Avoiding Tag F371

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Avoiding Tag F371

• Marie Carastro
• September 21, 2007

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Ten Most Frequently Cited TagsNationally

• F323 Facility is free of accident hazards
• F371 Store/prepare/distribute food under
  sanitary conditions
• F309 Provide necessary care for highest practical
  well being
• F281 Services provided meet professional
  standards

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Ten Most Frequently Cited TagsNationally

• F279 Develop comprehensive care plans
• F329 Drug regimen is free from unnecessary
  drugs
• F315 Resident not catheterized unless
  unavoidable
• F314 Proper treatment to prevent/heal pressure
  sores

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Ten Most Frequently Cited TagsNationally

• F253 - Housekeeping and maintenance services
• F441 Facility establishes infection control
  program

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Ten Most Frequently Cited TagsAlabama

• F371 Store/prepare/distribute food under
  sanitary conditions
• F281 Services provided meet professional
  standards
• F282 - Services by qualified persons in
  accordance with care plan
• F279 Develop comprehensive care plans

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Ten Most Frequently Cited TagsAlabama

• F248 Activity program meets individual needs
• F431 Proper labeling of drugs and biologicals
• F323 Facility is free of accident hazards
• F315 Resident is not catheterized unless
  unavoidable

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Ten Most Frequently Cited TagsAlabama

• F441 Facility establishes infection control
  program
• F166 Facility resolves resident grievances

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F371

• 483.35(i)(2) Store, prepare, distribute, and
  serve food under sanitary conditions
• Using the Kitchen/Food Service Observation sheet
  (Form HCFA-804(7-95)

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Food Storage

• Are the refrigerator and freezer shelves and
  floors clean and free of spillage, and foods free
  of slime and mold?

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Food Storage

• Is the freezer temperature 0 degrees F or below
  and refrigerator 41 degrees F or below (allow 2-3
  degrees variance)?
• Do not check during meal preparation.

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United States Food Code

• 3-501.11 Frozen Food.
• Stored frozen FOODS shall be maintained frozen.

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Example

• Ice cream stored in walk-in freezer may be a 0
  degrees. Probably need -10 degrees to remain
  frozen. Residents complain of having to drink
  the ice cream. Soft to touch.

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United States Food Code

• 3-303.12 Storage or Display of Food in Contact
  with Water or Ice.

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Examples

• Thawing of frozen Health Shakes (not in water)
• Milk with ice
• Health Shakes stored in Igloo containers in
  resident rooms

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Food Storage

• Are refrigerated foods covered, dated, labeled,
  and shelved to allow air circulation?

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United States Food Code

• 3-501.17 Ready-to-Eat, Potentially Hazardous Food
  (Time/Temperature Control for Safety Food), Date
  Marking.

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Examples

• Left-overs stored in refrigerator are not dated,
  covered.
• Disposing of out dated items (i.e. Pimento
  Cheese, Cottage Cheese, Milk etc.)

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Food Storage

• Are foods stored correctly (e.g., cooked foods
  over raw meat in refrigerator, egg and egg rich
  foods refrigerated)?

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Food Storage

• Is dry storage maintained in a manner to prevent
  rodent/pest infestation?

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United States Food Code

• 6-202.11 Light Bulbs, Protective Shielding.

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Example

• Inside stand-up refrigerators/freezers

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Food Preparation

• Are cracked eggs being used only in foods that
  are thoroughly cooked, such as baked goods or
  casseroles?

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United States Food Code

• 3-801.11 Pasteurized Foods, Prohibited
  Re-Service, and Prohibited Food
• In a FOOD ESTABLISHMENT that serves a HIGHLY
  SUSCEPTIBLEPOPULATION
• UNLESS

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United States Food Code

• (3) The preparation of the food is conducted
  under a HACCP PLAN that
• (a) Identifies the FOOD to be prepared,
• (b) Prohibits contacting READY-TO-EAT FOOD with
  bare
• hands, 99
• (c) Includes specifications and practices that
  ensure
• (i) Salmonella Enteritidis growth is controlled
• before and after cooking, and
• (ii) Salmonella Enteritidis is destroyed by
  cooking
• the EGGS according to the temperature and time
• specified in Subparagraph 3-401.11(A)(2),

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Food Preparation

• Are frozen raw meats and poultry thawed in the
  refrigerator or in cold, running water? Are
  cooked foods cooled down safely?

