A Nutrition And Food Service Audit Manual

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Audits&MoreA Nutrition and Food Service Audit ManualforAdult Residential Care Facilities with 25 or more Persons in Care

ISBN 978-0-7726-6059-6Audits & More: A Nutrition and Food Service Audit Manualfor Adult Residential Care Facilities with 25 or more Persons in Care

AcknowledgementsMany food and nutrition professionals from across BritishColumbia contributed their time and expertise to thedevelopment of this edition of Audits and More. Themembers of the Advisory Committee are gratefullyacknowledged for their tremendous dedication andcontribution to the project. th viewCareCenter r-Coull,MinistryHealth nKarenDavison,LangaraCollege,DepartmentandFood ServicesNutritionand FoodManagementServices Management ection,BC MinistryHealthof HealthHealth Protection,BC ianneHays,PineGroveCareCentre,Kamloops s,VancouverCoastalHealth NorthshoreAuthority, NorthshoreGlendaReid,Consultantin itionandFoodService ingRomanchuk,HealthServicesCommunityLiving ivatePracticeDietitianandVancouver tt,MorrisonHealthcareWendyScott,MorrisonHealthcare tcoastDieteticsLimited anSloun,VancouverIslandHealthAuthority The Advisory Committee would also like to thank thosewho assisted with this project by participating in the initialsurvey, providing and reviewing content and assisting withthe pilot testing of the audits. TableNetwork water,GroveCentre ZeliAwrey,HeritageVillageZeliAwrey,HeritageVillage eCountryHealth d,CommunityCareFacilities,Health ryHealth Danial Bertrand, St. Charles ManorJean Charman, Talarico PlaceNatalia Ciutat Terroba, Dufferin Care CenterBrandie Conners, Interior Health AuthorityColleen Ellens, Interior Health AuthorityMargaret Fenwick, Vancouver Coastal Health,Garibaldi AreaChad Forbes, Vancouver Coastal Health, ValueImprovement NetworkMairi Graves, Crofton ManorNadia Guirguis, Fraser HealthTara Harvey, Kamloops Seniors' VillageKathi Holt, Hawthorne Seniors Care CommunityHarneet Kaur, Dietetic InternElaine Kirby, North Okanagan Residential ServicesProgramSharon Kositsky, Kopernik LodgeElena Lam-Lau, Vancouver Coastal Health, ValueImprovement NetworkHeather Martin, Louis Brier Home and HospitalRoberta McCabe, Elk Valley Hospital and SparwoodHealth CentreStephanie Moen, Overlander Residential Care andPonderosa LodgesMary Pilipenko, Royal City Manor and Golden EarsSeniors VillageClaudia Surette, Westcoast Dietetics Limited,Menno HomeDeanna Tan-Francoeur, Fraser HealthTerry Yeh Cummings, Little Mountain Place and AdanacPark LodgeKaren Van Rheenen, Kardel Consulting Services Inc.Anja Vogt, Sherwood Crescent ManorJune Wade, Food Services North Island, CumberlandHealth CenterLiane Wally, Westcoast Dietetics Limited, YaletownHouseMargaret Yandel, Ministry of Healthy Living and SportIrene Zilinski, Lynn Valley Care CentreEdited by: Karen Davison and Barbara Dominiki

Table of ContentsChapter 1: OverviewChapter 1: OvervWhat is the Purpose of this Manual?What is in this Manual?How Do I Use this Manual?What does an Audit Score Mean?What if an Audit is Unacceptable?What if an Audit is Consistently Acceptable?What Tools are there to Facilitate Compliance with the Regulations?Can an Alternative Nutrition and Food Service Audit Program be Used?Roles of Selected Facility Staff and the Interdisciplinary TeamRole of the Registered Dietitian (RD)Role of the Supervisor of Food ServicesRole of Food HandlersRole of NursingRole of Interdisciplinary TeamThe Audit ProgramFrequency of Nutrition and Food Service AuditsSummary of Nutrition and Food Service AuditsGlossary of Terms1223333444555567711Chapter 2: Nutrition Care PlansChapter 2: NutritiNutrition Care Planning - Background InformationDeveloping a Nutrition Care PlanDietary Profiles for Those in Care who are Respite or Short StayInterdisciplinary Care ConferencesNutrition Transfer FormDocumenting Height, Weight and Waist CircumferenceMeasuring Height, Weight and Waist CircumferenceInterpreting Weight StatusDetermining Weight GoalsNutrition Care Plan AuditNutrition Care Plan Implementation - Background InformationNutrition Care Plan (NCP) - Meal Implementation and Consumption AuditSnacks as Nourishment - Background InformationNutrition Care Plan - Snack Implementation and Consumption Audit1314171717171820212328293540ii

