| VIRGIL CALVERT NURSING AND REHAB CENTER Facility I.D. Number 0039651 Date of Survey: 06/18/02 Annual and complaint survey "A" VIOLATION(S): Food Handling Sanitation Every facility shall comply with the Department’s rules entitled “Food service Sanitation” (77 Ill. Adm. Code 750) Maintenance Every facility shall have an effective written plan for maintenance, including sufficient staff, appropriate equipment, and adequate supplies. Each facility shall: Maintain the grounds free from refuse, litter, insect and rodent breeding areas. The building and grounds shall be kept free of any possible infestations of insects and rodents by eliminating sites of breeding and harborage inside and outside the building; eliminating sites of entry into the building with screens of not less than 16 mesh screen to the inch and repair of any breaks in construction. Walls and Ceilings Be constructed and maintained so as to prevent the entrance and harborage of rats, mice, flies, and other vermin. Housekeeping Every facility shall have an effective plan for housekeeping including sufficient staff, appropriate equipment, and adequate supplies. Each facility shall: Keep the building in a clean, safe, and orderly condition. This includes all rooms, corridors, attics, basements, and storage areas. General Food shall be in sound condition, free from spoilage, filth, and other contamination and shall be safe for human consumption. Food shall be obtained from sources that comply with all laws relating to food and food labeling. Use of home prepared or hermetically sealed food which has been processed in a place other than a wholesale food processing establishment is prohibited except where it is in compliance with Subpart K, Reduced Oxygen Packaging, of the Part. At all times, including while being stored, prepared, displayed, served, or transported, food shall be protected from potential contamination, including dust, insects, rodents, unclean equipment and utensils, unnecessary handling, coughs and sneezes, flooding, drainage, and overhead leakage or overhead drippage from condensation. Prior to July 1, 1996, the temperature of potentially hazardous foods shall be 40oF or below, or 140oF or above, at all times, except as otherwise provided in this Part. Refrigeration units unable to maintain a product temperature of 41oF may continue to be used until January 1, 2006, provided the product temperature is maintained at 45oF or less at all times and all potentially hazardous foods prepared on-site for opened containers/packages of commercially processed food products are dated and refrigerated for no longer than three days after preparation or opening, respectively. In the event the dated product is not used or sold within 3 days, the product shall be discarded. General - Insect and Rodent Control Effective measures intended to minimize the presence of rodents and flies, roaches, and other insects on the premises shall be utilized. The premises shall be kept in such condition as to prevent the harborage or feeding of insects or rodents. Protection of Openings Against Entrance of Insects and Rodents Openings to the outside shall be effectively protected against the entrance of rodents and shall be protected against the entrance of insects by tight fitting, self-closing doors, closed windows, screening, controlled air currents or other means. Screen doors shall be self-closing and screens for windows, doors, skylights, transoms, intake and exhaust air ducts, and other openings to the outside shall be tight fitting and free of breaks. Screening material shall not be less than 16 mesh to the inch. Cleaning Frequency Where equipment and utensils are used for the preparation of potentially hazardous foods on a continuous or production-line basis, utensils and the food-contact surfaces of equipment shall be washed, rinsed and sanitized at intervals throughout the day on a schedule subject to the approval of the regulatory authority. This schedule shall be based on food temperature, type of food, and amount of food particle accumulation. Based on surveyor observation and staff interview, the facility does not store, prepare and distribute foods under sanitary conditions. Findings include:
Based on surveyor observation, staff interview and interview of others, the facility has failed to maintain an environmental free from flying and crawling insects and rodents. Findings include: 1. During the initial tour of the dietary department on 6/10/02, the surveyor immediately noted mouse droppings on top of plastic food containers in the dry food storage area as well as a foul "mouse" odor. Upon further inspection, the surveyor realized that there was widespread infestation of mice in the dietary department as all of the plastic storage containers had mouse droppings inside and outside of the containers, and droppings were lying on packages, boxes, bags and cans of food. A second surveyor was summoned to assist in assessing the extent of the