WHAT DID YOU FIND OUT? TO WHAT EXTENT WERE YOUR OBJECTIVES ACHIEVED? PLEASE RE-STATE YOUR OBJECTIVES. NCDOH has found that taking a non-regulatory, educational approach to enforcement, reinforced with the teeth of a structured formal enforcement program that includes a published list of FSE closures on the NCDOH website, leads to desired outcomes and meeting our objectives. The Program works because the various divisions within NCDOH work collaboratively rather than in silos; together, the divisions within NCDOH integrate with the Enforcement team, sharing information learned in the field about the regulated community during inspections, in FMT classes through interactive Q&A, in conferences and in court. An added benefit to this Program is that due to the increased accountability of the regulated facilities, the number of trials has significantly reduced. For these reasons, the NCDOH enforcement program is a Model Practice of great value to other LHDs and the populations they serve. The infrastructure, practices and procedures developed by NCDOH in implementing its enforcement program may be appropriately tailored and used as a guidepost for other jurisdictions.
ALL OBJECTIVES HAVE BEEN MET. Objectives of the proposed practice are to improve knowledge; attitudes; behavior; policies and procedures of the regulated community to support safer public health practices that meet or exceed the requirements of applicable laws. An additional objective of the Program is to ensure that administrative hearings are conducted fairly with proper due process afforded to the respondents and to reduce the number of regulated facilities requiring formal hearings (trials).
WHAT WE FOUND OUT. We have found across our different bureaus that our Enforcement Strategy of combining educational [non-regulatory] resources with a structured [regulatory] enforcement framework has led to fewer food service establishments being closed by NCDOH for critical and imminent public health hazard violations such as severe infestations and food adulteration.
IMPROVING KNOWLEDGE. With respect to improving knowledge, pass rates continue to improve as the FMT program matures. We believe this improved pass rate correlates to reinforcement of education through compliance conferences and during inspectors' educational directives during FSE inspections. Additionally, we have modified the FMT curriculum to reinforce the need for exercising sanitary habits via participatory demonstrations (i.e., black lights, handbooks). This allows the opportunity for people taking the class to engage with the instructor and ask questions.
- Food workers have expressed their appreciation for what they have learned. In order to measure student perceptions of teaching effectiveness and receive additional feedback from the regulated community, student paper surveys were distributed at selected classes. In 2015, paper surveys were distributed to five FMT classes (February 20; March 20; March 27; May 22; August 28; September 4) which contained quantitative checklist questions as well as space for general comments and suggestions for future programming.
- The quantitative questions included (among several others) whether [My] knowledge of the subject is significantly improved after completing this course"; and, "[I] will be able to apply the information I learned." The students were asked to select one of the following answers to these questions, including, strongly disagree, disagree, neutral, agree, strongly agree, and not applicable.
- Based on 24 responses in the February 20, 2015 class, 79% of students agreed or strongly agreed that their knowledge was significantly improved while 90% agreed or strongly agreed that they would be able to apply the information they learned. General comments about content of the course were positive, with one responder stating that, teacher was amazing so knowledgeable and class was much more interesting and intense than I thought it would be.”
- All twenty March 20, 2015 class responders agreed or strongly agreed that their knowledge was significantly improved and would be able to apply the information they learned.
- 76% of the twenty-six responders from the March 27, 2015 class agreed or strongly agreed that their knowledge improved and indicated that they agreed or strongly agreed that they would be able to apply the information they learned.
- 93% of the fifteen responders in the May 22, 2015 class indicated that they strongly agreed that their knowledge was significantly improved and 86% strongly agreed that they would be able to apply the information learned.
- 90% of the ten responders in the August 28, 2015 class indicated that they strongly agreed that their knowledge significantly improved and the same strongly agreed they would be able to apply the information learned. One responder indicated, the Food Managers Training Course helped me to realize how important the manager position plays a big part in this world of food industry. The people of the world are in our hands when you are in the food industry so its our job to keep people safe, healthy and happy.”
- All of the twelve responders in the September 4, 2015 class agreed or strongly agreed that their knowledge of the subject was significantly improved and all agreed or strongly agreed that they would be able to apply the information learned.
