atx32 - "keep off the dietary 'hot' plate"

Donna M. Manring Innovative Dining Solutions 608.225.0126

Keep Off The Dietary Hot Plate Donna M. Manring

Innovative Dining Solutions

Nothing stops an organization faster than people who believe that the way you worked yesterday is the best way to work tomorrow. Jon Madonna Leadership would be easy if we didn’t have to deal with people! What is Leadership Leadership is a process by which a person influences others to accomplish an objective and directs the organization in a way that makes it more cohesive and coherent. Human Conflicts in Leadership

Inconsistency

Dishonesty

Inflexible

Afraid to make decision

Poor communicator Human Conflicts in Leadership

Self-centered

Lack of trust

Unrealistic expectations

Doesn’t share recognition

Refuses to admit errors

Doesn’t listen

Lacks enthusiasm

Lacks respect for others Change Agents

You are the change agents.

People don’t want to hear cheerleading or corporate hype. Resistance to Change 80% Are Resistant to Change. Change creates a natural disconnect.

When addressing change; keep the conversation in the room not outside in the halls.

Give a positive, upbeat speech and then ask if there are any questions.

No one responds “in the room”. That’s where the negativity and fear is.

Change Template for Leaders

Stress the urgency.

Why do you have to make the changes;

Loss of customers

Decreased satisfaction

Address concerns and fears.

Present the challenges at the beginning not just the advantages.


Concerns and Values

Talking about the most perceived concerns will help alleviate the problems.

Talk about what is not going to change to preserve the value. Fierce Conversations

Failed or missed conversations.

The challenge with leaders is not having conversations to build relationships.

What Did They Say

Listen to learn.

Let silence do the heavy lifting.

Jim Sorenson

Hearing is a courtesy.

Listening is a compliment. Key Steps in Problem Solving

Identify the issue

Clarify the issue

Determine current impact

Determine future implications

Examine personal contribution to the issue

Describe the ideal outcome

Commit to action Communication

Listen before reacting

Create communication systems and tools

Use open ended questions Communication and Training-Appreciative Leadership

Focus on the behaviors you want more of, be specific

Focus on the results

Shift your thinking to appreciate what is going right New Ideas

Welcome new ideas.

Abolish the “this won’t work way of thinking.”

Can’t be done

This is stupid

Listen and process new ideas. Forward thinking

We did it this way for years Job Well Done

We all seek affirmation of a job well done.

Thank staff or employees for progress.

Verbal rewards are cheap and go far.

Keep the positive attitude cycle going.


Positive Work Environment

Eliminate negativity from the workplace.

Establish the “no dumping policy”.

Sharpen your positive way of thinking.

Positive energy is contagious.

Provide consistent coaching on keeping it positive. Recipe for Leadership

3 parts communication

1 part motivation

10 drops of honesty

Healthy Dash of humor

Immeasurable care

Pinch of creativity

Dollop of enthusiasm

Top with commitment

Mix all ingredients

Serve regularly Time, Money and Budgets

Serving meals that look and taste good does not have to break the budget.

There are many simple changes and additions that can improve the look of foods.

Communication

Communicate your dining vision to everyone including residents and families.

Develop teams that include all levels of management, departments, residents and family.

Develop systems in communicating to keep care plans updated.

Communicate your dining vision to everyone including residents and families

Develop teams that include all levels of management, departments, residents and family.

Develop systems in communicating to keep care plans updated. Plating Tips

If the old adage "you eat with your eyes" is true, then the manner in which we present food is of paramount importance.

There are many factors and techniques to consider in food plating that affect the overall customer experience.

When plating food attractively, it's important to remember the actual plate is critical to the final presentation.

Keys to Food Presentation

Use different textures.

Match flavors-garnish with meal ingredients when possible.

Sauces should complement not cover.

Pay attention to scale-this applies to the plate arrangement as well as garnishes.

Do not overdo it.


Ice Cream - Yogurt

Since ice cream goes with almost anything, keep your eyes peeled for possible toppings (or yogurt/soft serve mix-ins).

