great-kitchen-staffIn preparation for an upcoming regulatory visit (TJC, State Survey, CMS), let’s ensure that you and your team are prepared to respond to the following key nutrition/ kitchen/ dietary regulatory hot topics that are frequently being focused on by regulatory surveyors:

Hygiene and Infection Control Practices

    1. Food Service personnel should be able to describe and demonstrate acceptable hygiene and infection control practices, including designated hand washing sinks, appropriate location of staff lockers and the availability of hair nets at entrances to food preparation areas.
    2. Ensure related Policies and Procedures are in place.

 Food Temperature 

    1. Appropriate food temperatures must be maintained for hot and cold foods being transported from the kitchen to the patient. 
    2. Staff needs to be able to articulate the path of travel, time and distance.  Staff may be required to walk the path of travel from the kitchen to the Patient Care Unit with the surveyor.
    3. Ensure related Policies and Procedures are in place.

Paths of Travel 

    1. Staff must be able to describe the path of travel of clean (patient food, food supplies) and dirty (trash, dirty trays) to and from the kitchen and cafeteria areas to patient care areas.
    2. Ensure related Policies and Procedures are in place.

 Responsibility for the Pantry/Nutrition Rooms

    1. Know who is responsible for maintaining the Pantry/Nutrition Rooms on each Patient Care Unit.
    2. Staff needs to be able to articulate the role of Nutrition and Nursing, who is responsible for nutrition refrigerator monitoring, ice machine cleaning and maintenance, monitoring that food is not outdated, tray delivery and collection.
    3.  Ensure related Policies and Procedures are in place.

 Cleaning and Sanitation

    1. Staff must be able to describe how to clean and sanitize all kitchen equipment, contact surfaces, utensils, and food preparation areas. 
    2. Ensure that staff can articulate what cleaning solutions are used and what the appropriate concentrations are of the cleaning solutions.
    3. Ensure related Policies and Procedures are in place.
    4. Ensure you are addressing all manufacturer’s guidelines.

Diet Manual and Menus

    1. Be prepared to show the Diet Manual and the therapeutic diet menus to meet patients’ nutritional needs. 
    2. Ensure related Policies and Procedures are in place.
    3. Staff must be able to articulate the system for diet ordering, change in diet orders, nutritional supplements and accommodation of non-routine occurrences (e.g., tube feeding), and TPN.

 Temperature Record Logs

    1. Ensure that all temperature record logs for refrigerators and freezers are complete.
    2. Ensure related Policies and Procedures are in place.

 Thermometers

    1. Ensure that thermometers are clean, calibrated and sterilized.

 Appropriate Storage Space for Food Supplies

    1. Ensure that there is adequate storage of food supplies (including dry storage areas and refrigerator/freezer storage) and emergency food supplies.  Per Title 24, 4.20 A.209, dietary stores (emergency must be 400 square feet for the first 200 beds plus 1 square feet/bed above 200 (dry store + 2 cargo).
    2. Per California Code of Regulations, Title 22 (§ 70279), ensure a minimum of .057 cubic meters (2 cubic feet) of usable refrigerator space per bed for the storage of frozen and chilled foods.
    3. Per California Code of Regulations, Title 22 (§ 70277), ensure that at least a one week’s supply of staple foods and at least a 2 day supply of perishable foods is maintained on the premises.
    4. Supplies must be appropriate to meet the requirements of the menus.
    5. Ensure that you have site plans, drawings and floor plans available for the surveyors.

Appropriate Staffing

  1. Be prepared to demonstrate current work schedules by job titles and weekly duty schedules (you are required to post these in the kitchen).  In addition, be prepared to demonstrate that you are maintaining a record of the # of persons by job title employed full or part-time in dietetic services and the # of hours each works weekly.
  2. Be able to demonstrate how you have sufficient staff to comply with all regulatory requirements and to ensure that the ongoing nutritional needs of patients are being met.

Ensure that your overall plan accommodates any expansion of patient care services, including vendor delivery, de-boxing, storage, food preparation, catering, retail and room service cooking lines, ware washing, changing rooms and restrooms, administrative offices and support areas, clean room, service elevators and dining room. Need to demonstrate that you are also taking into account the # of unlicensed beds for which dietary provides meals and the projected demand for the new facility/expansion.  Unlicensed bed types include PACU, ED and Dialysis – these are areas where food is also provided to patients.

Lastly, If NICU or Pediatric patients then be prepared to address provision and/or preparation of infant feeding and specialty formulas/tube feedings and the impact on the kitchen.

The above topics related to Nutrition and Food Services have been raised at other hospitals that were adding beds and services.  These other facilities have had to demonstrate all of the above so be prepared.