Shore View Nursing & Rehabilitation Center
September 28, 2017 Certification Survey

Standard Health Citations

FF10 483.60(i)(1)-(3):FOOD PROCURE, STORE/PREPARE/SERVE - SANITARY

REGULATION: (i)(1) - Procure food from sources approved or considered satisfactory by federal, state or local authorities. (i) This may include food items obtained directly from local producers, subject to applicable State and local laws or regulations. (ii) This provision does not prohibit or prevent facilities from using produce grown in facility gardens, subject to compliance with applicable safe growing and food-handling practices. (iii) This provision does not preclude residents from consuming foods not procured by the facility. (i)(2) - Store, prepare, distribute and serve food in accordance with professional standards for food service safety. (i)(3) Have a policy regarding use and storage of foods brought to residents by family and other visitors to ensure safe and sanitary storage, handling, and consumption.

Scope: Isolated
Severity: Potential to cause more than minimal harm
Citation date: September 28, 2017
Corrected date: October 31, 2017

Citation Details

Based on observation, record review and staff interviews during the recertification survey, the facility did not ensure that food was served under sanitary conditions. Specifically, during a dining observation conducted on the 4th, the unit CNA (Certified Nurse Assistant) was observed touching two resident sandwiches, the inner surfaces of cups and container lids with her bare hands, wiping her hands on the back of her pants and picking up plate covers that fell on to the floor and replacing them on a cart without performing hand hygiene. Additionally, during follow-up observations, the 2nd floor CNA was observed touching the resident's bread with her bare hands and continuing on with serving other resident trays without performing hand hygiene. This was evident during observations conducted for the Dining Observation Task. (Unit 2 & 4). The findings are: On 9/21/2017 at 12:42:01 PM, a lunch observation was conducted on the 4th floor and the following observed: The CNA opened the plastic wrapper of a resident sandwich and touched the sandwich with her bare hands. When the resident stated that she wanted an alternate sandwich, the CNA retrieved another sandwich, opened the clear wrapping and used her bare hands to pull the sandwich apart. Additionally, the CNA picked up plate covers that fell on to the floor, replaced them on a cart and proceeded to distribute trays and open up food items without performing hand hygiene. The CNA also wiped her hands on the back of her pants and touched the inner surfaces of cups and soup container lids with her bare hands. On 9/25/17 at 1:03 PM, the second floor dining service was observed. CNA #2 was observed opening the plastic wrapper of the residents bread with her bare hands. The CNA then placed the lunch tray in the pantry area and disposed of the food wrappers in the garbage and proceeded with serving other resident trays without washing or sanitizing her hands. On 9/25/2017 at 11:56 AM, a 4th floor CNA was interviewed and stated that before and after I serve food, I wash my hands. When I open the plastic bread wrappers, I am not supposed to touch the bread with my bare hands. If a lid cover falls on the floor, after I pick it up, I wash my hands. After picking up anything from the floor, hand washing should be done. This is done to prevent bacteria from being transmitted from the floor to the hands and food. The RN (Registered Nurse) Charge Nurse was interviewed on 9/25/2017 at 12:04 PM. The RN stated that staff are supposed to perform hand hygiene before, during and after serving food as well as whenever picking up items from the floor. As far as food handling is concerned, gloves should be worn to prevent direct contact with the food item. If you touch your uniform, hand washing should be done to prevent cross contamination. The RN Inservice Coordinator/ Infection Control Nurse was interviewed on 9/25/2017 at 12:18:13 PM. The staff are taught that when they enter the dining room, hand washing is performed. Touching resident food with the bare hands is never acceptable. If they touch anything from the floor, hair, face or articles of clothing, hand washing is indicated. The CNA (who displayed the safe food handling and infection control breaches) works for an agency. All the agency CNA's are given the same inservice training as the facility staff and I conduct ongoing audits of staff performance. This CNA was recently audited and no issues were identified. On 9/25/17 at 1:33 PM, CNA #2 was interviewed and stated that she started work at the facility one month ago and received infection control in-service training on hand washing. The training included hand washing when first entering the dining room and before serving meal trays. The CNA further stated that she did not know that she was not supposed to touch food items with her bare hands. 415.14(h)