Crumbled cookies

Chopped fruit

Cereal

Granola Plating Tips

Piping foods onto plates

Ready cuts

Doilies under bowls or plates

Garnishes

Clean edges

Syrups or sauces Comfort Memories

Mini ice cream parlors

Bistro setting

Café

Deli

Family style

Happy hour Community Chef Events

Solicit chefs in your area to come and give you some ideas on food preparation.

Recruit hospitality experts.

Involve your food purveyors to do food demo’s.

Cruise ship dining. Color Considerations

Always consider color as an important part of plate presentation.

Always try to have a variety of colors on the plate.

People respond to certain colors more favorably than others. Color is Important With Vegetables

Blanching and refreshing green vegetables ensures they are fresh and vibrant when served

Always complement green vegetables with other colored vegetables such as carrots, sweet peppers and beets

Avoid clustering vegetables and arrange them more naturally around the plate to increase the contrast in colors

Eight Keys to Food Presentation Use complementary colors-avoid too much of the same color.

Arrange the food in interesting manner.

Use interesting shapes and garnishes-consider different shape options for each food.

Use different cuts and shapes of vegetables to add visual interest


Food presentation: Make Meals Look Festive and Inviting

Colorful meals: Using small amounts of contrasting colors, pleases our eyes.

Add some bright green herbs or some yellow frozen corn to a dish of black beans or lentils and save some to sprinkle on top for a garnish.

Cut some orange carrots and red tomatoes or peppers on a dark green leafy salad. To Enhance Flavor:

Lemon juice on grilled fish

Sesame oil, low-sodium soy sauce on

vegetables

Low-sodium chicken broth in rice

Peppermint slivers on fruit salad

Fresh berries on cereal with strawberries

Kick Up the Flavor

Try marinating or adding extra sauces or seasonings while cooking. These may add a little "spice" to the food and enhance the flavor.

Using tart foods such as sherbet, orange juice, lemonade, relishes, vinegar and lemon juice as seasonings may help intensify flavor

Marinades

Barbecue Sauce

Meat Marinade

Beer

Mustard Catsup

Soy Sauce

Extracts and other flavorings

Sweet & Sour Sauce

Fruit

Sweet Fruit Juice Herbs & Spices Sweet Wines

Italian Dressing

Teriyaki Sauce

Mix and Match Spicing up meals can be as easy as adding salsa to cooked meat.

For the "Mix and Match" theme, try adding salsa to cooked beef or chicken. Toss lightly to coat.

Then serve the meat with tortillas or taco shells. You have an instant Mexican meal.

For extra flair, serve a salad on the side.

Cooking Tips

Add low-sodium, no-salt stock to a sauce to make it taste like it has been simmering all day.

Cook rice in chicken or vegetable stock rather than water, and replace cream with stock when making mashed potatoes for a flavorful, low-fat alternative.

Spice Up Your Menu

Fresh herbs brighten the flavor of salads, dressing and sauces.

Add chopped basil to tomato soup.

Add parsley and thyme to chicken soup.

Loaded mashed potatoes.

Grilled cheese with tomatoes, or a variety of cheeses.

Add veggies to macaroni and cheese


Centers for Disease Control & Prevention

The Centers for Disease Control and Prevention (CDC) estimates;

Each year roughly 1 in 6 Americans (or 48 million people) gets sick from foodborne illness.

Of these, approximately 128,000 are hospitalized, and 3,000 die of foodborne diseases

These estimates, most recently updated by the CDC in 2011 Elderly at Greater Risk

The CDC Foodborne Disease Active Surveillance Network states that the deaths “from foodborne illness among nursing home residents are 10 to 100 times greater than for the general population

The CDC Foodborne Disease Active Surveillance Network states that the deaths “from foodborne illness among nursing home residents are 10 to 100 times greater than for the general population

Norovirus Striking Nursing Home Residents Nationwide

According to a spokeswoman for the U.S. Centers for Disease Control and Prevention (CDC), “It appears that there is an upswing.”

The virus is highly contagious and can be transmitted through close contact with infected people or by eating contaminated food.

Hand washing and good sanitation are recommended to prevent the virus from spreading. Growing Senior Population

As the senior population grows, those who reside in residential care facilities will increase, resulting in a greater numbers of seniors at risk for foodborne illness.

The person who manages the foodservice plays a vital role in protecting the residents in their care from foodborne illness.

