Health inspection·November 9, 2023

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. The facility failed to maintain cleanliness and good repair of the walls in the chemical storage closet, kitchen floors, and baseboards. Live roaches were observed crawling on plastic drink lids and packages of bread. The facility failed to seal and date mark two open bundles of bread on the bread rack and failed to clean one of two microwaves located in the north unit nourishment room. 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 11/06/23 at 7:25 a.m. During the tour, the kitchen floor tile was covered with food substance and grime. Floor tiles were cracked around the cook and prep area, in and around the utility room, and between the drink and ice machine area. Baseboards were cracked, filled with debris, and pulled away from the wall in the cook and prep area, the dish machine room, the utility room, and behind the drink machine next to the door entrance from the dining room. A utility cart holding plastic cups and lids had dark residue around the bottom shelf and a live roach crawling on the plastic container of lids. The wall panel was pulled away from the wall in the dish machine room and utility room. (Photographic evidence obtained) No date markings were observed on two open bundles of bread located on the bread rack in the dry storage room. A live insect was observed crawling in one open bundle of bread, which was provided to the Certified Dietary Manager (CDM) to discard. Another observation was made again on 11/07/2023 at 9:04 a.m. During this time, new observations of two open bundles of bread were on the bread rack in the dry storage room with no date marking. (Photographic evidence obtained) A follow-up tour of the kitchen was conducted on 11/8/23 at 11:30 a.m. New observations of black substances of unknown origin were spread over the walls and door in the chemical storage closet located in the dish room next to the utility room. The chemical storage closet floor tile was filled with loose dirt and debris. Used standing mop water was found sitting in a mop bucket in the utility room. Baseboards were cracked, filled with debris, and were pulled away from wall behind the drink machine next to the door entrance from the dining room and cracked and stained floor tiles were observed in the nourishment room on the north unit. (Photographic evidence obtained) On 11/08/23 at 11:45 a.m., the microwave in one of two nourishment rooms located on the north unit was observed to have food debris and black substances of unknown origin resembling biological growth Page 1 of 3 105653 105653 11/09/2023 Aviata at Orange Park 1215 Kingsley Ave Orange Park, FL 32073

F 0812 on the inside top panel. (Photographic evidence obtained) Level of Harm - Minimal harm or potential for actual harm An interview was conducted on 11/09/23 at 1:03 p.m. with Dietary Aide A, who confirmed that the Dietary Aides cleaned the floor areas in the tray line area, dish room, dry storage room, freezer, and refrigerator daily. The Cooks were responsible for cleaning the floor daily in the stove and prep area. She thought deep cleaning of the kitchen floor occurred monthly. She confirmed that the facility's policy for date marking leftover bread was to close the bread and label it with the date opened and use by date. When asked who was responsible for cleaning the nourishment room microwave, she replied Housekeeping. Residents Affected - Many An interview was conducted on 11/09/23 at 1:20 p.m. with Dietary Aide B, who confirmed that all Dietary Aides were responsible for cleaning the floor in the kitchen. The floors were cleaned nightly. Deep cleaning of the kitchen floor was completed monthly but she was unaware of who completed the task. She confirmed that opened and used bread placed back on the bread rack was to be dated. When asked who was responsible for cleaning the nourishment room microwave, she replied, the dietary aides. An interview was conducted on 11/09/23 at 1:28 p.m. with [NAME] C, who stated the Dietary Aides were responsible for sweeping and mopping the entire kitchen floor. Maintenance /Housekeeping deep cleaned the floor monthly, overnight. Kitchen floors were cleaned twice daily. [NAME] C confirmed that opened and used bread placed back on the bread rack was to be dated and used wihint three days. When asked who was responsible for cleaning the nourishment room microwave, she stated the CDM (Certified Dietary Manager) cleaned the microwaves in the nourishment rooms. An interview was conducted on 11/09/23 at 1:46 p.m. with Maintenance Director D, who stated he received maintenance requests verbally or from the maintenance logbook located at each nursing station. Any staff could report or add to the logbook. He confirmed receiving maintenance requests from Dietary related to the missing floor tiles and grout. He also noticed the grout in the kitchen and stated he could repair it as soon as possible but needed to locate the tile pieces and schedule two evenings to complete the repairs. He stated kitchen staff were responsible for cleaning the kitchen floor at the end of each day and Housekeeping was responsible for deep cleaning the kitchen floor. An interview was conducted on 11/09/23 at 1:58 p.m. with Environmental Service Director E, who confirmed that Dietary cleaned the kitchen floors, and Environmental Services/Housekeeping provided a monthly deep cleaning of the kitchen floors. An interview was conducted on 11/09/23 at 2:00 p.m. with Dietary Aide E, who confirmed that the kitchen staff were responsible for cleaning the nourishment room refrigerators and microwave ovens. A review of the facility's policy and procedure titled Safety (dated 7/2014), revealed: The kitchen and associated equipment will be properly maintained and all Dining Services staff will follow safe operating practices. All kitchen and kitchen equipment issues will be promptly reported to facility staff and recorded according to facility protocol. (Copy obtained) Reference: FDA Food Code 2022. https://www.fda.gov/media/164194/download (Accessed on 11/14/2023) Page 156. Chapter 6. Physical Facilities. 6-5 Maintenance and Operation. 6-501 Premises, Structures, Attachments, and Fixtures - Methods. 6-501.11 Repairing. Physical Facilities shall be maintained in good repair. 6-501.12 Cleaning, Frequency and Restrictions. (A) Physical Facilities shall be cleaned as often as necessary to keep them clean. 105653 Page 2 of 3 105653 11/09/2023 Aviata at Orange Park 1215 Kingsley Ave Orange Park, FL 32073

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many A review of the facility's policy and procedure entitled Preventing Foodborne Illness - Food Handling (dated 7/2014), revealed: Food will be stored, prepared, handled, and s.erved so that the risk of foodborne illness is minimized. Policy and procedure entitled Safety (dated 7/2014), revealed: The kitchen and associated equipment will be properly maintained and that all Dining Services staff follow safe operating practices. All kitchen and kitchen equipment issues will be promptly reported to facility staff and recorded according to facility protocol. (Copy obtained) Reference: FDA Food Code 2022. https://www.fda.gov/media/164194/download (Accessed on 11/13/2023) Annex 4. Equipment, Utensils, and Linens. 4-602.12. Cooking and Baking Equipment. Page 129. (B) The cavities and door seals of microwave ovens shall be cleaned at least every 24 hours by using the manufacturer's recommended cleaning procedure. 4-602.13 Nonfood-Contact Surfaces. Nonfood-Contact Surfaces of Equipment shall be cleaned at a frequency necessary to preclude accumulation of soil residues. Annex 5. Conducting Risk-Based Inspections Annex 5 - C. Intervention Strategies for Achieving Long-term Compliance. 4. Establish First-In-First-Out (FIFO) Procedures. Page 31. https://www.fda.gov/media/164194/download (Accessed on 11/13/2023): Product rotation is important for both quality and safety reasons. First-In-First Out (FIFO) means that the first batch of product prepared and placed in storage should be the first one sold or used. Date marking foods as required by the Food Code facilitates the use of a FIFO procedure in refrigerated, ready-to-eat, TCS foods. The FIFO concept limits the potential for pathogen growth, encourages product rotation, and documents compliance with time/temperature requirements. . 105653 Page 3 of 3