ltc and al conference call agendafiles.ctctcdn.com/fc8e20e5201/8e439af9-cdff-462a-9a12-44... ·...

LTC AND AL CONFERENCE CALL AGENDA

Tuesday, June 23, 2015 1:00 or 3:00 PT /AZ Time 2:00 4:00 MT 3:00 5:00 CT 4:00 6:00 ET

OR Wednesday, June 24, 2015 1:00 or 3:00 PT /AZ Time

2:00 4:00 MT 3:00 5:00 CT 4:00 6:00 ET

OR Thursday, June 25, 2015 11:00 or 1:00 PT /AZ Time

12:00 2:00 MT 1:00 3:00 CT 2:00 4:00 ET

Call in Number: 1-800-550-8104

Participant ID: 4832756 1. Policies:

a) 59 – Food Storage (AL and LTC) • In the Fresh Fruit section, #4 added a Food Code Reference

i. Produce should be covered if you have Fruit Flies b) 65 – Dining Room Place Setting (AL and LTC)

• Local and State Regulators – wrapping, covering, or inverting cups or glasses c) 159 – Meat Cookery and Storage (AL and LTC)

• Larger meats may require additional cooking time i. Inservice 244 - Thawing Food Properly

d) 161 – Mechanically Altered Diets and Thickened Liquids (AL and LTC) • Tray Card System - new default option, Pudding thick / Spoon thick

e) 225 – Survey Preparedness (LTC)* • Doc 608 – Red Flag Audit and Compliance Survey Readiness Procedure(LTC)* • Most Common Challenges (2.1.15 to 6.22.15)*

i. Posted monthly on CWC / Resources / RES 37 – Red Flag Most Common Challenges

f) RES 48 – How to Calculate Labor Hours for LTC Communities (LTC)* • RD Time Requirement (FORM 611 LTC and FORM 611 AL)*

2. Documents/Forms: a) Doc 603 – Criteria (AL and LTC)

• Updated 06.15 see CWC / Systems / LTC (or AL)

Attached Documents indicated with a “*” All RD Conf. Call 6.15 of 4

• Sanitation section – # 25 clarified hair restraints i. All staff preparing food in the dietary department must wear hair

restraints. Staff coming into the dietary department, i.e. maintenance, should also wear hair restraints. Servers and wait staff should not wear hair covering while serving meals to residents. If staff has long hair, the hair must be restrained with a hair tie or similar restraint to prevent hair from touching the resident’s meal. Staff should avoid touching their hair and face while serving food.

• Nutrition section update (AL Only)* • The Criteria must be used to complete Quarterly Audits

b) Form 526 AL – Meal Inspection (AL)* • Replacing Form 404 AL • Removed bedside temperatures • Added total points section

c) Memo – LTC Reporting* • Submit a report for every visit to a community.

d) Form 601 – Quarterly Report (AL and LTC) • Be sure to include hours on all reports

e) Form 602 – Monthly Report (LTC)* • New Web based and Fillable Forms

f) Form 604 – Nutrition Consultant Report (AL and LTC)* • New Web based and Fillable Forms

g) Form 915 – Additional Hours Pre-approval (AL and LTC)* • Lodging and travel

3. Inservices:

a) Are you talking to your communities about Huddle Inservices? • 164 Total Inservices

i. 41 Huddle Inservices Specific to Consulting ii. 17 Huddle Inservices Specific to Menus

iii. 14 Sanitation - Tip of the Month iv. 5 Clinical - Tip of the Month

b) Sanitation and Clinical Tips are emailed and posted on the CWC under Training / Hardcopy Inservices

c) 115 – Proper Wearing of Gloves • Ready-to-eat foods

4. Menus/CWC:

a) Heart Healthy Diet (DM 16) - (AL and LTC) • Low Fat / Low Cholesterol, Sodium Restriction

b) Encrypted email and Wi-Fi / TrayCard: IDs, communication, disposal c) TrayCard (LTC) / DietCard (AL)


d) CWC • Training: Bi-Monthly CWC webinar • CWC Training Dates added to Community Home Page

• Individual Logins for Communities • Systems: Diet Manual - Posting to CWC

5. Training/Conferences:

a) 2015 Crandall Conference* • Save the Date* • Schedule* • Registration (Community, RD and Corporate Leaders)* • Community Showcase Contest* • Go for the Gold (FORM 707LTC, FORM 709AL and Sunrise FORM 709AL)*

