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Summary of Food/Feed Safety Incident Root Cause Analysis (RCA) informationRoot Cause Analysis data received in October 2021
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Download this file| Incident Reference Number | Date RCA Received | Incident Type | Hazard Type | Product Type | Why 1 | Why 2 | Why 3 | Why 4 | Why 5 | Root Cause | Corrective Actions | ALPHA TEST: FSA RCA Categorisation | ||||||||||||||||||||||||||||||||||||||||
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| I-001-982 | 01/10/2021 | Non-Pathogenic Microorganisms | Mould | Other Food Product / Mixed | Customer complaint of mould in the packet of microwavable Basmati Rice | This type of product is classed as commercially sterile, meaning no microorganisms are present and grow can only occur if the seal or pouch has been compromised in some way, in this instance this seems to be the case. There may have been a tiny hole in the packaging. | This individual bag may have been damaged during storage and distribution, or during transport with the other shopping from store to the customers home. | Blank | Blank | This individual bag may have been damaged during storage and distribution or during transport with the other shopping from store to the customers home. This type of product is classed as commercially sterile, meaning no microorganisms are present and grow can only occur if the seal or pouch has been compromised in some way, in this instance this seems to be the case. There may have been a tiny hole in the packaging. | The process is monitored during each cook, details recorded and verified by a QA every 12 hours. Samples are routinely sent to an external lab for microbiological testing, there have been no fails to date. There have been several site improvements made and further investment is being made with the introduction of online seal checkers, which adds closer monitoring to ensure pouch integrity. There have been no other complaints for this batch of product | Process: Packaging - defective | Not set | Not set | Not set | Not set | Not set | Not set | Not set | Not set | Not set | Not set | Not set | Not set | Not set | Not set | Not set | Not set | Not set | Not set | Not set | Not set | Not set | Not set | Not set | Not set | Not set | Not set | Not set | Not set | Not set | Not set | Not set | Not set | Not set | Not set | Not set | Not set | Not set | Not set | Not set | Not set |
| I-001-842 | 05/10/2021 | Pathogenic Microorganisms | Not Determined / Other | Poultry Meat & Poultry Meat Products | n/a | n/a | n/a | n/a | n/a | Following an investigation at the slaughterhouse, the root causes identified are ageing evisceration equipment, uneven size of birds within the same batch causing difficulty to eviscerate them properly, and inadequate staff training and FBO management supervision, all leading to inadequately eviscerated birds leaving the slaughterhouse and entering production. | The management at the slaughterhouse have commissioned a review of their evisceration equipment by the manufacturer to determine whether it can be upgraded or requires complete replacement (the report is expected). In the interim they have adopted and implemented other mitigating actions, including training and supervision of staff, increase in the number of monitoring and verification checks to ensure all carcases are properly eviscerated and changes to their food management procedures to prevent further contaminated product being placed in the market; they are also liaising with their producers to reduce bird size variation. The FBO has temporarily stopped exports to the EU. Review carried out in liaison with the slaughterhouse operator and management actions implemented, including a review of the performance of plant inspection assistants (PIAs), an increase in the levels of supervision at the co-located cutting plant and verification of the corrective actions put in place by the food business operator (FBO), taking robust enforcement action as necessary to ensure compliance. | Equipment: Other - Incorrect machinery specification Process: Quality Control Checks - inadequate | Not set | Not set | Not set | Not set | Not set | Not set | Not set | Not set | Not set | Not set | Not set | Not set | Not set | Not set | Not set | Not set | Not set | Not set | Not set | Not set | Not set | Not set | Not set | Not set | Not set | Not set | Not set | Not set | Not set | Not set | Not set | Not set | Not set | Not set | Not set | Not set | Not set | Not set | Not set | Not set |