IMPROVING ATTITUDE. With respect to attitude changes, we have noted that high-risk FSE owners indicate during conferences that they will send additional food service workers for FMT, even though they may have a sufficient number required by this local health department, in an effort to create a safer environment.
IMPROVING BEHAVIOR. Our ATUPA program has an approximate 95% compliance rate among tobacco retail vendors. Additionally, improved behavior is demonstrated via FSEs being closed by NCDOH for severe imminent public health hazard violations such as severe infestations and food adulteration. Further, compared with the number of facilities under permit, only a small number are brought into Enforcement, signifying that the vast majority of permitted facilities are compliant with public health laws.
REDUCTION OF THE NUMBER OF REGULATED FACILITIES REQUIRING FORMAL HEARINGS (TRIALS) AT NCDOH.
The following chart reflects that all cases that came to be heard in court in 2017 and 2018 were resolved informally via stipulation and none through a formal hearing (trial). Additionally, we provide the breakdown of the stipulations by bureau.
HOW CASES RESOLVED: INFORMALLY OR VIA FORMAL TRIAL Year | Informal Resolution (No. of Stipulations Ending Cases) | Formal Hearing (Trial) |
2018 (up to November) | 315 | 0 Trials |
2017 | 288 | 0 Trials |
2018 ENFORCEMENT ACTIVITY BY BUREAUBureau of Environmental Sanitation (BES) | 158 Stipulations | 0 Trials |
Bureau of Environmental Investigation (BEI) | 115 Stipulations | 0 Trials |
Bureau of Environmental Protection (BEP) | 38 Stipulations | 0 Trials |
Bureau of Environmental Engineering (BEE) | 0 Stipulations | 0 Trials |
TOTAL: | 315 Stipulations | 0 Trials |
2017 ENFORCEMENT ACTIVITY BY BUREAUBureau of Environmental Sanitation (BES) | 177 Stipulations | 0 Trials |
Bureau of Environmental Investigation (BEI) | 91 Stipulations | 0 Trials |
Bureau of Environmental Protection (BEP) | 19 Stipulations | 0 Trials |
Bureau of Environmental Engineering (BEE) | 1 Stipulations | 0 Trials |
TOTAL: | 288 Stipulations | 0 Trials |
Legend:
- Bureau of Environmental Sanitation (BES) (food safety; pools; beaches; children's summer camps; and, temporary residences)
- Bureau of Environmental Investigation (BEI) (lead poisoning prevention; rabies; community sanitation; Adolescent Tobacco Use Prevention Act (ATUPA)
- Bureau of Environmental Protection (BEP) (petroleum bulk storage program; public water supply)
- Bureau of Environmental Engineering (engineering plans: water supply, PBS facilities)
BUREAU OF ENVIRONMENTAL SANITATION COMPLIANCE CONFERENCES 2017 and 2018Reason for Office Compliance Conference | Poor Score | Critical Violations | Other Chronic Violations | Other/Special Problems | TOTAL |
2018 (up to November) | 88 | 298 | 41 | 19 | 446 |
2017 | 115 | 293 | 31 | 20 | 459 |
Critical Violations refers to a chronic issue or violation that are in a category where a single public health hazard warrants a Compliance Conference, i.e. no shellfish tags, adulterated foods. Other Chronic Violations denote non-critical and/or repeat sanitary violations
CHANGES AND/OR IMPROVEMENTS IN POLICIES AND PROCEDURES. Following compliance conferences, regulated facilities have supplemented and enhanced their sick worker policies and cleaning schedules; remediation plans for lead abatement; increased chlorine residual testing; revised children's summer camps' buddy check procedures during swim activities; engaged experts and consultants to remedy ongoing issues, such as exterminators and food service consultants.
It should be further noted that currently less than 5% (4.86%) of high risk food service establishments are brought into court. The vast majority of high risk FSEs are not in any type of formal enforcement because most food establishments are in compliance with public health laws. In 2018, there were approximately 3,500 high-risk FSEs (this number is approximate because restaurants come in and out of business throughout the year) and of those approximate 3,500 high-risk FSEs there were 170 FSE cases commenced in 2018 due to poor score inspections or repeat violations were commenced in that year. The reason only high risk FSEs are included in this calculation is that medium and low risk FSEs are not inspected on an annual basis.
