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WC CWF Health District Board Minutes - 06/15/2012WICHITA FALLS - WICHITA COUNTY PUBLIC HEALTH BOARD MINUTES June 15, 2012 ,j, RK �`sy�l Wichita Falls- Wichita County Public Health District r ;fir,, r : ( 1700 Third Street - Parker Conference Room T IME: Qj Wichita Falls, Texas MEMBERS PRESENT: David Carlston, Ph.D. Clay Clark, D.V.M. Tracy Hill, D.D.S. Scott Plowman MEMBERS ABSENCE EXCUSED: Richard Sutton, M.D., Chair Lauren Jansen, R.N., M.S.N., Ph.D., Vice -Chair Robin Moreno, M.T., Secretary Clay Clark, D.V.M. Lou Kreidler, R.N., B.S.N. Amy K. Fagan, M.P.A. Not Present Not Present Not Present Ray Gonzalez Board Members Director of Health Assistant Director of Health Health Authority Assistant City Manager Council Liaison County Commissioner I. CALL TO ORDER & INTRODUCTIONS Dr. Carlston called the Board of Health meeting to order at 12:00 pm after a quorum of members was attained. II. APPROVAL OF APRIL MEETING MINUTES AND ABSENCES Dr. Carlston called for the review and approval of minutes from the last meeting held on April 27, 2012. Dr. Hill introduced a motion to approve the minutes as presented and Scott Plowman seconded the motion. Motion passed unanimously. At this time it was noted the excused absence of Dr. Sutton, Dr. Jansen, and Robin Moreno. III. FDA Standardization of Retail Food Inspections Susan Morris, Environmental Health Administrator presented the nine FDA Voluntary Retail Food Regulatory Program Standards. Standard 1: Regulatory Foundation • Food Code Interventions and Risk Factor Control Measures • Good Retail Practices • Compliance and Enforcement The outcome is the adoption of a sound, science -based regulatory foundation for the public health program and the uniform regulation of industry (the food code). The food code adopted is the Texas food establishment rules based off the FDA food code. The Regulatory Foundation Standard was completed and being audited by the State. Standard 2: Trained Regulatory Staff 1. Pre - Inspection Curriculum (Employee Training Records) a. Prevailing statutes, regulations, ordinances (specific laws and regulations to be addressed by each jurisdiction) b. Public Health Principles c. Food Microbiology d. Communication Skills The staff options are to complete an on -line training course, be a registered sanitarian, a registered environmental health specialist, or certified already trained. All the current Inspectors completed the on -line training. 2. Initial Field Training and Experience a. Twenty -five joint field inspections with a trainer who has successfully completed all training elements required by this standard b. Trainers has to be assessed by a State trainer to conduct an Assessment of Training Needs (ASN) c. Individual corrective action plan developed All current Inspectors are exempt due to their training before the Standard became effective, any new inspectors will be required to complete the initial field training. A development of plan is needed to become complete. 3. Independent Inspections and Completion of ALL Curriculum Elements d. Within 18 months complete 25 independent inspections in high risk categories e. Additional course work must be finished; Epidemiology and Hazardous Analysis Critical Control Points (HACCP) High risk inspections are those following the HACCP principle that have certain analysis; a critical to -kill point where the food goes through the danger zone of temperature control more than once. The additional course work is needed to complete. 4. Field Standardization Determine the inspector's ability to apply the knowledge and skills obtained from the training curriculum and address the five following performance areas; • Risk -based inspections focusing on the factors that contributes to food borne illness • Food retail Practices • Application of HACCP • Inspection of equipment • Communication In the process of the field standardization an Inspector currently is going through the trainer process, a State trainer should be here in October. 5. Continuing Education and Training a. 20 hours every 36 months b. Training on any rule changes must be within 6 months of the rule change and documented. Continued education is in process and every 2 years the legislature meets there are rule changes. Standard 3: Inspection Program Based on HACCP Principles 1. Inspection Form Design a. Identifies food borne risk factors and Food Ccde interventions b. Documents actual observations using IN, OUT, NA and NO c. Documents compliance and enforcement issues E HACCP was designed by NASA when food was being taken into space. It began like a farm to market inspection process, to take the food anytime it goes through a process possibly dangerous, to document how the food is handled, document what the temperatures are when it has to be out of temperature control. Now streamlined the inspection form identifies the foodborne risk factors in the food code and observes whether In Compliance, Out of Compliance, Not Applicable or Not Observed (IN, OUT, NA, NO). The inspection documents compliance and issues with risk assessment categories; Process 1 -Low Risk (inspected 1 -2 times a year), Process 2- Medium Risk (inspected 2 -3 times a year), Process 