Health inspection·May 11, 2023

F 0802 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many Provide sufficient support personnel to safely and effectively carry out the functions of the food and nutrition service. Based on observations, record review, and staff interviews, the facility failed provide sufficient kitchen staff with the appropriate competencies and skills sets to carry out the functions of food and nutrition service. Failure to ensure that dietary staff were trained and knowledgeable about the proper procedures for food safety and sanitation had the potential to negatively impact all residents who received meals from the kitchen. The findings include: A kitchen tour was conducted on 05/10/23 at 10:40 a.m. During the tour, [NAME] D was asked to explain the appropriate method of calibrating a food thermometer. She stated, A glass of water in ice starting at 40°F and up to 165°F. It should be below 40°F for cold food. When asked what the thermometer should read to ensure it was accurate and working appropriately, she replied, 40°F. When asked how often and what training she had in the kitchen for food safety and sanitation, she replied, Not too often. My last training was a couple of years ago. I can't remember, one to two years ago. She reported that she assisted with training new kitchen staff. I train new staff on what I like, I have no manual. When asked what training topics she was teaching, she replied, Pureed and mechanical diets and seasonings. At this time, the Food Service Director was notified that the cook was not knowledgeable of the calibration process or how to read the thermometer for accuracy. He stated another cook was on their way to assist with the meal service. On 05/10/23 at 11:35 a.m., Assistant Food Service Director C entered the kitchen. He was asked to explain the thermometer calibration process. He stated, The thermometer is placed in ice water and should read 10°F. When asked at what temperature the thermometer should read to ensure it was accurate and working appropriately, he replied, 10°F. When asked who was responsible for training dietary staff, he replied, The Food and Nutrition Service Manager and the Assistant Food and Nutrition Service Manager provide monthly in-services. Lunch was scheduled to begin at 11:30 a.m. There were only two cooks in the kitchen at this time. The Assistant Food Service Director was informed that training related to the thermometer calibration process was to be completed prior to serving the lunch meal to ensure the food was safe for residents to consume. On 05/11/23 at 9:15 a.m., a review of the job description titled Food and Nutrition - Cook was signed by [NAME] D and dated 02/15/19. The summary revealed that the cook prepares palatable, nourishing, well-balanced meals to meet the daily nutritional and special diet needs for each resident. A review of the facility's web-based education module for Safe Food Handling training, dated 03/22/23 for [NAME] C, revealed it included the thermometer calibration process. A review of the Employee In-Service/Educational Attendance Record titled 3rd Aide Meeting, dated 02/26/22, and In-Service Report titled Explained Correct Thermometer Calibration Method, dated 05/10/23, revealed two Dietary Page 1 of 4 105735 105735 05/11/2023 Orange City Nursing and Rehab Center 2810 Enterprise Rd Debary, FL 32713

F 0802 in-services were held for support staff since the facility's last recertification survey. Level of Harm - Minimal harm or potential for actual harm An interview was conducted with Assistant Food Service Director C on 05/11/23 at 12:29 p.m. He confirmed that he and Food Service Director E were responsible for training the Dietary staff. He stated Dietary Aides assisted with training new Dietary Aides about how to set up in the kitchen for each meal service, and Food Service Director E provided training to all new staff at the facility orientation. Residents Affected - Many An interview was conducted with Food Service Director E on 05/11/23 at 12:39 p.m. During orientation, he confirmed that, Generally, training is mostly in the kitchen. New staff are assigned to shadow the most experienced staff for two weeks. We follow and answer questions. We explain dates, time, and temperature; how to work with residents, and how to use and clean equipment. When asked to provide documentation of the training provided, he stated, We try to follow a path, no documentation. Yearly competency reviews include a discussion of job tasks, accomplishments, and opportunities for additional learning. A review of the facility's policy and procedure titled Prepared Food Temperature Record (Revised 02/21/17), revealed the following: Purpose: Ensure food is held and delivered at accepted temperatures to control and reduce the chances of foodborne illness. 2. In the service line - a. If temperatures are less than or equal to 135 degrees fahrenheit for hot foods, reheat to an internal temperature of 165 degrees fahrenheit for 15 seconds. b. If temperatures are great than or equal to 41 degrees fahrenheit for colds foods, chill to an internal temperature of less than or equal to 41 degrees fahrenheit. . 105735 Page 2 of 4 105735 05/11/2023 Orange City Nursing and Rehab Center 2810 Enterprise Rd Debary, FL 32713

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 store food in accordance with professional standards for food service safety, by failing to follow proper food handling practices to prevent the outbreak of foodborne illness with the potential to affect all residents who consumed foods from the facility's kitchen. Unsafe food handling practices represent a potential source of pathogen exposure. The findings include: An initial tour of the kitchen was conducted on 05/07/23 at 11:11 a.m. During the tour, no date markings were observed on two crates sitting between the shelves and filled with fresh onions; one open carton of cottage cheese, and one open box filled with fresh grapes on the shelf in the walk-in refrigerator. In the dry storage room, there was no date marking observed on two open bundles of bread and one open bag of bagels. (Photographic evidence obtained) Another tour of the kitchen was conducted on 05/08/23 at 9:10 a.m. The same observations made on 05/07/23 at 11:11 a.m. in the walk-in refrigerator were made again. At this time, a new observation of one open bag of English muffins with no date marking was observed on the bread rack in the dry storage room. On the same bread rack, there was no date marking observed on one open bag of bagels. (Photographic evidence obtained) An interview was conducted with Dietary Aide A on 05/11/23 at 8:19 a.m., who confirmed that the facility's policy about date marking was to ensure first in and first out (FIFO). Open food was to be covered and dated the date the item was opened. Leftover bread was wrapped, date marked the date it was opened, and then discarded after three days. An interview was conducted with Dietary Aide B on 05/11/23 at 8:33 a.m., who stated the Dietary Aides were responsible for maintaining the dry storage and Cooks were responsible for maintaining the refrigerator and freezer. She confirmed that once a food item was opened, it was to be wrapped or placed in a container and dated before going back into the refrigerator, freezer, or the dry storage shelf. Opened bread was wrapped and dated before placing it back on the rack. An interview was conducted with Assistant Food Service Director C on 05/11/23 at 12:29 p.m., who confirmed that Dietary Aides were responsible for maintaining the dry storage and Cooks were responsible for maintaining the refrigerator and freezer. He confirmed that when a food item was opened, used, and placed back in the refrigerator or freezer, it was to be taken out of the original package and placed into a container, then labeled, dated, and discarded after three days. He also confirmed that when bread was opened, used and placed back on the bread rack, it was to be wrapped, labeled, dated the date it was opened, and then discarded after three days. A review of the facility's policy and procedure titled Food and Supply Storage (dated 6/26/18) revealed the following: Proper food storage is essential for preserving food quality. This applies to foods stored prior to preparation, and also to prepared foods (leftovers) that are placed in storage. Storage factors that impact the preservation of quality include holding period, temperature, and humidity. Procedures: 2. Rotate stock so that the old supplies are placed in front of the new supplies, ensuring that the product first in will be first out (FIFO). 3. Label each package, box, can, etc. 105735 Page 3 of 4 105735 05/11/2023 Orange City Nursing and Rehab Center 2810 Enterprise Rd Debary, FL 32713

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many with date of receipt, and when the item was stored after preparation . b. Discard leftover foods that have not been used within 72 hours of preparation . 5. Label opened food items with date opened. (Copy obtained) According to FDA Food Code 2022 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 1/23/2023): Product rotation is important for both quality and safety reasons. First-In-FirstOut (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. . 105735 Page 4 of 4