A Nutrition and Food Service Audit Manual
[Pages:261]Audits & More
A Nutrition and Food Service Audit Manual
for Adult Residential Care Facilities with 25 or more Persons in Care
ISBN 978-0-7726-6059-6
Audits & More: A Nutrition and Food Service Audit Manual for Adult Residential Care Facilities with 25 or more Persons in Care
Acknowledgements
Many food and nutrition professionals from across British
? Danial Bertrand, St. Charles Manor
Columbia contributed their time and expertise to the development of this edition of Audits and More. The members of the Advisory Committee are gratefully acknowledged for their tremendous dedication and contribution to the project.
? Jean Charman, Talarico Place ? Natalia Ciutat Terroba, Dufferin Care Center ? Brandie Conners, Interior Health Authority ? Colleen Ellens, Interior Health Authority ? Margaret Fenwick, Vancouver Coastal Health,
Garibaldi Area
?ChCrhisrtiisnteinCehCohuo,uF,raFsraesreHr eHaeltahlth ?JoJyocyecCehCohwo,wF,aFiraHir aHvaevneUn nUitneidteCd hCuhrcuhrcHh oHmoemseasnadnd LaLkaekveievwiewCaCrearCeeCnetenrter ?LisLaisFaoFrosrtesrte-Cr-oCuollu,lBl,CBCMiMnisntirsytroyfoHf eHaeltahlth ?KaKraerneDn aDvaisvoisno,nL,aLnagnagrarCa oClloelgleeg, eD, eDpeapratmr temnet notfoNf utrition anNduFtoriotiodnSaenrvdicFeosodMSaneravgiecmeseMntanagement ?MeMlaenlaieniGeoGldoeldre, rS,pSepceiacliaPlrPorjeocjetsctRseRseidseidnetinatliaClaCrea,reH,ealth PrHoteeaclthionP,roBtCecMtioinni,sBtrCy oMfiHniesatrltyhof Health ?DiDaniannenHe aHyasy, sP,inPeinGe rGorvoevCe aCrearCe eCnetrnet,reK,aKmalmooloposps SeSneionriosr' sV'iVllailglaegeanadndPiPciccacdaidllyillyCaCraereCtCr.e(nStraelm(SoanlmAormn )Arm) ?BeBtteyttHy oHlmolemse, sV,aVnacnocuovuevreCr oCaosatasltaHl eHaeltahltAhuthority, NoAruththsohroitrye, Northshore ?GlGenlednadRaeRide,idC,oCnosnusltualntatnint iNnuNtruitiroitnioannadnFdoFoodoSdeSrevircveice
? Chad Forbes, Vancouver Coastal Health, Value Improvement Network
? Mairi Graves, Crofton Manor ? Nadia Guirguis, Fraser Health ? Tara Harvey, Kamloops Seniors' Village ? Kathi Holt, Hawthorne Seniors Care Community ? Harneet Kaur, Dietetic Intern ? Elaine Kirby, North Okanagan Residential Services
Program ? Sharon Kositsky, Kopernik Lodge ? Elena Lam-Lau, Vancouver Coastal Health, Value ? Improvement Network
Heather Martin, Louis Brier Home and Hospital ? Roberta McCabe, Elk Valley Hospital and Sparwood
?JilJliRll oRmoamnacnhcuhku, kH, eHaeltahltSheSrevircveicsefsorfoCr oCmomumnuitnyitLyivLiinvging
Health Centre
anadnCdoCmomumnuitnyitLyivLiinvginBgCBC
? Stephanie Moen, Overlander Residential Care and
?SwSawtiatSicSoctto,ttP,rPivraivteatPerPacraticcteicDeiDetiietitaitniaannadnVdaVnacnocuovuevrer IslIasnladnHd eHaeltahltAh uAthuothroityrity ?WWenednydSycSoctto,ttM, oMrorirsroisnoHneHaeltahlcthacreare ?RhRohnodnadSamSyml,yWl, WesetcsotcaosatsDtiDetietiectsicLsimLiimteidted ?MaMraiarivaavnaSnlSoulonu,nV,aVnacnocuovuevreIsr lIasnladnHdeHaeltahltAhuAthuothroityrity
Ponderosa Lodges ? Mary Pilipenko, Royal City Manor and Golden Ears
Seniors Village ? Claudia Surette, Westcoast Dietetics Limited,
Menno Home ? Deanna Tan-Francoeur, Fraser Health
The Advisory Committee would also like to thank those who assisted with this project by participating in the initial survey, providing and reviewing content and assisting with the pilot testing of the audits.