FOOD MANAGERS TRAINING COURSE: 2010 - 2017
Pass rates continue to improve as the FMT program matures; we believe this improved pass rate correlates to reinforcement of education through compliance conferences and during inspectors' educational directives during FSE inspections. Note that although there is no examination following the renewal 3-hour review course and therefore, there is no pass rate percentage assigned to the 3-hour review class. However, the Department notes that the questions asked by food managers at the renewal class are more sophisticated and demonstrate more working knowledge of food handling procedures than the types of questions asked at initial food manager training classes.
Food Managers Training Course - 2010-2017Year | 10 hr attended | 10 hr passed | % passing | 3 hour review | 10 hr. Spanish attended | 10 hr. Spanish passed | % passing |
2017 | 961 | 928 | 96 | 1145 | 302 | 289 | 96 |
2016 | 814 | 790 | 97 | 1219 | 275 | 258 | 94 |
2015 | 906 | 862 | 95 | 1018 | 258 | 236 | 91 |
2014 | 891 | 868 | 97 | 1040 | 237 | 207 | 87 |
2013 | 948 | 873 | 92 | 1218 | 196 | 165 | 84 |
2012 | 879 | 874 | 99 | 1027 | 167 | 150 | 89 |
2011 | 928 | 835 | 89 | 923 | 190 | 171 | 90 |
2010 | 818 | 757 | 92 | 1083 | 286 | 252 | 88 |
Therefore, in 2017 96% of English language 10-hour FMT course takers successfully completed the course (up from 92% in 2010) and 96% of Spanish language 10-hour FMT course takers successfully completed the course (up from 88% in 2010).
TOBACCO SALES COMPLIANCE.
Compliance checks under the Adolescent Tobacco Use Prevention Act (ATUPA) program are conducted to ensure that tobacco vendors comply with state laws which prohibit tobacco sales to minors.
THE FOLLOWING IS THE NCDOH ATUPA COMPLIANCE HISTORY FOR GRANT YEARS 2018 -1998. (Note that all grant years in ATUPA run from April 1 to March 31. Also, the number of Tobacco retailers has dropped during the duration of the program.)
TOBACCO SALES COMPLIANCEGrant Year | Compliance Checks with Minor | % Compliance |
2018-2019 | 1411 | 95% |
2017-2018 | 1269 | 93% |
2016-2017 | 1242 | 94% |
2015-2016 | 1310 | 94% |
2014-2015 | 1373 | 96% |
2013-2014 | 1461 | 96% |
2012-2013 | 1380 | 92% |
2011-2012 | 489 (partial grant year) | 94% |
2010-2011 | 1665 | 97% |
2009-2010 | 1454 | 93% |
2008-2009 | 1820 | 95% |
2007-2008 | 1953 | 92% |
2006-2007 | 559 (partial grant year) | 91% |
2005-2006 | 2097 | 90% |
2004-2005 | 2367 | 87% |
2003-2004 | 2004 | 87% |
2002-2003 | 1716 | 87% |
2001-2002 | 1761 | 86% |
2000-2001 | 1759 | 79% |
1999-2000 | 1707 | 84% |
1998-1999 | 1919 | 78% |
As demonstrated above, our tobacco compliance rate is currently at 95%. We attribute this success rate in part to our corresponding and conferencing with tobacco retail dealers to ensure that they understand the requirement in Nassau County local law that every tobacco retailer must satisfactorily complete a tobacco sales training program given and administered pursuant to Section 1399ee of the New York State Public Health Law.
FOOD SERVICE ESTABLISHMENT CLOSURES. In 2016, there were 42 FSE closures (vast majority of which were due to failed inspections); in 2017 there were 10 FSE closures; in 2018 up to November, there were 32 closures, but of those only 7 were due to failed inspections (other closure reasons included power outages, fire, inadequate hot water). A significant change in 2016 was posting on the NCDOH website: (1) Food Service Establishment Closure List; (2) Fines Assessed by the Board of Health; and, (3) 2016 Case Reports. See, https://www.nassaucountyny.gov/3880/Regulations-Enforcement. We believe that including this information on the NCDOH website is a powerful tool that leads to greater accountability among FSE owners and operators who are now acutely aware that the public has access to these records.