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United States Food Code

• 3-501.13 Thawing.
• (A) Under refrigeration that maintains the FOOD
  temperature at 5C (41F) or less, or at 7C
  (45F) or less as specified under Subparagraph
  3-501.16(A)(2)
• or

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United States Food Code

• (B) Completely submerged under running water
• (1) At a water temperature of 21C(70 F) or
  below
• (2) With sufficient water velocity to agitate and
  float off loose particles in an overflow, and
• (3) For a period of time that does not allow
  thawed portions of READY-TO-EAT FOOD to rise
  above 5C (41F), or 7C (45F) as specified
  under Subparagraph 3-501.16(A)(2),
• or
• (4) For a period of time that does not allow
  thawed portions of a raw animal FOOD requiring
  cooking as specified under 3-401.11(A) or (B)
  to be above 5C (41F), or 7C (45F) as
  specified under Subparagraph 3-501.16(A)(2), for
  more than 4 hours including
• (a) The time the FOOD is exposed to the running
  water and the time needed for preparation for
  cooking, or
• (b) The time it takes under refrigeration to
  lower the FOOD temperature to 5C (41F), or 7C
  (45F) as specified under Subparagraph
  3-501.16(A)(2)

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Food Preparation Example

• Thawing chicken in deep sink with just a trickle
  of water.

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Food Preparation

• Are food contact surfaces and utensils cleaned to
  prevent cross-contamination and food-borne
  illness?

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United States Food Code

• 3-304.14 Wiping Cloths, Use Limitation.
• (A) Cloths in-use for wiping FOOD spills from
  TABLEWARE and
• carry-out containers that occur as FOOD is being
  served shall be
• (1) Maintained dry and
• (2) Used for no other purpose.
• (B) Cloths in-use for wiping counters and other
  EQUIPMENT surfaces shall be
• (1) Held between uses in a chemical sanitizer
  solution at a
• concentration specified under 4-501.114 and
• (2) Laundered daily as specified under
  4-802.11(D).

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United States Food Code

• (C) Cloths in-use for wiping surfaces in contact
  with raw animal FOODS shall be kept separate from
  cloths used for other purposes.
• (D) Dry wiping cloths and the chemical sanitizing
  solutions specified in Subparagraph (B)(1) of
  this section in which wet wiping cloths are held
  between uses shall be free of FOOD debris and
  visible soil.
• (E) Containers of chemical sanitizing solutions
  specified in Subparagraph (B)(1) of this section
  in which wet wiping cloths are held between uses
  shall be stored off the floor and used in a
  manner that prevents contamination of FOOD,
  EQUIPMENT, UTENSILS, LINENS, SINGLE-SERVICE, or
  SINGLE-USE ARTICLES.
• (F) SINGLE-USE disposable sanitizer wipes shall
  be used in accordance with EPA-approved
  manufacturers label use instructions.

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Examples

• Testing of chemical concentration
• How often to replenish or make new supply

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Food Service/Sanitation

• Are hot foods maintained at 140 degrees F or
  above and cold foods maintained at 41 degrees F
  or below when served from tray line?

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Examples

• a. Food temperature 140 vs 135 Degrees
• Don't foreget to measure the alternates
• What about Fried Chicken/Fried Fish refer to
  Food Code 3-501.19 (A)(1-4) Time as a Public
  Health Control.

