City of Port Arthur, TX Inspection Practices: Did They Have an Impact Upon Critical Food Safety Violations Between 2017-2019?
Lacy Brown
Chief Sanitarian, City of Port Arthur, TX
Abstract
The purpose of this study was to determine the prevalence of critical violations found during inspections of restaurants in Port Arthur, TX, and to investigate the correlation between new food safety policies and critical violations found. Foodborne illness risk should be identified during inspections and mitigating actions should be implemented to reduce the risk of foodborne illness. Prior to 2016, the City of Port Arthur did not have a written food safety policy or training criteria for food safety staff. New policies were put in place in 2016, based upon the Voluntary National Retail Standards, and the first full year of implementation was 2017. Data from 2017 to 2019 health inspection reports on approximately 400 licensed restaurants were collected and analyzed using the City of Port Arthur inspections database. Analysis of the data revealed an association between food safety policy implementation and critical violations found during health inspections. Results indicated a positive relationship between new food safety policies implemented by the City of Port Arthur and a reduction in the rate of critical violations found during health inspections. Interview data revealed an association between inspection practices and critical violations found during health inspections. Monitoring of compliance with implemented food safety policies is recommended to assure continued emphasis on addressing critical violations through on-site corrective actions, reinspection, and follow-up inspections. Food safety programs and policies may assist in the protection of public health from foodborne illnesses.
Key words: Critical violations, food safety, policy, foodborne illness, health inspection
City of Port Arthur, TX Inspection Practices: Did They Have an Impact Upon Critical Food Safety Violations Between 2017-2019?
The City of Port Arthur Health Department enrolled in the Voluntary National Retail Food Regulatory Program Standards (Program Standards) in May 2015. The Program Standards were developed by the U.S. Food and Drug Administration (FDA) with a goal of providing regulators with a framework for food safety regulation. Regulatory agencies are provided with the foundation to build upon and continually improve, while considering emergence of differing food safety tactics. (U.S. Food and Drug Administration (FDA), 2021).
The implementation of the Program Standards began mid-2016 in the City of Port Arthur. The goal of implementation was to adopt a uniform inspection report to be used by the City of Port Arthur; to consistently perform routine inspections and follow-up inspections, and to improve staff development and training. The implementation efforts continued for approximately six months.
Implementation of the Program Standards allowed for a modification in inspection practices, including a focus on several areas of food protection. One such focus was regulatory foundation which ensures that local food protection programs, such as those in the of City of Port Arthur, are aligned with Food and Drug Administration (FDA) Food Code and State laws. Additionally, staff were trained to the standardization criteria set forth in the Program Standards, and participated in continued education.
A quality assurance program was established by the City of Port Arthur Health Department to ensure uniformity in the interpretation and application of the Texas Food Establishment Rules (TFER). Follow-up inspections and timely corrections of risk factors were a focus of implementation for the Program Standards. City of Port Arthur food protection staff participated in local and regional task force meetings to foster communication and information exchange, and developed a city webpage and social media pages to provide educational information to industry members and public citizens. Finally, implementation of the Program Standards encouraged a budget increase that permitted the addition of food protection staff and the purchase of necessary equipment to perform inspections.
To put into perspective the challenges faced by the City of Port Arthur food inspection staff, one must consider the demographic make-up of the retail food establishments. Language barriers exist as nearly 40% of the establishments are ethnic-influenced and English is not the primary language. One study by Roberts, Kwon, Shanklin, Lui, & Len (2011) suggests that language barriers are believed to play a critical role in compliance for some ethnic restaurants. Furthermore, Petran et al. (2012) suggest violations noted on inspection reports could assist in the classification of risk level for food establishments, as well as the action items identified and applied at such food establishments. Additionally, by identifying, prioritizing, and implementing necessary actions at food establishments deemed high risk for foodborne illness, there is an opportunity to reduce or mitigate the risk of illnesses. (Petran, White, & Hedberg, 2012).