Plan of Correction: ApprovedOctober 11, 2017

F-371 Food Procure, Store/Prepare/Serve-Sanitary
I. Immediate Correction
? The Director of Nursing conducted a complete and thorough investigation into the residents care. The staff involved in the deficiency were identified and were given disciplinary counseling for failure to follow the facility?s policy on hand hygiene and sanitary food handling during meal services.
? A facility wide re-inservice was conducted immediately by the Infection Control Nurse focusing on appropriate hand hygiene and sanitary food handling.
II. Identification of Other Residents
? The facility has identified that all residents have the potential to be affected by the same deficient practice.
III. Systemic Changes
? The policies on meal service, handling of dishes, sanitary food handling and
hand hygiene protocols were reviewed and found to be compliant with the
regulations.
? The Infection Control Nurse will re-educate on these policies, all staff involved in
meal service, food storage, its procurement and preparation. A copy of the
Lesson Plan and attendance will be filed for reference and validation.
? Meal pass observation to ensure that food is served under sanitary conditions will
be incorporated with the weekly Infection Environmental Rounds. Meal rounds
will help identify problem areas and allow the Nursing Department to
implement corrective actions including staff retraining.
? Director of Nursing and Director of Food Services will be responsible for ensuring corrective action is implemented.
IV. QA Monitoring
? The Director of Nursing or designee will use the audit tool which was developed to conduct observations of staff members to ensure they are complying with the facility procedures for sanitary food handling and hand-washing, while handling food. These observations will be done 3 times a week covering all meals for 1 month, then monthly. Any noted violation of procedures will result in education and/or corrective action with the staff responsible, as needed.
? The Director of Nursing or designee will report the trends identified from the audits to the QA Committee who will determine if substantial compliance has been achieved.
V. Responsible Party
? Director of Nursing will be responsible.

Standard Life Safety Code Citations

K307 NFPA 101:SMOKING REGULATIONS

REGULATION: Smoking Regulations Smoking regulations shall be adopted and shall include not less than the following provisions: (1) Smoking shall be prohibited in any room, ward, or compartment where flammable liquids, combustible gases, or oxygen is used or stored and in any other hazardous location, and such area shall be posted with signs that read NO SMOKING or shall be posted with the international symbol for no smoking. (2) In health care occupancies where smoking is prohibited and signs are prominently placed at all major entrances, secondary signs with language that prohibits smoking shall not be required. (3) Smoking by patients classified as not responsible shall be prohibited. (4) The requirement of 18.7.4(3) shall not apply where the patient is under direct supervision. (5) Ashtrays of noncombustible material and safe design shall be provided in all areas where smoking is permitted. (6) Metal containers with self-closing cover devices into which ashtrays can be emptied shall be readily available to all areas where smoking is permitted. 18.7.4, 19.7.4

Scope: Isolated
Severity: Potential to cause more than minimal harm
Citation date: September 28, 2017
Corrected date: December 4, 2017

Citation Details

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation and staff interview, the facility did not ensure that the facility's premises were kept smoking free in a non-smoking area. Reference is made to the outside patio where multiple cigarette butts were observed on the floor. The Finding is: On (MONTH) 25 (YEAR) at approximately 11:30 am during life safety rounds, it was observed that an outside patio had a no smoking sign in the area. Also in the area, propane tanks were observed stored in a locked metal cage. In close proximity to the propane tanks, numerous cigarette butts were observed on the floor. In an interview with the Facility Director on 9/25/17 at approximately 11:45 am, he stated that it is a non-smoking facility and will ensure that it is corrected. In an interview with the Administrator at approximately 2:00 pm, he stated that a single resident who was discharged on [DATE] is the only smoker and sometimes family members supply him/her with cigarettes. 711.2(a) NFPA 101 (2012 edition) 19.7.4

Plan of Correction: ApprovedOctober 12, 2017

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** K741 NFPA 101 Smoking Regulations
I. Immediate Correction
a. Shore View Nursing Home is a Non-Smoking Facility. There are signs around the facility that indicate the same, including the patio area where the cigarette butts were found. More signs will be purchased for that area.
b. The metal cage containing the propane tanks, has been moved to another location away from the building structure.
c. The non-compliant resident was discharged home on[DATE]. There are no other smokers in the facility at this time.
II. Identification of Other Residents
a. The resident in question, who was non-compliant to the facility?s no smoking policy, has been discharged home.
b. No residents or family members were affected by the practice of the non-compliant smoker.
c. There are no other residents in the facility that are smokers.
III. Systemic Changes
a. The facility remains a Non-Smoking Facility.
b. Residents coming out to the patio, will continue to be monitored closely.
c. If a resident is admitted into the facility, who is a known smoker, we will continue to provide education and offer the ?Patch? to assure that the non-smoking policy is strictly adhered to.
IV. Monitoring
a. The facility?s Nursing, Social Work and Recreational Therapy departments will continue to monitor all residents, and report any potential issues or violations to Administration.
V. Responsible Party
a. The Administrator is responsible for ensuring compliance with the facility?s no-smoking policy. The corrective action is immediate.