Chapter 3: Nutrition Care - Special ConsiderationsChapter 3: NutritiHydration - Background InformationHydration Program AuditEnteral Feedings - Background InformationEnteral Feeding Implementation AuditNutrients from Non-Food Sources - Background InformationAudit of Excess Nutrient Intakes424451525657Chapter 4: Menu PlanningChapter 4: MenuMenu Planning - Background InformationThe Cycle MenuStandardized RecipesCultural, Religious and Personal ConsiderationsNutrient Analysis of MenusMenu AuditComputerized Nutrient Analysis of Menu AuditMenu Substitutions - Background InformationMenu Substitutions Tracking Form and Audit636465666769788687Chapter 5: Food Preparation and Service Chapter 5: FoodPolicies and Tools - Background InformationPolicies and ProceduresTools for Organization and AdministrationFood Product Quality - Background InformationMeal Service AuditDining Environment - Background InformationDining Environment Audit9191929395100103Chapter 6: Satisfaction and Accountability Chapter 6: SatisfaSatisfaction with Food and Nutrition Services - Background InformationSatisfaction with Nutrition and Food Services QuestionnairePlate Waste AuditNutrition and Food Service Records - Background Informationiii106108112116

Chapter 7: Emergency and Sustainability PlanningChapter 7: EmergEmergency Planning - Background InformationEmergency Food Service PlanningThe Emergency Menu and SuppliesReviewing, Testing and Distributing the Food Service Emergency PlanFood Services Sustainability - Background Information119119121121122Chapter 8: Forms for the Audit ProgramChapter 8: FormsSummary of Nutrition and Food Service Audits and ChecklistsNutrition Care Plan AuditNutrition Care Plan (NCP) - Meal Implementation and Consumption AuditNutrition Care Plan (NCP) - Snack Implementation and Consumption AuditHydration Program AuditEnteral Feeding Implementation AuditMenu AuditComputerized Nutrient Analysis of Menu AuditMenu Substitutions Tracking Form and AuditMeal Service AuditDining Environment AuditSatisfaction with Nutrition and Food Services QuestionnaireSatisfaction with Nutrition and Food Services Questionnaire Scoring FormPlate Waste AuditNutrition and Food Services Policies and Procedures ChecklistAudit of Excess Nutrient IntakesEmergency Preparedness ChecklistSustainability in Food Services 4145148149151AppendicesAppendicesAppendix 1 Appendix 2 Appendix 3 Appendix 4 Appendix 5 Appendix 6 Appendix 7 Appendix 8 Appendix 9 Appendix 10 Appendix 11 on AssessmentRegistered Dietitian Referral FormNutrition Transfer FormSignificant Weight Loss TableMonthly Weight GraphSuggested Minimum Serving Sizes for the ElderlySuggested Menu ItemsConversions and EquivalentsEducation and Training Attendance FormEmergency Planningiv