infestation. The surveyors began to shuffle containers of food items around on the shelf to compile a list of contaminated items. As they did so, they could hear loud squeaking noises, which sounded like mice or rats, and nymph cockroaches scurried out from behind boxes and containers. The surveyor noted at least 5 live nymph cockroaches scurrying out from behind a plastic container when it was shifted. The surveyors had to continually wave humpback flies away from their faces as they inventoried the dietary department. Following is a list of food items found in the dry food storage area which were contaminated with either rodent droppings, urine or gnawing marks: Droppings were lying on top of and throughout packages of gelatin which were stored in a plastic container. There were droppings mixed in with dry spaghetti, lasagna and macaroni noodles stored in large plastic containers. There were droppings and what appeared to be dried urine on top of the plastic lids containing the noodles. There was a large plastic container which held packages of Cinnamon Streusel Topping. Mouse dropping were mixed in with the packages and were on the lid. There were droppings inside a box of cocoa and pancake mix. Another partially used bag of cocoa mix, which had been wrapped in plastic wrap, had a 3 inch by 3 inch hole gnawed into the side, mouse droppings inside the plastic wrap and yellow staining on the exterior of the bag. A large bag of coffee cake mix had an approximate 2 inch by 2 inch hole chewed into the side and there was droppings on the packaging. Cans of evaporated milk had droppings all over the top. As the surveyor pulled out a plastic container from the shelf, she noted a large number of droppings and urine puddled on top of the lid. The urine smelled fresh and began to run when the container was moved. Packages of pudding was stored inside the container and there were droppings in with the packages of pudding. Plastic containers holding biscuit mix and muffin mix had droppings inside mixed in with the packaging and on top of the lid. A large container holding bags of marshmallows had droppings mixed in with the bags as well as numerous gnaw marks and holes in the bags. There were 22 boxes of Angel Food Cake mix which had droppings on them as well as gnaw marks on the boxes. 1 box of Pop Tarts had the interior aluminum pouches chewed all of the way through and at least one third of the Pop Tarts were gone. The box was covered in droppings and urine. There were 20 additional boxes of Pop Tarts which had droppings on the top of the boxes. A carton container of Diced Potatoes had droppings on top. There were 14, 1 gallon jars of salad dressing which had droppings on top of the lids. There were droppings on top of a 2 pound can of coffee. There were droppings on top of boxes of straws. The top of a box of napkins was covered in droppings and appeared to have been saturated with urine which was now dry and had a foul odor. There were droppings on top and in with a box of china coffee cups. There were droppings on mop heads stored in plastic bags. Droppings were on top of all of the canned food items. 2. At 11:20 AM, while the surveyor was standing in the dry food storage area, she felt something on the toe of her shoe. She looked down in time to see a mouse run across her right foot then toward the corner of the dry storage area. The surveyor let out a loud exclamation of surprise and was visibly shaken. 3. After this occurrence, the surveyors proceeded to inspect the kitchen. Evidence of rodent infestation was also found throughout the kitchen. The following items were noted: A large bag of dried potatoes had a hole gnawed into it and droppings on top. There were 14 boxes of cookies with droppings on top and holes gnawed into the plastic covering the cookies. All of the large bulk plastic container holding oatmeal, sugar, flour and cereal had droppings on top. The box of baking paper sheets had droppings on top of the box. Hump back flies were noted on the spices on the rack by the cooks station. There were droppings on the counter top next to the coffee and tea dispensing machines. There were droppings on the shelf around the jars of spices over the food preparation table. All of the floors in the dietary department had rodent droppings at the floor/wall junctures, behind and underneath equipment. Holes were noted in the walls, around pipes and in corners. The exterior door from the service hallway to the exterior of the building near where dumpsters were located was propped open two hours after bringing the rodent problems to the attention of the facility. This door is located approximately 5 feet from the door to the kitchen, which was also propped open. This same door has a gap at the base of the door greater than 3/8 of an inch when it is closed. The exterior door leading from the dining room to the patio was propped open just prior to the noon meal being served, and at least 2 hours after the surveyors had brought the rodent problem to the attention of the facility. There was rotting pieces of chicken and assorted food debris on the ground lying next to the patio. Ants were noted in areas around the exterior of the building. 