07/07/2022

Survey Tip of the Week: Initial kitchen tour

F-tag 812 food safety is the number one cited F-tag in calendar year 2022 for annual recertification surveys. The Long-Term Care Survey Process (LTCSP) instructs a surveyor to conduct an initial brief kitchen tour immediately before going to their assignment. The kitchen citations reflect noncompliance with sanitary practices identified during that initial tour. The Kitchen Long-Term Care Survey Pathway instructs surveyors to review the following foodborne illness prevention practices:

• Potentially hazardous foods, such as beef, chicken, pork, etc., have not been left to thaw at room temperature.
• Food items in the refrigerator(s) are labeled or dated.
• Potentially hazardous foods such as uncooked meat, poultry, fish, and eggs are stored separately from other foods (e.g., meat is thawing so that juices are not dripping on other foods).
• Hand washing facilities with soap and water are separate from those used for food preparation.
• Staff are practicing appropriate hand hygiene and glove use when necessary during food preparation activities, such as between handling raw meat and other foods, to prevent cross-contamination.
• Cracked or unpasteurized eggs are not used in foods that are not fully cooked (per observation or interview).
• Food is prepared, cooked, or stored under appropriate temperatures and with safe food handling techniques.
• Staff are employing hygienic practices (e.g., not touching hair or face without hand washing) and then handling food.

CMS has added the following language under F-tag 812 with the release of the Requirements of Participation Phase 3 guidance:

GUIDANCE §483.60(i)(1)-(2) Nursing home residents’ risk serious complications from foodborne illness as a result of their compromised health status. Unsafe food handling practices represent a potential source of pathogen exposure for residents. Sanitary conditions must be present in health care food service settings to promote safe food handling. CMS recognizes the U.S. Food and Drug Administration’s (FDA) Food Code and the Centers for Disease Control and Prevention’s (CDC) food safety guidance as national standards to procure, store, prepare, distribute, and serve food in long term care facilities in a safe and sanitary manner. Effective food safety systems involve identifying hazards at specific points during food handling and preparation, and identifying how the hazards can be prevented, reduced or eliminated. It is important to focus attention on the risks that are associated with foodborne illness by identifying critical control points (CCPs) in the food preparation processes that, if not controlled, might result in food safety hazards. Some operational steps that are critical to control in facilities to prevent or eliminate food safety hazards are thawing, cooking, cooling, holding, reheating of foods, and employee hygienic practices 

Websites for additional information regarding safe food handling to minimize the potential for foodborne illness include: National Food Safety Information Network’s Gateway to Government Food Safety Information at http://www.FoodSafety.gov; United States Food & Drug Administration Food Code Website at https://www.fda.gov/food/fda-food-code/food-code-2017

Hair Restraints/Jewelry/Nail Polish – According to the current standards of practice such as the Food Code of the FDA, food service staff must wear hair restraints (e.g., hairnet, hat, and/or beard restraint) to prevent hair from contacting food.

According to the Food Code, food service staff must wear hairnets when cooking, preparing, or assembling food, such as stirring pots or assembling the ingredients of a salad. However, staff do not need to wear hairnets when distributing foods to residents at the dining table(s) or when assisting residents to dine.

According to the Food Code, gloves are necessary when directly touching ready-to-eat food. Additionally, per infection control guidance, gloves are necessary when serving residents who are on transmission-based precautions (See F880 for additional information on transmission-based precautions). However, staff do not need to wear gloves when distributing foods to residents at the dining table(s) or when assisting residents to dine, unless touching ready-to-eat food.

LeadingAge Ohio encourages facilities to utilize Long-Term Care Survey Pathways to monitor for compliance. The survey pathways can be found on the CMS Nursing Home webpage, under the download section, and within the zip file called LTC Survey Pathways.

For more information about the citations occurring in Ohio, please join us on the monthly STAT: Survey Tips and Tactics call. Register now for the July 13 call at 10:00AM.

Since Ohio annual surveys restarted in January, LeadingAge Ohio is sharing tips to assist members during the survey process. Send questions you’d like addressed in future Tips of the Week to Stephanie DeWees at sdewees@leadingageohio.org.