Prior to the adoption of the Program Standards the City of Port Arthur did not have any written policies in place for the regulation of food safety or food safety staff training. Since the adoption of the Program Standards there have been numerous policies adopted into the Department and the City codes of ordinance. The improvement efforts include an amendment to portions of the code of ordinance in reference to FDA and State of Texas law changes. One change in particular recommended by the Texas Food Establishment Rules (TFER) was to the inspection report. The newly-implemented inspection report separates core foundation items and requires the inspector to mark certain situations such as repeat violations and items corrected on site. Interdepartmental policy implementations outlined training requirements for food safety staff. In this training, staff would be responsible for learning the federal, state, and local laws governing food safety, as well as methods for applying those laws. Online and field training were implemented to ensure uniformity with inspections. During field training, inspectors were urged to attempt to get as many violations corrected on-site as possible, and to follow up within the scheduled timeframe for violations unable to be corrected on-site. At this time, how the new Program Standards have impacted the violation rates found in Port Arthur food establishments is not known.
Problem Statement
How the newly adopted City of Port Arthur inspection practices impacted critical violations at restaurants between 2017-2019 is not known.
Research Questions
1. What was the rate of critical violations for restaurants in Port Arthur, TX from 2017 to 2019?
2. How have the retail food inspection practices changed in the City of Port Arthur from 2017 to 2019?
3. How do restaurant operators believe adoption of the Program Standards by Port Arthur Health Department has impacted critical violation rates from 2017 to 2019?
Methodology
Data was collected in four phases:
In phase 1, an open record request was submitted to the City of Port Arthur City Secretary’s office to obtain inspection reports for food service establishments from 2017 to 2019. Once the inspection reports were obtained, phase 2 was initiated and included the development of a database to organize the inspection report data. Restaurants categorized as low risk, grocery stores, and schools were excluded from the study. The data were analyzed to identify the mean number of inspection scores and critical violations, the median inspection score, and to identify any trends in the inspection data.
Phase 3 included an analysis of the data to identify changes in City of Port Arthur food safety staff inspection practices. Analysis included finding the total number of inspections for each year within the target population beginning in 2017 and ending in 2019. Also, an analysis was done to separate initial inspections from follow-up inspections.
Phase 4 consisted of interviews with the restaurant Person-in-Charge (PIC) to discuss identified improvements in critical violations. Email invitations were sent to 35 food establishments identified as having at least a 20% increase in inspection scores from 2017 to 2019, and at least a 50% reduction in critical violations noted during inspections through that same time period. The qualifying food establishments were selected randomly using the RAND () function in Microsoft Excel. The respondents who agreed to participate were interviewed either in-person or by phone, and were promised anonymity. Interviewee responses were recorded on a form and analyzed.
Results
Port Arthur has approximately 400 licensed restaurants. Data was available from 1,296 restaurant inspections, involving 142 restaurants and two inspectors during the study period. Individual restaurant scores were between 67 and 100; the mean score was 84.6, and the median was 84. From 2017 to 2019, the mean inspection score increased gradually from 80.1 to 84.6, and the mean number of critical violations cited per inspection fell from 3.4 to 1. (Chart 1). Among restaurant inspections with a total score of >90, at least one critical violation was cited in 48% of those inspections.
Chart 1
Average Critical Violations Per Restaurants 2017-2019
As seen in Chart 2, 76% of all inspections performed had at least one critical violation in 2017, which dropped to 49% in 2019. The rate of critical violations decreased from 76% to 52% between 2017 and 2019. Chart 3 illustrates the City of Port Arthur policy changes that occurred in 2016 and in 2017 to 2019 after the policy changes were in place and implemented. The data show that the number of total initial inspections and the number of follow-up inspections increased from 2017 to 2019. The number of violations corrected on-site also increased between 2017 and 2019, while the number of repeat violations decreased from 2017 to 2019.
Chart 2
Rate of Critical Violation Per Restaurant
Chart 3
Food Safety Program Policy During Adoption of Retail Standards: Before (2016) and After Adoptions (2017-2019)
In an attempt to understand how restaurant operators believe the adoption of the Retail Standards by Port Arthur City Health Department influenced critical violation rates from 2017 to 2019, interviews were conducted with the Person-in-Charge (PIC) of restaurants. Interview requests were sent to qualifying restaurants—those that reduced the number of critical violations found during an inspection by at least 50% between 2017 and 2019. Forty interviews were performed with 32 phone interviews and eight in-person interviews. Ninety-five percent (38) of interviewees stated they believed the directives provided by the City of Port Arthur food safety staff assisted their establishment in correcting violations. Approximately 80% (32) of interviewees stated that the City of Port Arthur food safety staff pointed out violations during inspections that they were not aware of prior to the inspection. Fifteen percent (6) of interviewees stated they believed internal company policy changes assisted with a reduction in critical violations noted during inspections.
