Quality Without Question: Focus on Food Service - NCALA

1 1 Quality Without question : Focus on food ServiceThe Division of Health Service RegulationAdult Care Licensure SectionOur ObjectivesAt the end of this training, each participant will demonstrate an understanding of: The responsibility outlined in the nutrition and food Service rule How to use observation, record review, and interview to assess the Quality of services provided to residents Effective interventions to improve the Quality of food Service management2 Fundamentals of Nutrition and food Service rulesWHAT DO YOU WANT FROM ME????Come with me, let s go on a journey into the area of food (a) food Procurement and Safety in Adult Care Homes:(1)The kitchen, dining and food storage areas shall be clean, orderly and protected from (a)(4) Adult care homes shall.

2 Have a North Carolina Division of Environmental health approved sanitation classification at all times in facilities with 12 beds or less and North Carolina Division of Environmental health Sanitation scores of 85 or above at all times in facilities with 13 beds or moreSanitation InspectionLOOK FOR THE POSTED SANITATION GRADE Ask for copy of the sanitation report Compare the sanitation report to what you find in the kitchen/dining room4 Meet the Cook and the Kitchen StaffIntroduce yourself, let them know why you are thereDevelop a rapport with the kitchen staffTry to put them at ease, because by now their blood pressure has gone up5 ASK QUESTIONS What are you cooking today? Where is your diet list May I see your regular menus and your therapeutic menus Do you have any residents that require feeding assistance or eat in their rooms?

3 Do you have any residents on thickened liquids?Diet List .0904 (e)(3) The facility shall maintain an accurate and current listing of resident with physician-ordered therapeutic diets for guidance of food Service staff Diet list must be current, list each resident and the therapeutic diet as prescribed by the physician6 THERAPEUTIC DIET LIST FOR BUTTERFIELDS ASSISTED LIVING NO CONCENTRATED SWEETS Carolyn A. Myrtle W. Jewel C. Annie C. Homer G. Ann M. MECHANICAL SOFT John G. Lyle B. Simon L. Janet P. PUREED Foster C. Grant T. Genveva H. Margaret M. RENAL April B. 2200 Calorie ADA May .0904 (c)(2) Menus shall be maintained in the kitchen and identified as to the current menu day and cycle for any given day for guidance of food Service should not be in the Administrators office on a SHELF!

4 !REGULAR MENUS DO NOT HAVE TO BE SIGNED BY A REGISTERED DIETICIANT herapeutic Menus .0904 (c)(6) menus for all therapeutic diets shall be planned or reviewed by a registered dietitian. The facility shall maintain verification of the registered dietitian s approval of the therapeutic diets which shall include an original signature by the registered dietitian and the registration number of the .0904 (c)(3) Any substitutions made in the menu shall be of equal nutritional value, appropriate for therapeutic diets and documented to indicate the foods actually served to residentsSubstitutions Substitutions must be documented on a substitution log Substitutions must: Stay in the same food group Examples: Only citrus fruit or juice is a substitute for citrus fruit or juice Orange Juice substitution Grapefruit juice Collard greens substitution Turnip Greens Oatmeal substitution - Grits 9 Why did we ask those questions?

5 We need a sample of residents We want residents on therapeutic diets, thickened liquids, residents who require feeding assistanceNOTE: We want your most difficult residentsWhat Next???Now that we have picked a diet s see what s going on in the kitchen!!!!10 food Procurement and Safety in Adult Care Homes .0904 (a)(1) The kitchen, dining and food storage areas shall be clean, orderly and protected from contamination .0904 (a)(2) All food and beverage being procured, stored, prepared or served by the facility shall be protected from Units Refrigerated units should be at a temperature not to exceed 45 degrees Fahrenheit Raw meat/fresh eggs are not stored over ready to eat foods in refrigerator Leftovers appropriately stored, labeled, and dated No spoiled food in refrigeratorsThawing Foods food should be thawed using the following techniques: Under potable running water of a temperature of 70 degrees Fahrenheit As part of the conventional cooking process13 Thawing Foods (cont.)

