an expectation the dish machine temperatures reach manufacturer's recommended temperatures and sanitizing solution reach the appropriate concentrations per manufacturer's instructions.
F0812-All residents are at risk for food contamination and food-borne illnesses. Dietary Manager or designee will in-service dietary staff on proper methods for sanitizing dishes using chemicals at acceptable limits of Parts Per Million (PPM). The hot water is not being used at this time, strictly chemicals for sanitation. Dietary staff will be re-educated on using the 3 sink method for back-up for possible dish machine malfunctions.Dietary Manger or designee will audit the PPM 3 times per day for 4 weeks in addition to the regular scheduled temperature checks done daily , then 3 times per week for 2 months. Results of these audits will be brought to the monthly QA and quarterly QAPI meetings until substantial compliance is achieved for 2 consecutive QAPI meetings.
A COVID-19 Infection Control Survey and a COVID-19 Facility Review was conducted by the Oregon State Survey Agency on 12/1/20 to 12/3/20.
Total Residents: 72
A deficiency was cited.
Abbreviations possibly used in this document:
ADL: activities of daily living
bid: twice a day
BIMS: Brief Interview for Mental Status
CAA: Care Area Assessment
CBG: capillary blood glucose or blood sugar
cm: centimeter
CMA: Certified Medication Aide
CNA: Certified Nursing Assistant
CPR: Cardiopulmonary Resuscitation
DNS: Director of Nursing Services
F: Fahrenheit
FRI: Facility Reported Incident
HS or hs: hour of sleep
LPN: Licensed Practical Nurse
MAR: Medication Administration Record
mcg: microgram
MDS: Minimum Data Set
mg: milligram
ml: milliliters
O2 sats: oxygen saturation in the blood
OT: Occupational Therapist
PCP: Primary Care Physician
PO: by mouth, orally
PRN: as needed
PT: Physical Therapist
RA: Restorative Aide
RAI: Resident Assessment Instrument
RD: Registered Dietitian
ROM: range of motion
RN: Registered Nurse
RNCM: Registered Nurse Care Manager
SA: State Agency
SLP: Speech Language Pathologist
TAR: Treatment Administration Record
tid: three times a day
UA: Urinary Analysis
UTI: Urinary Tract Infection
A COVID-19 Confirmed Facility Review Revisit Survey was conducted by the Oregon State Survey Agency on 1/26/21.
Total residents: 77
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OAR 411-086-0250 - Food Procurement, Store/Prepare/Serve - Sanitary
Refer to F 812