Sanitation Citations

In a study released in 2011 by the University of California, San Francisco, nearly 40 percent of nursing homes had deficiencies in Food Safety and Sanitation (F 371) in 2009.8

Foodborne illness in the population we serve is a very important issue to address. The Perfect Storm

Presence of a pathogen (bacteria, viruses, or parasites) in the food

Food to carry the pathogen

Conditions that allow the pathogen to survive, multiply, and produce a toxin

High-risk person who eats enough of the pathogen or its toxins to cause illness Decreased Immunity

Our immune systems experience gradual changes as we grow older.

Those changes include a slower immune response and decreased immunity against pathogens. Our gastrointestinal tract becomes more easily inflamed as we age.

As a result, we become more susceptible to a variety of foodborne illnesses, particularly such pathogens as Salmonella and norovirus.

Increased Risk Factors

The elderly often have;

Chronic disease

A slower digestive process, reduced sense of taste and smell

Decreased effectiveness of antibiotics


Complications from Foodborne Illness

The elderly are more likely to contract and die from infectious disease than other groups.

Often it isn’t the disease itself that causes death, but the symptoms or other effects of the illness.

According to the CDC, people over 74 years of age are five times more likely to die from infectious diarrheal disease than in the next highest group (children under four years of age). They are also 15 times more likely to die than younger adults

Foodborne Roulette

Approximately one of four Americans may experience some form of foodborne illnesses each year, according to Centers for Disease Control and Prevention

Challenges in Monitoring Illness

Public health challenges in monitoring foodborne illness include a rising number of multistate foodborne outbreaks and new types of contaminated foods.

Many individual cases of acute gastroenteritis are not reported

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Factors for Increased Illness

Including the facts that many seniors are on antibiotics that kill beneficial bacteria

Long-term care facilities are confined environments where pathogens can spread easily. Who Comes in Contact with Food

A food handler is anyone that comes in contact with the food in any part of their duties. Every food handler has the obligation to avoid contamination of food;

________________________________ ________________________________

________________________________ ________________________________ Do Employees Have a Responsibility to Prevent Foodborne Illness?

Yes, food employees share the responsibility with management for preventing foodborne illness and are required to know:

The relationship between their job responsibilities and the potential risks of foodborne illness;

How employee health is related to foodborne illness;

The need to immediately report symptoms of vomiting, diarrhea, jaundice, sore throat with fever. Food Poisoning

Food poisoning is a general term for health problems arising from eating contaminated food.

Food may be contaminated by bacteria, viruses, environmental toxins, or toxins present within the food itself, such as the poisons in some mushrooms.

Symptoms of food poisoning usually involve the prompt onset of vomiting and diarrhea. Some toxins also affect the nervous system.

Spreading Germs

Cooked foods can also be contaminated after cooking by bacteria carried by food handlers or from bacteria in the environment.

It is estimated that 50% of healthy people have the bacterium Staphylococcus aureus in their nasal passages and throat, as well as on their skin and hair.


Ways Food Can Become Contaminated

Poor Personal Hygiene

Leading cause of foodborne illnesses

Improper handwashing

Dirty work clothes

Temperature and Time Abuse

No more than four hours in the danger zone

Cleaning and Sanitizing

Commonly Missed Areas Survival 101

Stay in shape. Inspectors and surveyors are trained to focus less on what you are doing the day they walk in…and much more about what you do every day.

As a manager, you already understand that food safety is a commitment every hour of every day. But do your employees know that, too?

You can be sure inspectors will look for evidence of routine food safety management;

—documentation up-to-date

Policies and procedures

Temperature logs

Infection control records

In-service training rosters

Equipment maintenance records. Train and Coach Staff

If someone on your team doesn’t know the answers, you can bet they are not carrying out the practices either.

One routine you can implement is asking questions of employees, just as inspectors often do.

Training, of course, is more than acquisition of knowledge. Its real goal is behavior. Map Out the Flow of Food

Because all food is potentially hazardous, it is important to establish a food safety program that prevents, eliminates, or reduces the risk of food contamination at each point in the flow of food.

The flow of food is the route food takes from the time it arrives at the facility until it reaches its final destination as part of a meal or snack.

