Long-Term Care Survey Alert

7 ways to translate a clean kitchen into a clean survey.

What's the number one F tag nationwide? You guessed it: F371.
 
This tag requires facilities to "store, prepare, distribute and serve food under sanitary conditions." And there's a saying that if you just stand around long enough in even the best of kitchens, you're bound to catch some little sanitation lapse -- especially if you are a picky surveyor hungering to write someone up.

Do not fear: These seven strategies can help protect residents from food-borne illness and keep your kitchen in the survey safety zone.

1. Implement a cleaning schedule that identifies who does what, how and when. "Assign duties that should be done every day, week and year," suggests Debra Miller, RD, LD, director of dietary services for Heritage Enterprises Inc. in Bloomington, IL. "If you maintain a cleaning schedule, things won't get out of hand," she adds. (See "Survey Citation" to find out what happened to a facility that didn't follow a regular cleaning schedule.)

2. Implement basic principles for storing food properly. Start with a "first in, first out" restocking procedure, which will prevent using outdated food and also help you know what to order. "Date the cans, so staff know which ones to use first," suggests Miller. Also make sure staff know to put raw foods (such as defrosting meats) on the bottom shelf of the fridge, advises Chris Kallas, RD, LD, vice president of MyRDtoGo (Myrdtogo.com). "The cooked and ready-to-eat foods should go on the higher shelves," she says.

Another storage tip: Store flour, rice and dry products in airtight containers and keep the scoops out of the product.

3. Inspect food deliveries while the delivery person is still there. The time for rooting out potentially spoiled food is when it arrives, so you can send it packing immediately. "Check for broken boxes, dry foods that are wet or damp, and food that has passed its expiration date," suggests Kallas. Double-check receiving food temperatures and any signs of pests, such as rodent droppings or insects.

Pest control tip: Prevent fruit fly infestations by rinsing bananas and fruit when you receive them to wash off fruit fly larvae. Teach staff not to leave the door cracked open when they step out to smoke.

4. Develop a quality assurance checklist for the kitchen. Then have someone from "the outside" come in and use the list to inspect the kitchen, because the regular kitchen and dietary staff can sometimes fail to see what a surveyor definitely will. "The person using the QA checklist might be the consultant dietitian or the administrator," suggests Annette Kobriger, a long-term care nutritional consultant in Chilton, WI. "The QA person should look first for dangerous practices, such as a puree left uncovered in the freezer that someone plans to serve for dinner," she says. Use the inspection as a learning opportunity for staff.

Keep it cool: Check the accuracy of your fridge thermometers at regular intervals, suggests Linda Williams, long-term care risk manager with GuideOne Insurance, West Des Moines, IA.

5. Teach handwashing until it becomes second nature to kitchen staff. You may feel like you're beating a dead horse by continually stressing handwashing, but it's actually one of the best ways to protect residents from illness -- and your facility from an F tag during a kitchen tour. If possible, designate a dedicated hand wash sink to provide a visible reminder to wash up.

6. Take a good look at your kitchen layout to see if it promotes good sanitation practices. "A kitchen's layout can make a difference" in how well staff tend to prevent cross-contamination of foods, Kallas says. For example, "having adequate preparation space with designated areas for cooked and ready to eat foods versus raw foods is a plus," she notes. The layout of equipment can also be important, so ask staff if they think a change would help.

7. Keep staff primed for prime time. Do a monthly mock survey in the kitchen using Exhibit 92 in the State Operations Manual just like surveyors will use for the kitchen tour (see checklist,"Survey Checklist").

"Surveyors may also use the U.S. Food & Drug Administration Food Code as a reference," Kallas says (see http://vm.cfsan.fda.gov/~dms/foodcode.html).