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United States Food Code

• 4-203.11 Temperature Measuring Devices, Food.
• (A) FOOD TEMPERATURE MEASURING DEVICES that are
  scaled only in Celsius or dually scaled in
  Celsius and Fahrenheit shall be accurate to "1C
  in the intended range of use.
• (B) FOOD TEMPERATURE MEASURING DEVICES that are
  scaled only in Fahrenheit shall be accurate to
  "2F in the intended range of use.

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Example

• a. Not calibrated
• b. Potential inaccurate measures
• c. Clean between use
• d. Lack of training, staff skill/proficiency
• Failure to measure ALL hot/cold items prepared
  for service
• Types of thermometers (10-20 degrees difference)
• Laser
• Stem (Nail Head)

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Food Service/Sanitation

• Are food trays, dinnerware, and utensils clean
  and in good condition?

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Example

• Plastic Sectional Plates are hard to clean,
  air/dry and protective coating wears off.
  therefore stains easily.

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Food Service/Sanitation

• Are the foods covered until served? Is food
  protected from contamination during
  transportation and distribution?

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Example

• Use of plastic wrap and enclosed carts.

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Food Service/Sanitation

• Are employees washing hands before and after
  handling food, using clean utensils when
  necessary and following infection control
  practices?

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Example

• One would be expected to wash their hands anytime
  they re-enter the dietary department, not just
  after using the bathroom.

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Food Service/Sanitation

• Are food preparation equipment, dishes and
  utensils effectively sanitized to destroy
  potential food borne illness?
• Is dishwasher's hot water wash 140 degrees F and
  rinse cycle 180 degrees F or chemical sanitation
  per manufacturer's instructions followed?

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United States Food Code

• 4-501.112 Mechanical Warewashing Equipment, Hot
  Water Sanitization Temperatures.
• (A) Except as specified in (B) of this section,
  in a mechanical operation, the temperature of the
  fresh hot water SANITIZING rinse as it enters the
  manifold may not be more than 90C (194F), or
  less than
• (1) For a stationary rack, single temperature
  machine, 74C (165F) or (2) For all other
  machines, 82C (180F).
• (B) The maximum temperature specified under (A)
  of this section, does not apply to the high
  pressure and temperature systems with wand-type,
  hand-held, spraying devices used for the in-place
  cleaning and SANITIZING of EQUIPMENT such as meat
  saws.

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United States Food Code

• 4-501.114 Manual and Mechanical Warewashing
  Equipment, Chemical Sanitization - Temperature,
  pH, Concentration, and Hardness.

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United States Food Code

• A chemical SANITIZER used in a SANITZING solution
  for a manual or mechanical operation at exposure
  times specified under 4-703.11(C) shall meet
  the criteria specified under 7-204.11
  Sanitizers, Criteria, shall be used in accordance
  with the EPA approved manufacturer's label use
  instructions, and shall be used as follows

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United States Food Code

• (A) A chlorine solution shall have a minimum
  temperature based on the concentration and PH of
  the solution as listed in the following chart

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United States Food Code

• (B) An iodine solution shall have a
• (1) Minimum temperature of 24oC (75oF),
• (2) PH of 5.0 or less or a PH no higher than the
  level for which the manufacturer specifies the
  solution is effective, and
• (3) Concentration between 12.5 MG/L and 25 MG/L

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United States Food Code

• (C) A quaternary ammonium compound solution
  shall
• (1) Have a minimum temperature of 24oC (75oF),
• (2) Have a concentration as specified under '
  7-204.11 and as indicated by the manufacturer's
  use directions
• included in the labeling, and 128
• (3) Be used only in water with 500 MG/L hardness
  or less or in water having a hardness no greater
  than specified by the manufacturer's label

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United States Food Code

• (D) If another solution of a chemical specified
  under (A) - (C) of this section is used, the
  PERMIT HOLDER shall demonstrate to the REGULATORY
  AUTHORITY that the solution achieves SANITIZATION
  and the use of the solution shall be APPROVED or
  
• (E) If a chemical SANITIZER other than chlorine,
  iodine, or a quaternary ammonium compound is
  used, it shall be applied in accordance with the
  manufacturers use directions included in the
  labeling.

