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.

1

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