Put your dietary kitchen to the test
Just like other units in a hospital, the work and conditions in a dietary kitchen change throughout the course of a day. In our experience, hospitals that are successfully ready for a visit from CMS surveyors take a systematic approach to examining and preparing their kitchen conditions to be as compliant in peak activity hours as in the quieter times of day.
A true kitchen environmental inspection cannot only occur when the kitchen staff is preparing meals for patients. Physical environment inspections must occur in phases to truly assess that food is being stored and prepared under sanitary conditions. This can translate into inspections during the least occupied hours of the day (while kitchen staff are performing their regular duties), and inspections during peak activity of meal preparation. Failure to recognize this dynamic is a common mistake, and one that takes close coordination with the kitchen staff leadership to correct.
When was the last time you inspected your Dietary Kitchen? Really, deeply, inspected your kitchen? A successful internal inspection team must be multidisciplinary, including Infection Prevention and Control, Facilities, Quality, and the Kitchen leadership. If you are unsure that your hospital’s kitchen would survive if CMS surveyors arrived today, the list below encompasses a systematic approach to self-assessment that includes: Environment of Care (EC), Life Safety (LS), and Infection Prevention and Control (IPC).
Assess your kitchen
- If you use a contracted vendor to manage your kitchen, review the contract to determine who is responsible for the cleaning process and evaluate whether the contract is being followed.
- Review facility work orders from the last 6 months. Work orders if reported reveal a lot about the overall condition of the kitchen and equipment.
- Examine the condition of the floor (e.g., dirt buildup to include corners, and underneath and behind cooking appliances, lose or broken tiles, floor drains).
- Scrutinize the walls (e.g. food stains, holes, dirt buildup especially at the of the cove basin).
- Assess the condition of the ceiling tiles (e.g., stained, holes, sagging, missing).
- Check hood system (e.g. grease buildup on filters, inspection sticker, sprinkler heads with cap attached, rust buildup, overall cleanness).
- Inspect cooking appliances (placed underneath sprinkler heads, deep fryer spacing from gas burner, rust buildup)
- Are the food delivery carts sanitized after every meal? Assure they are clean and in good repair including the wheels.
- Is food immediately removed from original shipping boxes and stored on shelves? Corrugated shipping boxes can harbor insects; remove contents and place in storage (shelves, refrigerator, freezer, etc.), Ensure no food items are stored on the floor.
- Assess the process for checking expiration dates.
- Evaluate the process of labeling foods to ensure it is consistent and accurate.
- Observe freezer, refrigerator, and dishwasher temperature logs.Is there documentation of a corrective action plan to include follow-up to address out range temperatures and malfunctioning equipment?
- Observe compliance of kitchen staff wearing hair nets, beard covers, performing hand hygiene, and wearing gloves as defined by the organization’s policy and procedure.
- Describe the routine cleaning schedule for all areas of the kitchen.
- Is there a past or present problem with pests or pest control? What is the routine pest management schedule?
- What is the quality control monitoring process for use of sanitizing solutions?
- Are pots, pans, and utensils stored in a clean, dry location without visible debris, grease, or rust?
- Is the ice machine visibly clean, regularly sanitized, with the ice scoop stored outside of the ice machine?
- Observe adherence to dietary policy and procedures to prevent foodborne illnesses.
- Monitor compliance with food delivery and tray pass for patients on isolation precautions.
- Perform a risk assessment on the dock to identify any opportunities for improvement. Discuss prevention strategies in place to ensure patient safety and prevention of foodborne illnesses.
In addition to these items, it helps to look at your kitchen operations through the lens of a CMS surveyor. Below are some of the most commonly identified kitchen observations with associated hospital CMS Conditions of Participation (CoPs) and Joint Commission Standards/Elements of Performance.
Observation: Rusted, damaged, and soiled equipment noted to be in-use in all kitchen areas.
- Knowledge point: Kitchen equipment is to be routinely monitored for operational functionality and physical condition. Work order history is reviewed with the recommendation of proper repair and replacement as appropriate.
- CMS §4482.41(d)(2) | TAG: A-0724 (2)
Joint Commission EC.02.05.05 EP6
Observation: Heat-sanitizing dishwasher documentation recorded temperatures that were out-of-range, with no noted follow-up documented.
- Knowledge point: Re-evaluate documentation log to include acceptable temperature ranges and include a comments section to record actions taken when the dishwasher is out of range or malfunctioning. Re-educate staff regarding the procedure to take when temperatures are out-of-range or the dishwasher is malfunctioning (e.g., use disposal dishes and utensils.
- CMS: §482.41(d)(2) | TAG: A-0724 (2)
Joint Commission: EC.02.05.05 | EP5
Observation: Kitchen server was observed wearing a hair net that left the front of his/her hair completely uncovered.
- Reeducate kitchen staff on the proper application and wearing of hair nets. Monitor for compliance.
- CMS: §482.42 | TAG: A-0747
Joint Commission IC.02.01.01 EP2
Observation: Opened food items were stored in dry, refrigerated, and freezer areas not labeled with expiration dates.
- Knowledge point: Determine what food items require discarding, based on lack of expiration dates. Reeducate staff on labeling opened food items with an expiration date. Audit process to assure compliance.
- CMS §482.28(b) | TAG: A-0629
Observation: The cumulative effect of unsanitary conditions in storing, preparing, and serving food could potentially be considered an immediate jeopardy situation or condition-level finding.
- Knowledge point: Take immediate actions to correct all deficiencies cited.
- CMS §482.13(c)(2) | Tag A-0144
How TiER1 Healthcare can help
If your organization needs help assessing your Kitchen/Dietary Program, please call (800) 241-0142 or email firstname.lastname@example.org