? Terry Yeh Cummings, Little Mountain Place and Adanac Park Lodge
? Karen Van Rheenen, Kardel Consulting Services Inc. ? Anja Vogt, Sherwood Crescent Manor ? June Wade, Food Services North Island, Cumberland
?KaKtiaetiAenAdnedresrosno,nG, rGeereneTnaTbaleblNe eNtwetowrok rk ?SaSnhnaonnnAontwAattwera,tePrin, ePiGneroGveroCvearCeaCrenCtreentre ?ZeZlieAliwArwerye, yH, eHrietarigtaegVeilVlailglaege ?SaSllayllByaBrakrwkewlle,lPl,ePaecaecCe oCuonutrnytrHy eHaeltahlth ?SuSeuBeeBdefodrfodr,dC, oCmomumnuitnyitCy aCrearFeaFcailcitileitsie, sH, eHaeltahlth
Health Center ? Liane Wally, Westcoast Dietetics Limited, Yaletown
House ? Margaret Yandel, Ministry of Healthy Living and Sport ? Irene Zilinski, Lynn Valley Care Centre
PrPorteocteticotnio, nB,CBCMiMnisntirsytroyfoHf eHaeltahlth
Edited by: Karen Davison and Barbara Dominik
i
Table of Contents
Chapter 1: Overview
Chapter 1: Overv
What is the Purpose of this Manual?
1
What is in this Manual?
2
How Do I Use this Manual?
2
What does an Audit Score Mean?
3
What if an Audit is Unacceptable?
3
What if an Audit is Consistently Acceptable?
3
What Tools are there to Facilitate Compliance with the Regulations?
3
Can an Alternative Nutrition and Food Service Audit Program be Used? 4
Roles of Selected Facility Staff and the Interdisciplinary Team
4
Role of the Registered Dietitian (RD)
4
Role of the Supervisor of Food Services
5
Role of Food Handlers
5
Role of Nursing
5
Role of Interdisciplinary Team
5
The Audit Program
6
Frequency of Nutrition and Food Service Audits
7
Summary of Nutrition and Food Service Audits
7
Glossary of Terms
11
Chapter 2: Nutrition Care Plans
Chapter 2: Nutriti
Nutrition Care Planning - Background Information
13
Developing a Nutrition Care Plan
14
Dietary Profiles for Those in Care who are Respite or Short Stay
17
Interdisciplinary Care Conferences
17
Nutrition Transfer Form
17
Documenting Height, Weight and Waist Circumference
17
Measuring Height, Weight and Waist Circumference
18
Interpreting Weight Status
20
Determining Weight Goals
21
Nutrition Care Plan Audit
23
Nutrition Care Plan Implementation - Background Information
28
Nutrition Care Plan (NCP) - Meal Implementation and Consumption Audit 29
Snacks as Nourishment - Background Information
35
Nutrition Care Plan - Snack Implementation and Consumption Audit
40
ii
Chapter 3: Nutrition Care - Special ConsideCrhaatipontesr 3: Nutriti
Hydration - Background Information Hydration Program Audit Enteral Feedings - Background Information Enteral Feeding Implementation Audit Nutrients from Non-Food Sources - Background Information Audit of Excess Nutrient Intakes
Chapter 4: Menu Planning
42 44 51 52 56 57
Chapter 4: Menu
Menu Planning - Background Information
63
The Cycle Menu
64
Standardized Recipes
65
Cultural, Religious and Personal Considerations
66
Nutrient Analysis of Menus
67
Menu Audit
69
Computerized Nutrient Analysis of Menu Audit
78
Menu Substitutions - Background Information
86
Menu Substitutions Tracking Form and Audit
87
Chapter 5: Food Preparation and Service Chapter 5: Food
Policies and Tools - Background Information
91
Policies and Procedures
91
Tools for Organization and Administration
92
Food Product Quality - Background Information
93
Meal Service Audit
95
Dining Environment - Background Information
100
Dining Environment Audit
103
Chapter 6: Satisfaction and Accountability Chapter 6: Satisfa
Satisfaction with Food and Nutrition Services - Background Information 106
Satisfaction with Nutrition and Food Services Questionnaire
108
Plate Waste Audit
112
Nutrition and Food Service Records - Background Information
116
iii
Chapter 7: Emergency and Sustainability PClahnanpintegr 7: Emerg
Emergency Planning - Background Information
119
Emergency Food Service Planning
119
The Emergency Menu and Supplies
121
Reviewing, Testing and Distributing the Food Service Emergency Plan 121
Food Services Sustainability - Background Information
122
Chapter 8: Forms for the Audit Program Chapter 8: Forms
Summary of Nutrition and Food Service Audits and Checklists
126
Nutrition Care Plan Audit
129
Nutrition Care Plan (NCP) - Meal Implementation and Consumption Audit 130
Nutrition Care Plan (NCP) - Snack Implementation and Consumption Audit 131
Hydration Program Audit
132
Enteral Feeding Implementation Audit
134
Menu Audit
135
Computerized Nutrient Analysis of Menu Audit
137
Menu Substitutions Tracking Form and Audit
139
Meal Service Audit
140
Dining Environment Audit
141