Chapter OneOverview

What is the Purpose of this Manual?In British Columbia, residential community care facilitiesmust be licensed under the Community Care and AssistedLiving Act (“the Act”). The Act requires that community carefacilities be operated in a manner that will maintain the spirit,dignity and individuality of the persons being cared for andthat will promote the health and safety of persons in care.The Act, which replaced the Community Care Facility Act onMay 14, 2004, empowers the government to makeregulations. It is recommended that all licensed adultresidential community care facilities have a program whichmonitors their nutrition and food services. This monitoringor audit program assists facilities in maintaining basic healthand safety standards. Refer to Appendix 1 (Resources) forinformation on how to obtain a copy of the Community Careand Assisted Living Act and associated regulations.The Auditing CycleIdentify reasonsfor uditan audit program that is consistent with the regulations. Tofacilitate understanding of the Legislation and as the basisfor the audit tools, resources in nutrition and food servicesthat reflect best practice are included.Residential community care facilities include thosedesignated for care of seniors, care of persons with mentalhealth concerns, and drug and alcohol rehabilitation. Thismanual is a resource to develop a nutrition and food servicesmonitoring/audit program in residential facilities having 25or more persons in care. The British Columbia Ministry ofHealth Services publication Meals and More, available onthe BC Government publications website(http://www.publications.gov.bc.ca), contains the nutritionand food service monitoring program for facilities with 24 orfewer people in care. Facilities may choose the programoutlined in these publications. Alternatively, they maychoose to develop their own monitoring tools or auditsprovided that they are acceptable to the medical healthofficer in their region.Regional licensing/community nutritionists and licensingofficers inspect and monitor licensed residential carefacilities to promote and protect the health, safety and wellbeing of persons cared for in these facilities. As part of theirreview, they will examine tools for self-monitoring such asthose provided in this manual.This manual is an update of the Audits and More manualpublished in 2001. Since the last edition, there have beenchanges in the Legislation as well as the referencestandards for diet planning including the Eating Well withCanada's Food Guide and the Dietary Reference Intakes.This manual reflects those changes. All of the audits havebeen reviewed and revised. In addition, four new audits orchecklists have been introduced: the Nutrition and FoodServices Policy and Procedures Checklist, the HydrationProgram Audit, the Dining Environment Audit, and the Auditof Excess Nutrient Intakes. Finally, this edition also includescontent related to emergency and sustainability planning.Throughout the manual the term audit will be used to refer totools for monitoring nutrition and food services.This manual is intended for use by interdisciplinary teamsworking in adult residential community care facilitiesincluding, but not limited to, the Registered Dietitian (RD),supervisor of food services/nutrition manager, RegisteredNurse and other facility staff. It provides backgroundinformation on how to interpret and meet the provincialstandards, and tools to assist facility staff in implementing1

What is in this Manual?facilities should be obtained by contacting the regionalenvironmental health office. The regional environmentalhealth officer/public health inspector inspects and monitorsall food safety processes in facilities requiring food permits.This manual contains eight chapters and 11 appendices.Chapter 1 provides an introduction and overview of themanual including the audit requirements. It also provides aneasy-to-follow sample summary of the nutrition and foodservice audit program for licensed community carefacilities.How Do I Use this Manual?This manual describes a nutrition and food servicemonitoring or audit program that meets the requirements ofthe Legislation and provides additional tools that comparenutrition and food services functions with best practices. Itincludes required and optional audits. Required audits arethose that are intended to meet the criteria of the Legislation.Optional audits reflect best practice in nutrition and foodservices and are provided as additional resources forassessing operations and systems.Chapters 2, 3 and 4 focus on the food and nutrition-relatedcomponents of the Legislation. Chapter 2discusses nutrition care planning and implementation andChapter 3 discusses special considerations in nutritioncare. Chapter 4 focuses on menu planning. Chapter 5discusses the preparation and service of food. Chapter 6discusses satisfaction with nutrition and food services andaccountability. Chapter 7 addresses emergency andsustainability planning. These chapters:The Registered Dietitian, super visor of foodservices/nutrition manager and other members of theinterdisciplinary team should:measure OutlineOutlinethetheauditaudit toolstools thatthat facilities can use to icstopics Providerelatedto llas itauditforms.forms. tion and audits. plinaryinterdisciplinaryteam.team. DevelopafacilityauditplanthatdeterminesDevelop a facility audit plan that dto tothetherestofofthetheteam.Chapter 8 is the “hands-on” component of the manual. Itcontains all of the audit forms, which can be copied andused in an audit program. Blank electronic copies of theaudit tools and forms (“Forms To Accompany the Audits andMore Manual” and “Audit Tools To Accompany the Auditsand More Manual”) can be obtained on the BC governmentpublications website at:http://www.publications.gov.bc.caIf an audit identifies areas of concern, the interdisciplinaryteam rshortcomings.shortcomings. essthem.them. tocorrectcorrectthem.them. beresponsibleresponsible Determineforforfollow-up.follow-up. cceptableacceptable Repeat thescoreis ismet.scoremet.The appendices contain a variety of resource materials aswell as sample forms and tools to assist facility staff innutrition and food services planning.This manual does not include information on food safety.Information on food safety standards, including HazardAnalysis Critical Control Points (HACCP), for residential2