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Example

• Failure to monitor/document the temperatures
  prior to operation

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United States Food Code

• 4-302.14 Sanitizing Solutions, Testing Devices.
• A test kit or other device that accurately
  measures the concentration in MG/L of SANITIZING
  solutions shall be provided.

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Example

• Staff would be expected to demonstrate compliance
  using a measuring a device.
  Staff placed entire plastic container into
  the solution.
• Use of Chlorine test strip when the chemical was
  Quaternary Ammonia or vice/versa.

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Food Service/Sanitation

• Is facility following correct manual dishwashing
  procedures (i.e., 3 compartment sink,
• correct water temperature,
• chemical concentration, and
• immersion time)?

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United States Food Code

• 4-501.114 Manual and Mechanical Warewashing
  Equipment, Chemical Sanitization - Temperature,
  pH, Concentration, and Hardness.

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United States Food Code

• A chemical SANITIZER used in a SANITZING solution
  for a manual or mechanical operation at exposure
  times specified under 4-703.11(C) shall meet
  the criteria specified under 7-204.11
  Sanitizers, Criteria, shall be used in accordance
  with the EPA approved manufacturer's label use
  instructions, and shall be used as follows

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United States Food Code

• (A) A chlorine solution shall have a minimum
  temperature based on the concentration and PH of
  the solution as listed in the following chart

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United States Food Code

• (B) An iodine solution shall have a
• (1) Minimum temperature of 24oC (75oF),
• (2) PH of 5.0 or less or a PH no higher than the
  level for which the manufacturer specifies the
  solution is effective, and
• (3) Concentration between 12.5 MG/L and 25 MG/L

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United States Food Code

• (C) A quaternary ammonium compound solution
  shall
• (1) Have a minimum temperature of 24oC (75oF),
• (2) Have a concentration as specified under '
  7-204.11 and as indicated by the manufacturer's
  use directions
• included in the labeling, and 128
• (3) Be used only in water with 500 MG/L hardness
  or less or in water having a hardness no greater
  than specified by the manufacturer's label

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United States Food Code

• (D) If another solution of a chemical specified
  under (A) - (C) of this section is used, the
  PERMIT HOLDER shall demonstrate to the REGULATORY
  AUTHORITY that the solution achieves SANITIZATION
  and the use of the solution shall be APPROVED or
  
• (E) If a chemical SANITIZER other than chlorine,
  iodine, or a quaternary ammonium compound is
  used, it shall be applied in accordance with the
  manufacturers use directions included in the
  labeling.

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Examples

• Problems identified with the temperature of the
  final rinse w/ Quaternary Ammonia. (Water above
  75 Degrees).
• Problems with correct immersion times

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Other Issues

• PREVENTING POTENTIAL CROSS CONTAMINATION
• Hair/beard restraints
• Fingernails
• Wearing of jewelry
• Wet nesting tubes of plastic glasses
  

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F373

• 483.35(h) - Paid Feeding Assistants
• (1) State-approved training course. A facility
  may use a paid feeding assistant, as defined in
  488.301 of this chapter, if
• (i) The feeding assistant has successfully
  completed a State-approved training course that
  meets the requirements of 483.160 before feeding
  residents and
• (ii) The use of feeding assistants is consistent
  with State law.

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F373

• (2) Supervision.
• (i) A feeding assistant must work under the
  supervision of a registered nurse (RN) or
  licensed practical nurse (LPN).
• (ii) In an emergency, a feeding assistant must
  call a supervisory nurse for help on the resident
  call system.

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F373

• (3) Resident selection criteria.
• (i) A facility must ensure that a feeding
  assistant feeds only residents who have no
  complicated feeding problems.
• (ii) Complicated feeding problems include, but
  are not limited to, difficulty swallowing,
  recurrent lung aspirations, and tube or
  parenteral/IV feedings.
• (iii) The facility must base resident selection
  on the charge nurses assessment and the
  residents latest assessment and plan of care.

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Questions?