MOBILE, AL - Federal inspectors found multiple food safety violations and quality assurance failures at Knollwood Healthcare during a March 2025 inspection, citing the facility for practices that could potentially impact all 53 residents receiving meals from the kitchen.
Critical Food Safety Violations Identified
The most significant violations centered on food safety practices in the facility's kitchen, where inspectors documented a pattern of unsafe food handling that violated basic food service standards. These violations included improperly labeled food items, contaminated ice machines, and cross-contamination in the dishwashing area.
On March 18, 2025, inspectors discovered multiple food items stored without proper labeling or dating in both the freezer and refrigerator. A large clear bag of okra and approximately six chicken fingers were found in the freezer with no opening or expiration dates. Similarly, corned beef was stored in the cooler without any date markings.
The facility's Food Service Director acknowledged these violations during interviews, stating that "the chicken tenders and okra in the freezer did not have an open or use by date on it" and confirming that "the corn beef in the cooler did not have an open and a use by date on it." According to facility policy, all opened food items must be labeled with the current date, use-by date, item name, and initials of the staff member who stored the item.
The Food Service Director explained the importance of proper labeling, noting that "food that was not dated and label could cause food borne illness" and that labeling helps "keep [food] within the time line of safe food."
Contaminated Ice Machine Poses Health Risk
Inspectors also found a contaminated ice machine that violated the facility's own sanitation policy. Black substance was observed on the ice guard and lid inside the ice machine, which serves ice to residents throughout the facility.
The contamination represented a direct violation of the facility's ice machine sanitation policy, which requires kitchen staff to "wash, rinse and sanitize the ice making machine." When questioned about the contamination, the Food Service Director described it as "dirty with debris" and acknowledged that "the machine had not been serviced."
The director recognized the health implications, stating it was "important that the ice machine was clean on the inside to make sure no bacteria or infection disease got into the ice that was served to the residents." The facility's policy required monthly cleaning of the ice machine lid and guard, but this standard was clearly not being met.
Cross-Contamination in Dishwashing Operations
Perhaps the most concerning violation involved cross-contamination in the dish room, where staff worked on both dirty and clean sides without changing protective equipment. On March 20, 2025, inspectors observed Dietary Aide #23 handling dirty dishes while wearing gloves and an apron, then moving to the clean side of the dish room without changing either piece of protective equipment.
The aide used the same contaminated gloves to remove clean dishes from the dishwasher and handle clean plates, cups, and trays. Her contaminated apron also made contact with clean items throughout the process. When interviewed, the aide acknowledged using "the same gloves on the dirty and clean side of the dish room" and admitted she "did not change her apron from the dirty side to the clean side."
A second dietary aide, DA #24, was observed working without gloves on the dirty side while washing glasses, then moving to the clean side with the same contaminated apron to handle clean dishes. When questioned, he stated he "did not change the apron because he was so busy he did not think about it."
Medical Context and Health Implications
These food safety violations represent serious breaches of infection control protocols that are essential for protecting vulnerable nursing home residents. Proper food labeling and dating systems prevent the consumption of spoiled or expired foods, which can cause foodborne illnesses ranging from mild gastroenteritis to severe infections that can be life-threatening for elderly residents with compromised immune systems.
Ice machine contamination poses particular risks because ice comes into direct contact with beverages and can harbor harmful bacteria such as Legionella, E. coli, and other pathogens. For nursing home residents, who often have weakened immune systems due to age and underlying health conditions, exposure to these bacteria through contaminated ice can lead to serious respiratory infections, gastrointestinal illness, or other complications.
Cross-contamination in dish rooms violates fundamental food safety principles designed to prevent the transfer of harmful microorganisms from dirty surfaces to clean ones. When staff handle dirty dishes and then touch clean items without changing gloves or aprons, they can transfer bacteria, viruses, and other pathogens directly to surfaces that will come into contact with residents' food and beverages.
The Food Service Director demonstrated awareness of these risks, acknowledging that cross-contamination "could get residents sick" and represented a fundamental breach of infection control protocols.
Industry Standards and Best Practices
Federal regulations require nursing homes to procure food from approved sources and store, prepare, distribute, and serve food according to professional standards. These standards include maintaining proper food storage temperatures, implementing effective labeling systems for opened items, ensuring sanitary conditions for all food service equipment, and preventing cross-contamination through proper use of protective equipment.
Best practices in nursing home food service require strict adherence to HACCP (Hazard Analysis and Critical Control Points) principles, which identify potential food safety hazards and establish controls to prevent them. Proper labeling systems should include not only the date items were opened but also clear use-by dates based on food safety guidelines that account for the specific storage conditions and food types.
Ice machines require regular cleaning and sanitization, typically following manufacturer guidelines and facility policies. The presence of visible contamination indicates a breakdown in routine maintenance protocols that should include daily visual inspections and regular deep cleaning procedures.
Quality Assurance Failures
Beyond the food safety violations, inspectors also cited the facility for failures in its Quality Assurance and Performance Improvement (QAPI) program. The facility's QAPI committee failed to properly review and analyze an allegation of abuse reported to the state agency on January 30, 2025.
According to inspection findings, the committee did not adequately identify concerns with reporting and investigation procedures for the abuse allegation, representing a failure to implement the systematic review and corrective action processes required by federal regulations. This violation affected one of the 18 sampled residents and was linked to a specific complaint investigation.
Additional Issues Identified
The inspection also revealed deficiencies in staff training and supervision. The Food Service Director acknowledged responsibility for training kitchen staff on infection control but admitted that staffing challenges sometimes led to shortcuts in proper procedures. One dietary aide cited being "a new employee" as an explanation for not following proper protocols, suggesting gaps in initial training or ongoing supervision.
The facility's hand washing policy requires staff to wash hands "before and in between switching tasks," but observations showed this policy was not consistently followed during dish room operations.
These violations highlight the interconnected nature of food safety protocols and the importance of comprehensive training, adequate staffing, and consistent oversight to maintain standards that protect resident health and safety. The inspection findings demonstrate how operational pressures and staffing challenges can compromise fundamental safety practices if not properly managed through effective quality assurance programs.
Full Inspection Report
The details above represent a summary of key findings. View the complete inspection report for Knollwood Healthcare from 2025-03-27 including all violations, facility responses, and corrective action plans.
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