BEST PRACTICES FOR COMPLIANCE TO FOOD ... ... Best Practices for Compliance to Food Sanitary...

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  • BEST PRACTICES FOR COMPLIANCE TO FOOD SANITARY CONDITIONS

    IN FLORIDA SKILLED NURSING FACILITIES It is recognized that food safety is a shared responsibility between food service establishments and government. Based on this, the Agency for Health Care Administration created a Quality Council to examine this non-compliance issue and to develop best practices to educate providers to improve compliance under CFR 483.35(h)(2). This document was created by the Quality Council to describe some of the specific non-compliance issues cited under CFR 483.35(h)(2) in Florida, and to share best practice advice for skilled nursing facility providers. Three categories of compliance issues were identified from analysis by the Quality Council from a sample of deficiencies cited at CFR 483.35(h)(2), statewide, during the State Fiscal Year 2002-2003. These three compliance issues are:

    1. Limiting Organisms of Public Health Concern (Food Holding); 2. Food Protection from Contamination; and

    3. Warewashing and Equipment Sanitation.

    For each category of compliance issues, the corresponding 2001 Food Code Provision and the State Food Hygiene Code will be identified, the food safety risks and outcomes will be deliniated, and finally the best practice advice will be presented. The best practice advice is not all-inclusive and will not guarantee compliance.

    FOOD CODE PROVISIONS AND FLORIDA ADMINISTRATIVE CODE The compliance issues are found under the US Department of Health and Human Services, Public Health Service and Food and Drug Administration, Food Code, 2001 Recommendations. This Food Code “is a model for safeguarding public health and ensuring food is unadulterated and honestly presented when offered to the consumer.”1 It represents the Food and Drug Administration’s best advice for a uniform system of provisions that address the safety and protection of food offered at retail and in food service. The corresponding Florida Administrative Code, 64E-11, Food Hygiene Code is also included to illustrate similarities and differences.2 Although the Agency for Health Care Administration does not enforce the State Food Hygiene Code, Florida licensed skilled nursing facilities are required to comply with this law.

    Identifies Food Code provisions which are critical. That is, noncompliance with these provisions is more likely than other provisions to contribute to food contamination, illness, or environmental health hazard.

    Identifies Food Code provisions that are noncritical items.

    Identifies Food Code provisions that may or may not be critical depending on the circumstances.

    Revised January 2004 Page 1 of 41

  • Best Practices for Compliance to Food Sanitary Conditions in Florida Skilled Nursing Facilities

    Compliance Issue #1 Limiting Organisms of Public Health Concern/Temperature and Time Control:

    ▪Frozen Food ▪Thawing ▪Hot and Cold Food Holding ▪Ready to Eat, Potentially Hazardous Food Date Marking and Disposition.

    SPECIFIC EXAMPLES OF ISSUES ACTUALLY CITED ▪ The ambient temperature of freezer units were not maintained 0° F or below. ▪ Frozen foods were not properly thawed. ▪ Hot foods held on the steam table during tray line were not maintained at 140° F or above. ▪ Cold foods held during tray line were not maintained at 41° F or below. ▪ The ambient temperature of cold food holding equipment, such as refrigerators units was not

    maintained at 41° F or below. ▪ Refrigerated food was not date marked. ▪ Refrigerated food was not discarded by its marked date.

    FOOD CODE PROVISIONS AND FLORIDA ADMINISTRATIVE CODE Frozen Food 3-501.11 Frozen Food.* Stored frozen foods shall be maintained frozen. 64E-11.004 (2) Food Protection.** (2) Perishable food shall be stored at such temperatures as will protect against spoilage. All

    potentially hazardous food shall be kept at safe temperatures, 41°F or below and 140°F or above, except during necessary periods of preparation and service.

    Food Thawing 3-501.13 Thawing.* Except as specified in ¶ (D) of this section, potentially hazardous food shall be thawed: (A) Under refrigeration that maintains the food temperature at 5°C (41°F) or less, or at 7°C (45°F) or

    less as specified under § 3-501.16(A)(2)(b); or (B) Completely submerged under running water:

    (1) At a water temperature of 21°C (70°F) or below, (2) With sufficient water velocity to agitate and float off loose particles in an overflow, and (3) For a period of time that does not allow thawed portions of ready-to-eat food to rise above

