| Greetings!
This issue of the RDNews contains extremely valuable information in regards to the Cool Down Log. Judy Morgan shares her own experience with a recent Cool Down Log Survey incident as well as tips and tools to keep facilities in compliance. |
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RD News |
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COOL DOWN LOGS: WHY AND HOW?
The top cited deficiency for surveys across the nation is still F371- Sanitary Conditions. With the revision of the surveyor guidance on this F tag last year, any deficiency under this F tag will now automatically be a scope and severity of at least a "D" (level 2) on the scope and severity grid. Why the change? Because the potential for harm to a resident is greater due to the risk for foodborne illness with improperly sanitized equipment or foods served that have had time and temperature abuse.
The most cited reasons for the F371 deficiency are:
 According to the Surveyor Guidance for F371, "Improper cooling is a major factor in causing foodborne illness. Taking too long to chill potentially hazardous foods has been consistently identified as one factor contributing to foodborne illness. Foods that have been cooked and held at improper temperatures promote the growth of disease-causing microorganisms that may have survived the cooking process (spore-formers)." This problem has been cited as an "IJ" (immediate jeopardy) in facilities more frequently now as the cool down logs are receiving increased scrutiny. How to correctly complete the cool down log once cooling procedures have been initiated:
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Begin recording the temperature when the hot food reaches 140F and document the time.
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Two hours later, take the temperature and document the time and temperature.
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The temperature at two hours MUST be 70F or lower
If the initial 2 hour temperature is 70F or lower, continue the cooling procedures.
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Check and record temperatures every 2 hours until 41F or lower is achieved.
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Hot foods MUST reach 41F or lower by a total of 6 hours or be discarded.
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Room temperature foods must reach 41F or lower by a total of 4 hours or be discarded.
If the temperature at two hours is not 70F or lower, the food MUST be reheated to 165F and the cooling process started over (or be discarded). The temperature must then reach 41F or lower within only 4 hours or be discarded.There is only one reheat allowed. |
| RD Tip |
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Facility Report Cards  Check your Facility's RD report Cards
over the past several months to see if cool down logs are an ongoing problem. Bring it to the Administrator's attention and make it a QA for study and improvement. Use HMC's P&P manual policy number 520 in the Food Service Management section as your reference for in-servicing the dietary staff. It thoroughly covers the cooling procedures and time/temperature requirements.
Cool down logs will always receive close scrutiny during a survey. This requirement has been in use for over ten years and still is being cited on too many surveys. Please make sure you are doing the same on your visits. Check the menu for the past several days as well as the refrigerator for leftovers that should have been documented. If there is not documentation of the cool down, insist the food be discarded. Provide an in-service on this topic at least annually and especially in the facility's survey window.
There are many foods which should receive a cool down monitoring. Take today's quiz to see if you can identify potentially hazardous foods. |
| RD in the Field - Judy Morgan |
| The Story of an "I-J"
Recently my position at HMC required that I race three hours to a facility with an "I-J" --- that's immediate jeopardy! All activity of the survey stops while the surveyors focus solely on the immediate correction of an issue which they believe places residents in immediate jeopardy or harm. And what do you think was the problem at this facility? The COOL DOWN LOG.
How can that be possible? The former DSS decided a while back to stop pre-cooking roasts the day before; therefore a cool down procedure was not necessary. On Sunday, a cook employed at the facility many years, did what she always does: pre-cook the roast for the next day. On Monday before noon tray line the surveyors asked for the cool down log. When dietary staff could not produce the log they earned a "G" level deficiency. When the dietary staff served the roast beef in question to the residents it escalated to an "I-J". And, when the two cooks involved lied to the surveyor it became cause for their immediate termination.
The dietitians immediately began a plan of correction which included re-training every dietary worker and each of the staff were quizzed directly by the surveyors. Within one day the "I-J" was lifted and the survey resumed. However, other facilities with the same deficiency have needed as many as five days to cure this "I-J" which is most unpleasant and costly to everyone.
The dietitian services were NOT cited in this I-J as there was written records of In-Service on the cool down logs and monthly RD Reports had also identified the dietitians concern. So be sure to check the cool down log every month! |
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Dear Dietitians; |
Notice in the side bar the quiz on cool down- Which of these commonly served items should be logged? The answer is everyone of these examples!
 May your survey be deficiency free - dietitians make a difference.
Judy
Judy Morgan, MBA, RD
HMComposite, Inc. |
Registered Dietitian Newsletter
