2024 Kitchen Tracer

• Site conducted

  Select

• Conducted on

  Date

• Prepared by

• Location
  Address

Summary of Survey

• Number of deficiencies found during this inspection

Clinical Section of Kitchen Tracer

• Select a patient with a special diet. Have the dietary staff member describe how they are communicated to about the special diet

• Observe, if possible, a diet tray being delivered to a patient, did the dietary person delivering the food tray to the patient use 2-patient identifiers?

  Yes

  No

  N/A

• Review process for a dietician referral as part of a patient tracer

  Yes

  No

  N/A

• “Trace” that patient to the kitchen

  Yes

  No

  N/A

• Determine how the diet order is communicated to the kitchen and how that order is applied to items selected for a patient meal tray

• Are menus posted or otherwise available to staff making the tray

  Yes

  No

  N/A

• Verify that the medical staff (and dietician) approve the current diet manual (diet manuals good for 5 years but still need annual review)

  Yes

  No

  N/A

• Review the job descriptions to make sure responsibilities are clearly defined

  Yes

  No

  N/A

Infection Control

• Are all staff members wearing hair nets

  Yes

  No

  N/A

• Are all beards covered

  Yes

  No

  N/A

• Is there an eyewash station, if yes, have all weekly checks been documented

  Yes

  No

  N/A

• Is handwashing being done

  Yes

  No

  N/A

Kitchen Environment

• Kitchen is organized and free of clutter

  Yes

  No

  N/A

• Dishes and utensils stored to prevent contamination

  Yes

  No

  N/A

• No sign of “pests”

  Yes

  No

  N/A

• Proper use and cleaning of cutting boards (one for meat, one for veggies) and other prep surfaces to avoid contamination

  Yes

  No

  N/A

Food Temperatures

• (Make sure to check all logs )

• Monitor the food temperature checks of the hot and cold items used to prepare patient meals

  Yes

  No

  N/A

• There should be logs of temperatures for each meal service; usually at the start, midpoint, and end if meal service is extended. Ask how these temperatures are monitored and when a mid-meal check is required (The log should have 3 times for EACH meal time served - breakfast, lunch, dinner). Are all logs filled in correctly?

  Yes

  No

  N/A

• Final cooking temps should be as follows:

• Poultry – 165

  Yes

  No

  N/A

• Ground meat, ground fish, eggs- 155

  Yes

  No

  N/A

• Fish and other meat – 145

  Yes

  No

  N/A

• Precooked, cooled, then reheated - 165

  Yes

  No

  N/A

• Holding temps should be at least 135 or higher for hot foods and 41 or below for cold foods

  Yes

  No

  N/A

Refrigerator Temperatures and

• Are refrigerator temperatures 41 degrees or below?

  Yes

  No

  N/A

• Is there action taken for any temperature out of range?

  Yes

  No

  N/A

• Is there a log for each freezer / refrigerator?

  Yes

  No

  N/A

• Is all food labeled with expiration date; food should also be covered

  Yes

  No

  N/A

• Look for labeling of opened containers with expiration date

  Date

• Are there any expired food items?

  Date

• Look for precooked food in the cooling process (may also be in the freezer)

  Yes

  No

  N/A

• Ask for policy/process on how the cooling process of food is done. (Should be cooled to 70 within 2 hours and to 41 within 4 (total cooling time not over 6 hours)

  Yes

  No

  N/A

• No uncooked food (chicken or other meat) stored over cooked food or produce to prevent contamination (should be on bottom shelves)

  Yes

  No

  N/A

• No thawing of frozen food at room temperature

  Yes

  No

  N/A

• Make sure food is stored in refrigerator/freezer to allow for ventilation

  Yes

  No

  N/A

• Look for sprinklers inside with adequate clearance

  Yes

  No

  N/A

• Look for monitoring of freezer temps

  Yes

  No

  N/A

• Ask for frequency and temperature limits per policy (temperature to assure food stays frozen)

  Yes

  No

  N/A

• Make sure monitored per policy

  Yes

  No

  N/A

• If temps out of range, what was done – is there evidence

  Yes

  No

  N/A

• Look for expiration dating as above

  Yes

  No

  N/A

• Are there sprinklers inside with adequate clearance

  Yes

  No

  N/A

• Look for ice build-up – there shouldn’t be any

  Yes

  No

  N/A

• Dry Storage

  Yes

  No

  N/A

• Look for any expired items

  Yes

  No

  N/A

• Look for unobstructed sprinkler flow

  Yes

  No

  N/A

• May ask about EM preparation and food storage items (how would they prepare for 90 days of supplies during emergency)

  Yes

  No

  N/A

• Ask about dishwasher temps or chemical preparation

  Yes

  No

  N/A

• Ask for policy on monitoring of dishwasher temps

  Yes

  No

  N/A

• Ask for log of dishwasher temperature/chemical monitoring

  Yes

  No

  N/A

• Wash temps 150

  Yes

  No

  N/A

• Rinse temps 180

  Yes

  No

  N/A

• If chemical process then wash temp 120 and 50ppm (reference IFUs)

  Yes

  No

  N/A

• If temps out of range, what was done, and what was evidence

• Review the process of the 3-sink cleaning. How much chemical per gallon of water? Review log that pH strip is done.

• §482.42 - (A-0747) - §482.42 Condition of Participation: Infection Control This Condition is NOT MET as evidenced by: In the kitchen, is the pH test strips used at the 3-part sink current

  Yes

  No

  N/A

Life Safety

• Do sprinkler heads have adequate 18" clearance?

  Yes

  No

  N/A

• Deep fat fryer. Is there at least 16" space between the fryer and surface flames from adjacent cooking equipment?

  Yes

  No

  N/A

• K fire extinguisher placard identifying need to activate the fixed suppression (ansul) system before using the extinguisher?

  Yes

  No

  N/A

• is the grease hood clean with no grease buildup?

  Yes

  No

  N/A

• Yes

  No

  N/A