A nutrition and food service audit program assists facilitiesin maintaining basic health and safety standards as set outin the Regulations. An effective and valid audit program willdocument acceptable and unacceptable audit results aswell as the actions taken to correct any concerns identified.What Does an Audit Score Mean?The audits in this manual measure the basic systems thatare in place for nutrition and food services. By conductingaudits such as these, you demonstrate that the care andwell-being of those who live in the facility is a priority.What if an Audit is ConsistentlyAcceptable?The specific systems measured in the various audits includethose for nutrition care planning, menu planning, foodpreparation and service, satisfaction and accountability.The items examined in each of the audits are based upon theLegislation and best practice standards relevant to thenutrition and food services system measured. Examinationof the items in each audit helps ensure the quality of theservices provided. If the audit score is 100%, this meansthat the performance of the particular system measuredmeets the standards as determined by the Legislation andis in line best practice standards.By keeping an ongoing file of the audits you may noticetrends. If scores consistently meet the acceptable level, youmay be confident that your level of care is meeting theLegislation. If this is the case, you may want to raise thestandard for that audit since you have demonstrated thatyou can consistently achieve a higher score. The audit toolsare available in electronic format so you can adapt them andbroaden your assessment criteria (refer to “Audit Tools ToAccompany the Audits and More Manual” on the BCgovernment publications website at:http://www.publications.gov.bc.caWhat if an Audit is Unacceptable?It is important to realize that an audit score that is less thanthe standard does not mean your nutrition and food serviceoperation does not meet the requirements of theRegulations. Rather it is in indication that something withinthe system is not working as well as it could be, and thataction is needed to have the nutrition and food servicesprogram operate at the optimum standard. If an audit resultis unacceptable, the underlying reasons must bedetermined by reviewing the overall system includingpolicies and procedures, tools for care, staff training andeducation and consultation with staff members. Whenassessing problems, be sure to identify their cause, ratherthan recording signs observed. Based on the informationgathered, corrective action should be documented andimplemented for each specific problem identified. After adefined period, the audit should be repeated to evaluate theeffectiveness of the corrective actions. Follow-up mayindicate that another approach to resolving the problem maybe necessary.You may also want to consider doing the optional auditsavailable in this manual.What Tools are there to FacilitateCompliance with the Regulations?All licensed adult residential community care facilities areexpected to comply with all requirements of the CommunityCare and Assisted Living Act and its associated regulations.These standards are intended to promote consistency ofservices throughout the province. Contact your locallicensing office if you would like to discuss theserequirements with your regional licensing staff. Unofficialcopies of the Community Care and Assisted Living Act andassociated /02075 01.htm)are available online. Official copies may be ordered fromCrown Publications (http://www.crownpub.bc.ca).3

In addition to these, other relevant policies, legislation andregulations include:generate the same information as that in the audits of thismanual. For these and similar instances, contact yourregional licensing staff for more information. Accreditation standards (where applicable) Workers Compensation Act and the OccupationalHealth and Safety Regulations (i.e. for healthcare) Professional regulatory acts Environmental protection (e.g. food safety) Medical and mental health acts International Organization for Standardization(ISO Standard

Role of the Supervisor of Food Services Role of Food Handlers Role of Nursing Role of Interdisciplinary Team The Audit Program Frequency of Nutrition and Food Service Audits Summary of Nutrition and Food Service Audits Glossary of Terms Chapter 2: Nutrition Care Plans Nutrition Care Planning

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