Culture Change and Dining and Regulatory Compliance

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1 Culture Change and Dining and Regulatory Compliance Carmen Bowman, MHS Regulator turned Educator EDU-CATERING Catering Education for Compliance and Culture Change in LTC

2 Culture Change and Dining Person-centered care Person-directed care Resident-driven driven care Choices Dignity Quality of Life Normalcy

3 Portion Sizes Menu items Scoop sizes Bottom line: per person through your assessment process

4 Buffet Dining

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6 Mullen Home Buffet Dining

7 Holly Care Center Holly, CO

8 Life Care of Greeley Daily Buffet at Each Meal

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10 Dessert Cart Infection control Choice

11 Display Cooking Mullen Home of Denver An artful, entertaining way of cooking. The chef prepares the food in the dining room as residents watch this entertaining event. JIT: Just in Time Cooking

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15 Buffet Service Regulations Tag 371 Food temperatures Tag 364 Palatability/Time left on steam table Tag 441 Infection control

16 Family Dining

17 Mullen Home of Denver Family Style Dining

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22 Family Dining Regulations Tag 371 Food Temperatures actually better than you may have thought Tag 441 Infection Control Residents able to serve selves/receive necessary assistance Tags 311 and 312 Choice

23 Salad Bars

24 What s wrong with this picture?

25 Rowan Community Salad Bar

26 Salad Bar Design Fairacres, Greeley Noon Meal Response to Food Committee ideas more salad Two protein salad choices Staff encourage residents to make well-balanced choices Potato/Macaroni salad choice Bread choice for sandwiches

27 Salad Bar Regulations Tag 371 Food temperature Tag 441 Infection control

28 Unique Snack Offerings Holly Care Center Activities refrigerator stocked with menu items Nursing staff prepare simple menu items for residents from 7:00 p.m. to 5:OO a.m. SNACKER S MENU: GRILLED CHEESE PRE-MADE MEALS CEREALS

29 Snacks Freely Available Pueblo ECF

30 Exempla CO Lutheran Home Arvada Open Snack Bar Refrigerator Rights

31 Snack Availability Regulations Tag 242 Choice versus risk Supervision to prevent accidents Tag 324

32 Baked goods in living environments Lots of benefits Issues: watch safety

33 OPEN KITCHEN Valley View Care Center, Canon City Kitchen open from 6:00 a.m. to 6:30 p.m. Closed only during activities Meals and snacks served all day long

34 General Snack Regulations Tag 368 Snacks must be offered at bedtime. Residents asked in Resident Interviews Documentation can show evidence

35 The Chateau Assisted Living Residents Preparing and Serving Snacks

36 Residents Preparing Food Regulations Good infection control practice Tag 441 Perhaps supervision Hand washing Tag 444 Practice more important than gloves

37 Special Events

38 Dew Drop Bar & Grill Night Holly Care Center Every 2 nd Thursday Special menus Live band Beer and wine coolers Residents invite community members

39 Annual Vacation Holly Care Center Activities and Dietary staff design a vacation plan The dining room and other areas are transformed every night to reflect the next destination Residents state they feel like they were really on a vacation! KANSAS TENNESSEE MISSOURI

40 Special Holiday Meals Arvada Care Center Residents design menu Residents prepare meal during day Staff wait tables Fine Dining: linen napkins placed in wine glasses, decorations to match theme, theme music Staff dine with residents Monthly basis

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45 Restaurant Style

46 Restaurant of the Month Restaurant theme chosen monthly by the culture change committee Printed menus Managers take resident orders Meal is served in courses

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50 Monthly Restaurant turns into daily Valley View Care Center, Canon City

51 OPEN BREAKFAST 6:00-8:00 am. Eggs cooked to order, breakfast meat, toast or biscuit as well as continental fresh fruit and hot or cold cereal

52 OPEN LUNCH 11:00 a.m. - 1:00 p.m. Mix and match cafeteria style Choice of 2 meats, 2-32 veggies, 2 starches, 2 types of bread and 2 desserts