Satisfaction with Nutrition and Food Services Questionnaire
142
Satisfaction with Nutrition and Food Services Questionnaire Scoring Form 143
Plate Waste Audit
144
Nutrition and Food Services Policies and Procedures Checklist
145
Audit of Excess Nutrient Intakes
148
Emergency Preparedness Checklist
149
Sustainability in Food Services Checklist
151
Appendices
Appendices
Appendix 1 - Resources
154
Appendix 2 - Nutrition Assessment
166
Appendix 3 - Registered Dietitian Referral Form
170
Appendix 4 - Nutrition Transfer Form
171
Appendix 5 - Significant Weight Loss Table
172
Appendix 6 - Monthly Weight Graph
173
Appendix 7 - Suggested Minimum Serving Sizes for the Elderly
174
Appendix 8 - Suggested Menu Items
175
Appendix 9 - Conversions and Equivalents
178
Appendix 10 - Education and Training Attendance Form
179
Appendix 11 - Emergency Planning
180
iv
Chapter One
Overview
What is the Purpose of this Manual?
In British Columbia, residential community care facilities must be licensed under the Community Care and Assisted
The Auditing Cycle
Living Act ("the Act"). The Act requires that community care
facilities be operated in a manner that will maintain the spirit,
dignity and individuality of the persons being cared for and that will promote the health and safety of persons in care. The Act, which replaced the Community Care Facility Act on
Identify reasons for unacceptable
score
Implement corrective
action
May 14, 2004, empowers the government to make
regulations. It is recommended that all licensed adult residential community care facilities have a program which monitors their nutrition and food services. This monitoring
Conduct audit
or audit program assists facilities in maintaining basic health
and safety standards. Refer to Appendix 1 (Resources) for
information on how to obtain a copy of the Community Care and Assisted Living Act and associated regulations.
an audit program that is consistent with the regulations. To facilitate understanding of the Legislation and as the basis
Residential community care facilities include those designated for care of seniors, care of persons with mental
for the audit tools, resources in nutrition and food services that reflect best practice are included.
health concerns, and drug and alcohol rehabilitation. This
Regional licensing/community nutritionists and licensing
manual is a resource to develop a nutrition and food services
officers inspect and monitor licensed residential care
monitoring/audit program in residential facilities having 25 or more persons in care. The British Columbia Ministry of Health Services publication Meals and More, available on
facilities to promote and protect the health, safety and wellbeing of persons cared for in these facilities. As part of their review, they will examine tools for self-monitoring such as
the BC Government publications website
those provided in this manual.
(), contains the nutrition
and food service monitoring program for facilities with 24 or fewer people in care. Facilities may choose the program outlined in these publications. Alternatively, they may
This manual is an update of the Audits and More manual published in 2001. Since the last edition, there have been changes in the Legislation as well as the reference
choose to develop their own monitoring tools or audits
standards for diet planning including the Eating Well with
provided that they are acceptable to the medical health officer in their region.
Canada's Food Guide and the Dietary Reference Intakes. This manual reflects those changes. All of the audits have
been reviewed and revised. In addition, four new audits or
This manual is intended for use by interdisciplinary teams
checklists have been introduced: the Nutrition and Food
working in adult residential community care facilities including, but not limited to, the Registered Dietitian (RD), supervisor of food services/nutrition manager, Registered
Services Policy and Procedures Checklist, the Hydration Program Audit, the Dining Environment Audit, and the Audit of Excess Nutrient Intakes. Finally, this edition also includes
Nurse and other facility staff. It provides background
content related to emergency and sustainability planning.
information on how to interpret and meet the provincial standards, and tools to assist facility staff in implementing
Throughout the manual the term audit will be used to refer to tools for monitoring nutrition and food services.
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