Steps in the flow of food for in-house production

Purchasing

� Receiving

� Storing

� Preparing

� Cooking

� Holding and Serving

� Cooling

� Reheating

Passing


Homework

Identify and write standard food handling practices for each point in the flow of food.

Keep Up to Date

Read your state agency’s newsletter and/or agency meeting minutes, many of which are posted online.

State agencies sometimes issue meeting minutes and/or memos clarifying interpretations of highrisk practices, such as dishwashing sanitation, refrigeration temperatures, and handling of hazardous food products. (Try searching your state name plus “department of aging”.)

You can also check the Nursing Home Compare website (www.medicare.gov/NHCompare) to see what health issues have been cited recently in your area.

Sample Questions

When do you need to change your gloves?

What temperature should the baked fish be before it goes to the buffet?

What is the procedure for thawing frozen chicken?

Try writing these on colorful 3 X 5 cards and have each work team pick a card from a hat every day.

Let them practice answering questions and coach each other with the help of a qualified supervisor. It’s a fun way to reinforce knowledge while preparing everyone for real interviews

Active Learning

Learning is not a spectator sport.

The more actively engaged the learner is, the more learning takes place.

Different instructional methodologies have greater rates of retention. Increase Learning By

Quiz

Games

Role-playing

Brainstorming

Group problem-solving

Lecture

Simulation

Case Study

Training Employees is a Forever Job.

Typically employees most likely handle food at work the same way they do at home.

Some employees do not bring safe food handling practices to the job, and habits are hard to change.

Cross Contamination

From hands to unclean surfaces is one of the leading contributing causes of the spread of pathogenic organisms

Eliminate bare hand contact with RTF

Proper hand washing

Hand sanitizers do not take the place of hand washing in the kitchen with food preparation Training Employees is a Forever Job

Centers using employees to work in more than one area (for example, personal care and food service) must train these individuals on safe food handling practices to prevent cross-contamination of foods.


Tips To Increase Food Safety

Ensure food safety starts at menu planning.

What PHF foods do you serve?

What PHF foods will you be serving in the future?

What are the risks in your facility?

Is everyone in your facility trained on risks?

Talk to high-risk patients about food safety. Together We Keep Foods Safe

Despite the focus on that short and stressful timeframe when inspection teams enter your operation’s doors, the reality is that food protection requires daily, concerted effort.

With commitment and leadership, you and your entire team can be ready to survive any day of the year!

Interview-Survey

During the course of the survey, interview the staff who performs the task about the procedures they follow to procure, store, prepare, distribute, and serve food to residents.

• 42 CFR 483.35(b), F362, Standard Sufficient Staff to Determine if the facility employs sufficient support personnel competent to carry out the functions of the dietary service.

Survey Observations

Provision of meals that are not consistent in quality (such as color and texture of vegetables or meats, the preparation and presentation of mechanically altered foods.

Determine if each resident is provided with nourishing, palatable, attractive meals that meet the resident’s daily nutritional and special dietary needs.

Survey Objectives

To determine if the dining experience enhances the resident’s quality of life and is supportive of the resident’s needs, including food service and staff support during dining.

General observations of the dining service/dining room. Dining Room/Meal Times

During the meal service, observe the dining room and/or resident’s room for the following:

Comfortable sound levels

Observe for institutional medication pass practices that interfere with the quality of the residents’ dining experience.

Is Your Facility Ready For Survey

Ask yourself if you have systems in place to protect your residents & your facility?

What can you do to improve?

There is not a better time to be in our field. Make the survey process work for you. Train and Coach Staff

Look for evidence.

If you continuously train and coach your work team, your operation will be in a stronger position to survive inspections.

If someone on your team doesn’t know the answers, you can bet they are not carrying out the practices either.

One routine you can implement is asking questions of employees, just as inspectors often do.


Major Food Safety Subject Areas

Personnel

Food

Equipment, facilities, related supplies

Compliance & enforcement

5 Identified Major Risk Factors

Poor personal hygiene

Improper holding temperatures

Inadequate cooking:

Such as undercooking raw shell eggs

Contaminated equipment

Food from unsafe sources Take a Breath & Apply Common Sense

While an inspector or surveyor is on site, it’s easy to overlook the obvious.

Keep tabs on the team, and correct any concerns on the spot as possible.