6 In a microwave oven only when the food will be immediately transferred to conventional cooking equipment as part of a continuous cooking process or when the entire, uninterrupted cooking process takes place in the microwave oven Foods may be thawed in the refrigerator143 Day / 5 Day food Supply .0904 (a)(4) There shall be at least a three-day supply of perishable food and a five-day supply of non-perishable food in the facility based on the menus, for both regular and therapeutic diets153 Day Supply of Perishable FoodPerishable food is usually foods that require refrigerationIf your menu calls for milk, orange juice, butter, etc. ensure you have enough of each item to cover all residents for 3 days3 Day Supply of Perishable food Example:Milk: one cup (8 ounces) twice a dayYour facility has 20 residents20 (residents) x 16 (ounces a day) =320 ounces163 Day Supply of Perishable FoodThere are 128 ounces in one gallon of milk320 (ounces) 128 = gallons of milk needed per dayIf you need a three day supply you will (gallons) x 3 (days) = gallons of milk5 Day Supply of Non-Perishable food Non-perishable food is usually food that does not require refrigeration Examples: canned fruit, vegetables, cake mixes, cereal, Preparation and Service in Adult Care Homes.

7 0904 (b)(1) Sufficient staff, space and equipment shall be provided for safe and sanitary food storage, preparation and Service . Ensure you have sufficient staff for the number of residents you have in your facilityFood Preparation and Service in Adult Care Homes: Ensure that all equipment is working properly: Leaking refrigerators/freezers Leaking sinks/dishwashers Refrigerators/freezers have thermometers18 Dishwasher Dishwasher should be equipped with wash, rinse and sanitizer. If sanitizer is not available dishwasher should be equipped with a booster of 170 degrees Compartment Sink Applies to facilities with 12 or more beds First Compartment wash water Second Compartment rinse water Third Compartment Sanitize Chlorine 50 PPM Iodophor products PPM (Iodine-not commonly used) Quaternary ammonium products 200 PPM (Sanitizing solution requires a test strip)20 What is the Cook Doing?

8 ??? Now while we are checking out the kitchen we still have one eye on the cook!! Is she frying/baking/broiling? What types of seasoning is she using? Does she have no added salt or no added sweet products to prepare her meal as stated on the menus? Did she wash her hands? Is her hair covered? Now if for some reason we were in the refrigerator and missed her making the cake and we asked her if the mix was unsweetened and she tells yes but she used the last box and put it in the trash We have been known s right, check the trash can!!!22 Observation of the Meal Service .0904 (b)(2) Table Service shall include a napkin and non-disposable place setting consisting of at least a knife, fork, spoon, plate and beverage containers.

9 Exceptions may be made on an individual basis and shall be based on documented needs or preferences of the .0904 (b)(3) Hot foods shall be served hot and cold foods shall be served cold Hazardous foods requiring cooking shall be cooked to heat all parts of the food to a temperature of at least 140 degrees Mechanical soft, pureed diets ensure that there is a continuous heat source until the plate is served to the resident2425 Resident Satisfaction How do staff respond to residents?2627 Observation of the Meal Service What are we writing???? Were are documenting start and end times of the meal Service How long did it take to plate the meal until it reached the resident? What did the resident actually receive?

10 How staff interacts with the residents28 Residents that require feeding assistance or eat in their rooms We are still writing? How long did it take for the resident to receive his meal? How long did it take until feeding assistance was offered to the resident?Individual Feeding Assistance in Adult Care Homes .0904 (f)(1) Sufficient staff shall be available for individual feeding assistance as needed .0904 (f)(2) Residents needing help in eating shall be assisted upon receipt of the meal and assistance shall be unhurried and in a manner that maintains or enhances each resident s dignity and respect29 Feeding Assistance Things we are looking for: If staff washed their hands? If staff identify foods to the resident?