3 -High Risk (inspected 3-4 times a year) or as needed depends on the determination of the establishments need to be inspected. Some issues on the new form are violations but no longer demerit violations, only to be observed and noted in the comment section by the inspector. As example: No hair restrains is a violation but not a point driven violation the inspector will document but not deduct points. Hair never has made anyone sick it is not science based it will not make anyone sick. The move to a science based inspection has initiated a lot of controversy and discussion from those trained on the floors, walls, ceiling, and filth conditions of an establishment. The establishment can be told it is a violation, a ticket written and put on a compliance plan, the Health Department can still enforce that they comply. On the non - demerit violations an establishment has 90 days to comply or can be extended on a compliance plan. For the demerit violations 10 days are given to comply. Written compliance plans need to be established. 2. Risk Assessment Categories A risk assessment is used to group food establishments into 3 categories based on their potential and inherent food safety risk. 3. Inspection Frequency The jurisdiction's inspection frequency is based on the assigned risk categories. 4. Written and Implement Corrective Action Policy a. Requires an on -site corrective action for foodborne illness risk factors observed to be out of compliance. b. Requires a discussion for long -term control of foodborne illness risk factors. c. Requires follow -up activities on foodborne illness risk factor violations. 5. Variance Requests a. The jurisdiction has a written and implemented policy on variance requests related to foodborne illness risk factors and Food Code interventions. Variances are granted done on a case by case basis but there is no written policy. 6. Verification and Validation of HACCP Plans a. The jurisdiction has a written and implemented policy for the verification and validation of HACCP plans when a plan is required by Code. The plan is partially done but no written policy has been established. Standard 4: Uniform Inspection Program 1. Written Quality Assurance Program Document a. Has a written quality assurance program that covers all regulatory staff that conducts retail food and /or foodservice inspections. b. Periodically conducts an analysis of the results of the quality assurance program to identify quality or consistency problems among the staff in ten quality elements. c. Has written quality assurance program describes corrective actions to address an individual retail food program inspector's performance quality or consistency issues when they are identified. The quality assurance program is not done but it is the plan to implement the program. The inspections are currently reviewed for accuracy by the Administrator Susan Morris and Health Inspections Supervisor James Garcia. 3 2. Ten Quality Assurance Program Elements I. Assure that each inspector documents the compliance status of each foodbome illness risk factor and intervention through observation and investigate. IL Assures that each inspector completes an inspection report that is clear, legible, concise, and accurately records findings, observations and discussion with establishment management. Ill. Assures that each inspector interprets and applies laws, regulations, policies and procedures correctly. IV. The jurisdiction's quality assurance program assures that each inspector cites the proper local code provisions for the CDC identified risk factors and Food Code interventions. V. Assures that each inspector reviews past inspection findings and acts on repeated or unresolved violations. VI. Assures that each inspector follows through with compliance and enforcement in accordance with the agency's procedures. VII. Assures that each inspector obtains and documents on -site corrective action for out -of -control risk factors at the time of inspection as appropriate to the violation. Vlll. Assures that each inspector documents that options for the long -term control of risk factors were discussed with managers when the same out -of- control risk factor occurred on consecutive inspections. IX. Assures that each inspector veered that the establishment is in the proper risk category and that the required inspection frequency is being met. X. Assures that each inspector files reports and other documents in a timely manner. The Health Department would need to do the 10 quality assurance elements to comply. 3. Demonstration of Program Effectiveness Using the Statistical Method: Self - Assessment Worksheet. The self- assessment worksheet will be done; a number of inspections in each category are taken from each Inspector and charted for field reviews. Standard 5: Foodborne Illness and Food Defense Preparedness and Responses 1. Investigation Procedures Complaints and referral reports are logged or put in the database the procedures are to be written to comply with the standard. 2. Reporting Procedures a. Possible contributing factors to the illness, food - related injury, or intentional food contamination are identified in each on -site investigation report. b. The program shares final reports of investigations with the state epidemiologist and reports of confirmed disease outbreaks with CDC. The reporting procedures are covered under the Nursing Division of the Health Department. 