CMS SOM App. U, Tag R141

The RNHCI must furnish food to the patient that is obtained, stored, prepared,

distributed, and served under sanitary conditions.

Interpretive Guidelines: §403.734(a)

Sanitary conditions means storing, preparing, distributing, and serving food properly to

prevent food-borne illness. Potentially hazardous foods must be subject to continuous

time/temperature controls to prevent either the rapid and progressive growth of infectious

or toxigenic micro-organisms, such as Salmonella, or the slower growth of Clostridium

Botulinum. In addition, foods of plant origin become potentially hazardous when the

skin, husk, peel, or rind is breached, thereby possibly contaminating the fruit or vegetable

with disease-causing micro-organisms. Potentially hazardous food tends to focus on

animal products, including but not limited to milk, eggs, and poultry.

Food Service & Distribution:

Food and drinks should be prepared in a sanitary setting, including use of gloves by food

service staff. Food should be served in accordance with industry standards for food

safety, such as temperature and refrigeration. Cold food products requiring refrigeration

should be served to patients in a manner which does not compromise the quality or make

the product unsafe for consumption. The food should be protected from contamination as

it is transported to the patient room or dining area.

Temperature Controls:

Improper holding temperature is a common contributing factor of food borne illness. The

facility must follow proper procedures in cooking, cooling, and storing food according to

time, temperature, and sanitary guidelines. Improper handling of food can cause

Salmonella and E-Coli contamination.

Refrigerated storage should be in accordance with state laws and manufacturer

instructions. The RNHCI is responsible for checking all refrigerators and freezers for

temperatures.

Dishwashing: The current Food Code, DHHS, FDA, PHS recommends the following

water temperature and manual washing instructions. Refer to

https://www.fda.gov/food/fda-food-code/food-code-2022 or the latest version published.

The RNHCI is expected to follow accepted standards of practice in regards to food

storage and handling to protect the health and safety of patients

Survey Procedures:

• Observe storage, cooling, and cooking of food. Record the time and date of all

observations performed. If a problem is noted, conduct additional observations

to verify findings.

• Observe that employees are effectively cleaning their hands prior to preparing,

distributing and serving food. Observe that food is covered to maintain

temperature and protect from other contaminants when transporting meals to

patients.

• Refrigerated storage: Check all refrigerators and freezers for temperatures. Use

the facility’s or the surveyor’s own properly sanitized thermometer to evaluate

the internal temperatures of potentially hazardous foods with a focus on the

quantity of leftovers and the container sizes in which bulk leftovers are stored.

• Food preparation: Use a sanitized thermometer to evaluate food temperatures.

In addition, how do kitchen staff process leftovers? Are they heated to the

appropriate temperatures? How is frozen food thawed? How is potentially

hazardous food handled during multi-step food preparation (e.g., chicken salad,

egg salad)? Is hand contact with food minimized?

• Food service: Using a properly sanitized thermometer, check the temperature of

hot and cold food prior to serving. How long is milk held without refrigeration

prior to distribution?

• Food distribution: Is the food protected from contamination as it is transported

to the dining rooms and residents’ rooms?

• Are hand washing facilities convenient and properly equipped for dietary

services staff use? (Staff uses good hygienic practices and staff with

communicable diseases or infected skin lesions do not have contact with food if

that contact will transmit the disease.)

• Are toxic items (such as insecticides, detergent, polishes) properly stored,

labeled, and used separate from the food?

• Observe food storage rooms and food storage in the kitchen. Are containers of

food stored off the floor and on clean surfaces in a manner that protects it from

contamination? Are other areas under storage shelves monitored for cleanliness

to reduce attraction of pest?

• Are potentially hazardous foods stored at 41º F or below and frozen foods kept

at 0º F or below, or consistent with the policies and industry standards for

safety?

• Do staff handle and cook potentially hazardous foods properly?

• Is food transported in a way that protects against contamination (i.e., covered

containers, wrapped, or packaged)?