Always have your thermometer and your food safety records ready. Conduct Mock Audits

A mock audit is the perfect routine for keeping your operation in shape day in and day out.

Involve your team, rotating who plays the role of “inspector”.

This builds familiarity and buy-in from the team.

Audit forms should reflect the guidance you are accountable for. Have fun With Practice Interviews

Create interview questions for associates.

When do you need to change your gloves?

What temperature should the baked fish be before it goes to the buffet?

What is the procedure for thawing frozen chicken?

Try writing these on colorful 3 X 5 cards and have each work team pick a card from a hat every day.

Dietary Out of the Kitchen

The people who were always on the serving line, always making up trays, now get into the dining room and actually meet people

Many homes have brought the kitchen staff out of the kitchen, with many stories of relationships forming and staff members realizing things like, “Why would we serve that to Mary? She doesn’t like it; never has.”

Mission or Vision

Creating Team Vision

Propose possible visions to get people going and have the team build on the vision.

After you have decided on a vision print it and post it. Make sure everyone sees it every day. The more they see it the more they will absorb it.


Department Vision

Does the department “get it”?

Is this a mission people can buy into? The team as to be on board for the mission to work. Establishing a Management Mission Your management mission statement will need to provide the team with: 1. Support 2. Fair leadership 3. Training with day to day coaching 4. Goals for the future Teams as Partners

Your team members are your partners in business, challenges and successes.

Team members should have a clear understanding of how the financial statement works.

Teams need to clearly understand profit and loss.

Motivation & Empowerment

People have to have a reason for what they do. We can impact the reason.

Treat team members as you do your boss. Eliminate or limit the term employee. Determine the Motivators for Your Team:

Money

Status

Just because I have to

Get In Touch

If staff or residents have an attitude, what is the attitude really about

Go beyond the anger or hostility

Think with your head and your HEART

Find the connection Inspire and Transform

People must be inspired to change before a transformation can take place

Key factor=making the connection

Identify what the client/staff triggers are to initiate the transformation Building Great Teams

Recruit and hire team players that share your vision.

Train and develop, coach and support the team.

People who feel good about the job they are doing are productive and creative.

Provide career development. Anyone Can Coach

Develop a team of coaches.

Everyone can be accountable for outcomes.

Coaching identifies problems and discovers solutions.


Benefits Of Humor

Humor reduces stress.

Increases productivity.

Humor eases tension.

Relieves boredom.

Breaks up the negative cycle.

Profits increase.

Keep energy high and create fun ways to get the job done. Successful Leaders

Try to hire potential successful leaders

Train your team to think like leaders

Learn to delegate Teach By Example

To be a leader you have to inspire, not control and then allow transformation.

Leaders constantly “coach” and fuel the process.

Attitude and actions are contagious.

Never set a rule that you yourself are not willing to follow. Leaders on all Levels

Leadership can be anyone that impacts others.

Successful leaders develop other leaders on every level.

Performance coaching and leading results in successful teams. WIFM

Try to use beneficial language that highlights the benefits to the individual while remaining realistic.

Throughout, ask the other person for their input into the task and objectives. The sooner that you empower the person in the shared responsibility of the task the more likely their motivation will increase

IKT or IDC New Ideas

Welcome new ideas.

Abolish this won’t work way of thinking.

Can’t be done

This is stupid

Listen and process new ideas.

Forward thinking

We did it this way for years Good Job

Thank you with continual affirmation for a job well done is an integral part of keeping the momentum going.

The ability to retain a good team could very well be one of your most important skills as a manager. Keeping team members satisfied will keep them from looking at other opportunities elsewhere.


Did They Hear What I Said

Everyone has a perception of what they thought they heard.

Communication is the number one tool in problem solving and having an aligned culture

Keep the lines of communication open. Positive Work Environment

Eliminate negativity from the workplace.

Establish the “no dumping policy”.

Sharpen your positive way of thinking.

Positive energy is contagious. Leadership Deals With

Change

Inspiration

Motivation

Influence

Allows for transformation SMART Goals

Specific

Measurable

Action Steps

Realistic

Timely

Mean What You Say

Authentic

Sincere

Speak forthrightly

Honest

atx32 - "keep off the dietary 'hot' plate"

Self Improvement