3. Laboratory Support Documentation Environmental does not need a Memorandum of Understanding (MOU) with an outside lab since the Health Department has an in -house lab with written procedures. 4. Trace -back Procedures Plans are to establish written trace -back procedures. 5. Recalls Recalls are investigated but there is no written program. 6. Media Management The City of Wichita Falls has a Public Information Office with a Media Management policy that is followed. 7. Data Review and Analysis Data review and analysis is required to be done once a year at that time it is not done. Standard 6: Compliance and Enforcement 1. Compliance and Enforcement Procedure a. A written step -by -step plan and enforcement procedure that describes what actions and tools are to be used to achieve compliance is needed. b. The inspection form used records the compliance status of foodborne illness risk factors, Food Code interventions and other serious code violations. 4 2. Assessment of Effectiveness a. Do not have written documentation that verifies the review process of the effectiveness of the staffs implementation of the program's compliance and enforcement procedure that includes a selection of establishment files for review in accordance with the Standard criteria. b. Do not have written documentation to comply with the unwritten step -by -step compliance and enforcement procedures. Standard 7: Industry and Community Relations 1. Industry and Consumer Interaction a. Maintains written documentation confirming that the agency has sponsored or actively participated in at least one meeting /forum annually, such as food safety task forces, advisory boards or advisory committees extended to industry and consumer representatives. 2. Education Outreach a. Maintains written documentation confirming that the agency has sponsored or coordinated at least one educational outreach activity annually directed at industry, consumer groups, the media, and or elected officers. Standard 7 has been met. Standard 8: Program Support and Resources 1. Staffing Level for Full Time Employees per Inspections Performed a. The standard states you should have one full time employee (FTE) for every 280 -320 retail food program inspections performed and they classify any inspection face to face encounter with an establishment even a food school. Environmental should have 11 -15 inspectors and staffs 4 inspectors. FDA has a five year grant at $60,000 per year that has been applied for the employ an additional inspector to help meet some of the standard 2. Inspection Equipment a. No written records or equipment inventories are kept. b. A written procedure is needed to obtain equipment should it not be part of the agency's general equipment inventory even though it never has been an issue to obtain the equipment. 3. Administrative Program Support a. Do not have written documentation, calculations or a program resource assessment b. Do have a system in place to collect, analyze, and retain that information. 4. Program Resource Assessment a. An assessment has not been done to determine if the agency has the budget, staffing and equipment necessary to meet each standard. Standard 9: Program Assessment 1. Risk Factor Study a. A study on the occurrence of foodborne illness risk factors has been completed and includes data for each facility type regulated. b. The data collection (inspection) form includes items pertaining to the following Center for Disease Control and Prevention (CDC) identified contributing factors to foodborne illness: Food from Unsafe Sources Improper Holding/Time and Temperature Inadequate Cooking Poor Personal Hygiene Contaminated Equipment/Protection from Contamination c. The data collection form provides for marking actual observations of food practices within an establishment (IN, OUT, NO and NA). 2. Report of Analysis and Outcome a. A report is available that shows the results of the data collection from the jurisdiction's foodborne illness risk factor study. 5 b. The report provides quantitative measurements upon which to assess the trends in the occurrence of foodborne illness risk factors over time. The Inspectors are to be held accountable to ensure report accuracy and the use of quantitative measurements. The program is voluntary but to receive funding participation is mandatory with an option to meet some are all of the 9 Standards. Once the Standard is met the paperwork is submitted for an audit by an outside entity of choice such as another Health Department, the State, or FDA. The State and FDA regulate the rules but do not agree and have all the answers. The Board members in attendance are in support of the FDA standardization of retail food inspections. IV. MEETING August 24, 2012 V. ADJOURN Dr. Carlston requested a motion to adjourn. The motion was made by Dr. Clark and seconded by Scott Plowman the motion carried and the meeting was adjourned at 12:55 pm. Richard Sutton, M.D., Chair, Lauren Jansen, M.S.V.. Ph.D., Vice - Chair, or Robin Moreno,M.T., Secretary Public Health Board L