    5°C (41°F), or 7°C (45°F) as specified under ¶ 3-501.16(A)(2)(b), or (4) For a period of time that does not allow thawed portions of a raw animal food requiring

    cooking as specified under ¶ 3-401.11(A) or (B) to be above 5°C (41°F), or 7°C (45°F) as specified under ¶ 3-501.16(A)(2)(b), for more than 4 hours including:

    * Food Code 2001, US. Public Health Service, U.S. Department of Health and human Services ** Chapter 64E-11 Food Hygiene, F.S Revised January 2004 Page 2 of 41

  • Best Practices for Compliance to Food Sanitary Conditions in Florida Skilled Nursing Facilities

    (a) The time the food is exposed to the running water and the time needed for preparation for cooking, or

    (b) The time it takes under refrigeration to lower the food temperature to 5°C (41°F), or 7°C (45°F) as specified under ¶ 3-501.16(A)(2)(b);

    (C) As part of a cooking process if the food that is frozen is: (1) Cooked as specified under ¶ 3-401.11(A) or (B) or § 3-401.12, or (2) Thawed in a microwave oven and immediately transferred to conventional cooking

    equipment, with no interruption in the process; or (D) Using any procedure if a portion of frozen ready-to-eat food is thawed and prepared for immediate

    service in response to an individual consumer's order. 64E-11.004(4) Food Protection.** (4) Frozen potentially hazardous food shall be thawed:

    (a) In refrigerated units at a temperature not to exceed 41 degrees Fahrenheit; or (b) Under cold potable running water with sufficient water velocity to agitate and float off

    loosened food particles into the overflow: 1. For a period of time that does not allow thawed portions of ready-to-eat food to rise above

    41ºF; or 2. For a period of time that does not allow thawed portions of a raw animal food requiring

    cooking to be above 41ºF for more than 4 hours including the time the food is exposed to the running water and the time needed for preparation for cooking; or

    (c) In a microwave oven; or (d) As part of the conventional cooking process.

    Hot and Cold Food Holding 3-501.16 Potentially Hazardous Food, Hot and Cold Holding.* (A) Except during preparation, cooking, or cooling, or when time is used as the public health control

    as specified under § 3-501.19, and except as specified in ¶ (B) of this section, potentially hazardous food shall be maintained: (1) At 57ºC (135°F) or above, except that roasts cooked to a temperature and for a time specified

    under ¶ 3-401.11(B) or reheated as specified in ¶ 3-403.11(E) may be held at a temperature of 54°C (130°F); or

    (2) At a temperature and time specified in the following: (a) At 5°C (41°F) or less for a maximum of 7 days; or (b) At 7°C (45°F) or between 5°C (41°F) and 7°C (45°F) for a maximum of 4 days in

    existing refrigeration equipment that is not capable of maintaining the food at 5°C (41°F) or less if: (i) The equipment is in place and in use in the food establishment, and (ii) Within 5 years of the regulatory authority's adoption of this Code, the equipment is

    upgraded or replaced to maintain food at a temperature of 5°C (41°F) or less. (B) Shell eggs that have not been treated to destroy all viable Salmonellae shall be stored in

    refrigerated equipment that maintains an ambient air temperature of 7°C (45°F) or less. 3-401.13 Plant Food Cooking for Hot Holding.* Fruits and vegetables that are cooked for hot holding shall be cooked to a temperature of 57°C (135°F).

    * Food Code 2001, US. Public Health Service, U.S. Department of Health and human Services ** Chapter 64E-11 Food Hygiene, F.S Revised January 2004 Page 3 of 41

  • Best Practices for Compliance to Food Sanitary Conditions in Florida Skilled Nursing Facilities

    3-501.19 Time as a Public Health Control.* (A) Except as specified under ¶ (B) of this section, if time only, rather than time in conjunction with

    temperature, is used as the public health control for a working supply of potentially hazardous food before cooking, or for ready-to-eat potentially hazardous food that is displayed or held for service for immediate consumption: (1) The food shall be marked or otherwise identified to indicate the time that is 4 hours past the

    point in time when the food is removed from temperature control, (2) The food shall be cooked and served, served if ready-to-eat, or discarded, within 4 hours from

    the point in time when the food is removed from temperature control, (3) The food in unmarked containers or packages or marked to exceed a 4 hour limit shall be

    discarded, and (4) Written procedures shall be maintained in the food establishment and made available to the

    regulatory authority upon request, that ensure compliance with: (a) Subparagraphs (A)(1)-(4) of this section, and (b) § 3-501.14 for food that is prepared, cooked, and refrigerated before time is used as a

    public health control.