CMS (Centers for Medicare and Medicaid Services) provided us updated regulations for long-term care facilities, with new clarifications under F812 for sanitation that surveyors are to observe and investigate. The primary objectives have not changed. Food professionals are to still provide safe and tasty food to our residents. We continue to use Food Code 2017 for our resource currently for sanitation reference. Of course, the overall need for continued compliance to meeting and maintaining proper temperatures of food, good hand washing, and proper glove usage is still vitally important.
Several key areas which continue to need oversight daily are: “Procure food from sources approved or considered satisfactory by federal, state or local authorities. (1)”. This may include food from local producers, or grown in facility gardens, however all needs to be in compliance with safe production, growing and then safe food-handling practices. Facility gardens need to have safe fertilizer and pest-management programs. Any produce needs to be washed and handled to decrease exterior contaminants, and any potential cross-contamination.
When receiving food items, packages need to be in good condition, protecting the integrity of the contents, so that the food is not exposed to potential contaminants (2). Part of the receiving process is dissembling the package and labeling food for facility with date received, identification if needed, and proper storage placement.
Store, prepare, distribute and serve food in accordance with professional standards for food service safety (1), is a primary goal of our service. Various systems are available for serving and distributing food items to residents. Food safety requires consistent temperature control from the tray line to transport and distribution to prevent contamination (e.g., covering food items). The length of time needed to transport trays is more critical when the food is simply covered and transported in open or closed carts without a heated and cooled environment. Additional, critical control points to remember are staff distributing trays without first properly washing their hands; and serving food to residents after collecting soiled plates and food waste, without proper hand washing. (1) Observation is our greatest tool. Step by step, how is the food being touched or moved? Is the cook using a gloved hand to pick up that toast, but didn’t that same gloved hand just touch the drawer handle? These are the processes that cause cross-contamination and are being observed by surveyors. We need to continue to educate and demonstrate the proper use of utensils to foods, proper hand washing, and single-use items if needed to pick up ready-to-eat foods. (1,2)
Nursing home residents’ needs are different than 20 years ago. They require more acute care, many are younger. Residents take prepared foods with them out of the facility (e.g., bag lunches for residents attending dialysis, clinics, sporting events, or day treatment programs). The foods must be handled and prepared for them with the same safe and sanitary approaches used during primary food preparation in the facility (1). Appropriate food transport equipment or another approach to maintaining safe temperatures for food at special events can help minimize the risk of foodborne illness (1, 2).
- State Operations Manual. Appendix PP – Guidance to Surveyors for Long Term Care Facilities Table of Contents (Rev. 173, 11-22-17). Focus F812, §483.60(i)(2)(accessed 2018) https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/som107ap_pp_guidelines_ltcf.pdf
- S. Dept Health and Human Services; U.S. FDA. (2017). Food Code. College Park, MD.