53 OPEN DINNER 5:00-6:30 p.m. Full menu meal offered Plus Soup of the Day, Sandwich of the Day and Salad

54 Crestview Bethany, MO

55 Exempla Colorado Lutheran Home Arvada Breakfast at 10:00 am! Who would rather be sleeping?

56 San Luis Care Center Alamosa Restaurant Dining

57 Christopher House Wheat Ridge Dining outside Chef Cooks from scratch Resident designed menu

58 Holly Nursing Care 1 st to offer 24 hour dining/café!

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60 Fairacres Greeley Weller s s Bistro

61 Restaurant Style Regulations Tag 242 Choice!

62 Arvada Care Center Daily Breakfast Specials

63 Food Cooked-to to-order

64 Fairacres Greeley

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67 Cook to Order Breakfast Fruit waffles - Tuesday Fruit crepes - Thursday Fruit pancakes - Saturday Breakfast Burritos - Sunday Omelets Mon., Wed., Fri.

68 Cook-to to-order order Regulations Grease laden vapors must be under standard exhaust and fire suppression system (NFPA 96) Any kind of egg if pasteurized Diet consistency Tag 365

69 Continental Breakfast

70 Berkley Manor

71 Continental Breakfast Regulations Tag 371 Temperatures Tag 441 Infection control Tag 365 Food consistency Healthy choices available?

72 Staff Dining with Residents

73 Berkley Manor Continental Breakfast Staff invited to eat with residents

74 Clear Creek Care Center Wednesday Buffet/Staff Dine with Residents

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76 Staff Dining with Residents Regulations Tag 441 Infection Control Assistance needed

77 Dining Service Practices Maitredee Welcome and seat residents Serve beverages Assist with hand washing before and after meals Hostess Offers showplate choices Indicates choice and gives kitchen dietary card Seats residents Writes names on paper placemat

78 Dining Atmosphere Dishware Glassware Tables No more bibs!

79 Shalom Village Overland Park, KS

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81 Valley View Canon City Fiestaware

82 LCC Longmont Real glassware Condiments on table

83 LCC Colorado Springs Real china cups Linen napkins

84 Mullen Home of Denver China ware Lazy Susan

85 Horseshoe tables a thing of the past Replaced with normal tables

86 Rowan Community Sierra Dining Room Quiet/Independent DR In response to resident requests

87 LCC Pueblo Ugly suction machines Now you see it

88 now you don t!

89 Julia Temple Center No bibs!

90 Appearance Changes Valley View, Canon City Cooks wear chef s s coats, black pants and a maroon apron Dietary aides wear white button up shirts, black pants and black aprons No longer to be confused by residents as nursing staff (wore scrubs) Dressed as professional caterers

91 Outcomes Decrease in behaviors Residents well rested Savings in wasted food Savings in supplements Savings on bread when toast is made fresh Savings on paper products when used throughout the day

92 Crestview Bethany, MO

93 Other Dietary Regulatory Issues Dishwashers on households state regs Microwaves on households - safety Coffee availability - safety Small refrigerators in resident rooms food kept safe Animals - kept out of dining rooms during meal times and kitchen

94 Traditions/Not regulations Meal intake records Dietary staff document meal intake instead of nursing staff when cleaning up Meal intake record per day rather than per resident Many homes document meal intake only for those residents at nutritional risk Dietary cards, can be lists, any system Table numbers and name plates

95 Survey Issues Feel free to call the state agency You have the right to explain your story and provide feedback Surveyors are supposed to dialog with you Study the regulations/they don t t belong to surveyors/know them Give the survey team the heads up Inform and educate surveyors

96 Risk You risk deficiencies every time survey takes place in your building. Survey occurs annually. You can continue to provide care in the old way and risk deficiencies or move toward the new way and risk deficiencies EDU-CATERING Catering Education for Compliance and Culture Change in LTC