Conclusions
The data show an increase in inspections performed, with inspection frequency appearing to double from 2017 to 2019. The data also illustrate that the occurrence of critical violations increased from 2017 to 2019
As the number of total inspections increased from 2017 to 2019, so did the number of critical violations. The increase in critical violations found during inspections increased as a result of more inspections being performed, however, when compared to the total number of inspections performed, there was a decrease in violation rate, indicating that the increased frequency of inspection had a positive impact overall on improved food safety measures in Port Arthur restaurants.
There also was an increase in follow-up inspections performed from 2017 to 2019. A reasonable inference is that policy changes made to the City of Port Arthur’s food safety program laid the foundation for inspection procedures and protocol. The policy implementation that occurred from 2017 to 2019 focused on regulatory foundation, staff training and development, uniformity of inspections, and regulation and compliance. The policy changes allowed for scheduling of routine and follow-up inspection at a frequency suggested in the Texas Food Establishment Rules (TFER). On-site corrective actions were advised, whenever possible, along with increased coaching of the Person-in-Charge (PIC). These measures appear to have influenced the improvement in violation rates between 2017 and 2019.
The restaurant operators interviewed noticed an increase in the inspection score as well as a decrease in critical violations received from 2017 to 2019, however, the researcher’s presence as an interviewer may have influenced the respondent’s answers. Similar to the Hawthorne effect, when asked to rate the performance of the City of Port Arthur’s food safety inspectors, most of the interviewees provided a rating of 10 out of 10. It is unclear if the presence of the interviewer, the Chief Sanitarian, influenced the behavior or responses of the interviewees.
Recommendations
The City of Port Arthur should continue to monitor compliance with implemented inspection policies to assure continued emphasis on addressing critical violations through on-site corrective actions, reinspection, and follow-up inspections.
Acknowledgments
I would like to thank the entire International Food Protection Training Institute (IFPTI) staff for selecting me for this opportunity and helping me through this process. Being selected as an IFPTI fellow is such an honor. I would like to thank Kathy Fedder for being my mentor and always being there when I needed her. Kathy was a lifesaver throughout this process and I don’t believe I would have made it through without her assistance and patience. My fiancé, Lou, has been supportive and helpful in every way possible throughout my research process. My daughters, Madison and Jaycee, have been amazingly supportive and patient as well. I am eternally grateful to be an inspiration to them. To my family and friends, thank you for understanding when I could not participate in every activity or function. Last, but certainly not least, I would like to thank my supervisor, Judith Smith, for allowing me to participate in the IFPTI fellowship; you have been a true role model that exemplifies leadership. Thank you all for your understanding and love.
References
Petran, R. L., White, B. W., & Hedberg, C. W. (2012). Using a theoretical predictive tool for the analysis of recent health department inspections at outbreak restaurants and relation of this information to foodborne illness likelihood. Journal of Food Protection, 75(11):2016-27.
Roberts, K., Kwon, J., Shanklin, C., Lui, P., & Len, W.S. (2011). Food safety practices lacking in independent ethnic restaurants. Journal of Culinary Science & Technology, 1-16.
Texas Department of State Health Services. (2015, October). Statutes and laws - Retail food establishments. https://www.dshs.texas.gov/foodestablishments/laws-rules.aspx
U.S. Food and Drug Administration (FDA). (2021, February 02). Voluntary national retail food regulatory program standards. https://www.fda.gov/food/retail-food-protection/voluntary-national-retail-food-regulatory-program-standards
Author Note
Lacy Brown, Chief Sanitarian
City of Port Arthur, TX
This research was conducted as part of the International Food Protection Training Institute’s Fellowship in Food Protection, Cohort IX
Correspondence concerning this article should be addressed to:
Lacy Brown and City of Port Arthur, TX, 444 4th Street Port Arthur, TX 77641
Lacy.brown@portarthurtx.gov
*Funding for this statement, publication, press release, etc., was made possible, in part, by the Food and Drug Administration through grant 5U18FD005964 and the Association of Food and Drug Officials. Views expressed in written materials or publications and by speakers and moderators do not necessarily reflect the official policies of the Department of Health and Human Services; nor does any mention of trade names, commercial practices, or organization imply endorsement by the United States Government.