4. An environmental tour of the entire facility revealed mouse droppings in resident rooms on every wing of the building, including clean utility rooms, Beauty Shop and tub/shower rooms. Droppings were found in resident closets, behind doors and underneath air conditioning units. Humpback flies are visible throughout the entire facility. Examples include the following: Resident room 403 had droppings inside all of the drawers in the dresser next to the sink and in the bedside stand, on the floor of the closet and under the sink. There were droppings on either side of the bathtub in the D Hallway shower/tub room. About 6 humpback flies were in the D Hallway shower/tub room. There were several mouse droppings behind the dresser in the Beauty Shop. There were droppings underneath the three soda and snack machines in the activity room. There were humpback flies swarming about the residents as they ate lunch in the activity room on 6/10/02 and 6/11/02. The flies were noted on the plates and food. There were rodent droppings under the cigarette machine in the activity room. There were droppings at the entryway into the large dining room. Room 416 had droppings under the air conditioning unit. Room 412 had droppings at the floor/wall juncture, in the bottom of the bedside stand and on the floor of the closet. Room 410 had droppings on the floor of the closet. There were several droppings near the entrance door into room 404 and under the air conditioning unit and sink. Room 501 had droppings next to the bed by the window and on the floor of the closet. Room 503 and 505 had mouse droppings in the bedside drawers. There were no screens present in the window of room 516 and the screen was torn in room 510. Room 507 had dropping on the floor of the closet and behind the dresser. Room 511 had droppings on the floor of the closet. The pantry located between halls A and B had droppings at the floor/wall juncture near the entrance door. There were numerous droppings on the shelf under the sink. The 200 Hallway tub/shower room had droppings behind the entrance door. There were droppings on the floor of the closet in rooms 206 and 212. Room 101 had droppings in the corner by the door into the room. Room 104 had mouse droppings in the bedside table drawer. Room 107 had a dead roach and mouse droppings in the bedside drawer. Room 114 had roach nymphs in the sink drawer. Room 302 had a mouse and insect glue trap under the sink. Room 311 and 309 had mouse droppings in the sink drawers. 5. On 6/10/02 at 3:30 PM, E2, consultant dietitian, stated staff were cleaning the kitchen. All contaminated food had or would be discarded. All surfaces would be bleached. The menus had been reviewed and substitutions made for any food that could have been contaminated for the evening meal and evening snack. All food would be placed in plastic containers with tight fitting lids. All containers would be sanitized. E2 stated staff were instructed to keep the doors to the outside shut. 6. On 6/11/02 at 8:30 AM, after the facility had completed a thorough cleaning of the dietary department, the surveyor noted one rodent dropping on the food contact surface of a divided plate which was sitting on a plastic cart next to the steam table in the main dining room where the breakfast was being served. The surveyor also noted numerous droppings on the bottom shelf of the cart which contained plates to be used for the breakfast food service. 7. Z1, pest control operator, stated on 6/10/02 that he has made many recommendations to the facility in the past few months on what steps needed to be taken to eradicate the problem and the facility has failed to follow any of those recommendations. Z1 stated that the area outside the facility was heavily infested with rats and that is why he placed the rat bait stations around the building. Z1 stated that he had not seen any rats in the building but had seen old rat droppings in the facility. Z1 stated that he had to replace the bait packets on a regular basis. He stated that he had not seen any rat burrows. 8. Z2, R15's family member, stated that on 6/9/02, when they came to visit their family member in the facility, there were "gnats" flying about her face and were "all over her". R15 is a bilateral amputee who is dependent on staff for care. 9. Another visitor stated in a confidential interview that they recently came to the facility to visit a friends mother who happens to be bedfast. As the visitor entered the residents room, they saw a mouse run across the resident, near her face. The visitor also stated that the residents toilet rooms was full of flying insects, about 30-40 of them. 10. Interview with R1 on 6/12 /02 confirmed that he had "seen a mouse running around" the facility. |