Health inspection·May 23, 2024

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on kitchen food service observations, staff interviews, facility document review, and facility policy and procedure review, the facility failed to follow proper sanitation and food handling practices to prevent the outbreak of foodborne illness with the potential to affect all residents who consumed foods from the facility, by failing to 1) Date mark numerous open bundles of bread on the bread rack, 2) Clean grease buildup inside and around the door area of the convection oven, and 3) Clean food debris stuck on and around the safety guard of the mixer. Food handling and sanitation is important in health care settings serving nursing home residents. Unsafe food handling practices represent a potential source of pathogen exposure. The findings include: A tour of the kitchen was conducted on 05/22/2024 at 7:00 AM. During the tour, the bread rack adjacent to the juice machine was observed with four open bundles of bread with no date markings. The inside door area and oven floor of the convection oven next to the steamer was covered with food grime and grease build-up. The mixer located next to the prep table was observed with food debris stuck on and around the safety guard. During the same tour, a test tray left the kitchen on the 100 hallways cart at 7:45 AM. The 100 hallways received their food cart at 7:46 AM. This surveyor received the test tray at 8:10 AM. Milk received on the food tray had a temperature of 56°F. The milk was discarded. At 8:20 AM, one milk carton pulled from a plastic bin with no ice, filled with other cartons of milk sitting on top of a cart and used for the tray line, tested at 62°F. All milk in the plastic bin was discarded. (Photographic evidence obtained) A tour of the kitchen was conducted on 05/23/2024 at 10:30 AM. New observations of eight open bundles of bread were observed on the bread rack with no date markings. The same observations as were made on 05/22/2024, were made again of the inside door area and oven floor of the convection oven covered with food grime and grease build-up, and the mixer located next to the prep table with food debris stuck on and around the safety guard. (Photographic evidence obtained) An interview was conducted with [NAME] A on 05/23/2024 at 10:17 AM. She stated when bread was opened, used, and placed back on the bread rack, it was closed tightly and placed on the rack. The cooks were responsible for cleaning the kitchen and food service equipment. The ovens were cleaned nightly. She acknowledged cleaning the oven once. She stated a staff member from the hospital came to the facility and deep cleaned the ovens; she was not sure when. The mixer was cleaned after each use by the staff member who used it, maybe once a week. An interview was conducted with the Executive Chef on 05/23/2024 at 11:00 AM. He stated the facility policy for date marking bread was to label, date, and discard after three days. Bread should be (continued on next page) Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following the date these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation. LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE TITLE (X6) DATE FORM CMS-2567 (02/99) Previous Versions Obsolete Facility ID: If continuation sheet Page 1 of 2 Event ID: 105645 Printed: 05/28/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 105645 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/23/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Bartram Crossing 6209 Brooks Bartram Drive Jacksonville, FL 32258 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)