6. Assisted Living Specifics:

a) There were 48 (32 Brookdale) audits submitted in 2nd quarter that were 95% or greater

b) New Divisional Assignment • Michelle Hansen assigned as divisional leader Merrill Gardens

c) Revision of Sunrise RD Performance Checklists • FL, GA, NC, SE and Mid Atlantic updated 9.29.14 • Next checklist to be updated – AZ, CA, CO, KS, LA, MN, MO, NE, NV, OK, TX,

UT & WA d) Web-based audits for OH / VA e) Sunrise Senior Living – Training Conference f) Nutrition Intervention Manual

• Importance of maintaining documentation

7. Management Reminders: a) Jon Williams – New Chief Operating Officer b) Newsletter will be Monthly Alerts emailed and posted on the CWC / System /

Resources c) Options for Decreased Egg Availability

a. Memo and Egg Cookery and Storage (POL 78)* d) CPR Reports (AL and LTC example)* e) Brookdale RD visit exits*

• CCRC - Region 4 Rental Division


8. Clinical Reminders: a) HIPPA Compliance with charting, remote charting b) Expected or unplanned weight loss / unusual body weight c) Obesity

• Dry body weight for calculation of needs • Do not put on weight loss regime unless requested by resident and care plan

d) Dietary MDS 3.0* e) Tube Feedings

• Use calorie count when decreasing tube feeding f) Clinical Charting Handbook updates

• IsoSource formula update memo* • Long Bone Fx – Include calories and protein when using 1.2 factor

g) Heart Healthy Manuals h) Nutrition Intervention Manual

9. Survey Issues

a) Planned weight loss with use of a diuretic b) Nectar thick liquids served thin coffee c) Multiple menu changes with spreadsheet not changing and menu approval d) In charting documentation, note the Root Cause of weight loss e) Consistent decline of intake should be reviewed in NAR f) Ice machine cleaned per manufacturer guidelines g) Food-borne illness outbreak

• Guide for Managing Gastroenteritis Outbreak – POL 113 (AL and LTC)* h) Dietitian Consultation vs. Dietary Consult

10. Questions/Answers:

Attachments: 55 Pages


POLICY

The Dietary Department should always be ready for survey. There are some pre-survey tools that are recommended and that should be used.

PROCEDURES

1. Orientation/Pre-Survey Inservice/Checklist (Form 702) is a checklist to use in trainingthe entire staff in preparation for survey or as a quick overview of the basic standardsrequired in the dietary department. It may also be used as an initial teaching tool for anew manager. A quiz, which is found in the Online Inservice Subscription, has beendeveloped to be administered after the training. Another inservice, Possible SurveyorQuestions, is included in the Online Inservice Subscription to also be given in preparationfor survey. A quiz is provided. Other Inservices recommended to be given in preparationfor survey are the following: Immediate Jeopardy #1, #2, #3, #4, and Possible SurveyorQuestions and Answers.

2. Nine months after the last survey a “Red Flag” audit will be completed in eachCommunity. The call will be made by the Crandall Corporate Leader with theCommunity RD. A Plan of Correction will be generated for the RD to use in helping thecommunity be survey ready. Follow-up calls will be made each month by the CrandallCorporate RD until the community is surveyed. The Sanitation QA (Form 610) shouldbe completed weekly by the Community and a Clinical Chart Audit (Form 128), alsocompleted once in the survey window.

3. The full clinical audit can be done by the RD if additional hours are approved or theclinical manager/DT/DTR can complete it once they have been instructed by the RD onwhat they are to audit.

4. On the Dietitian’s Home Page on the Crandall Web Center, a “Red Flag” Audit willappear showing the RD the results of the “Red Flag” Audits and Plans of Correction.

5. The “Red Flag” reports will drop off the Crandall Web Center once survey occurs.

6. A Survey Checklist (Form 703), included in the Forms and Documents section of thismanual, should be used in checking the Dietary Department once the surveyors arrive.

Refer to Forms and Documents Section: Form 128, Form 610, Form 702, Form 703 or other designated forms

SURVEY PREPAREDNESS

dwilliams

Highlight

dwilliams

Highlight

dwilliams

Highlight

Red Flag Audit and Compliance/Survey Readiness Procedure

Step I: Crandall Corporate Office will set up 9 month Red Flag call on a weekly basis

Step II: Crandall Corporate RD will do the following:

1. Conduct 9th month Red Flag call on a weekly basis.2. At the end of the Red Flag call, recommend (if necessary) follow-up

calls: 10th, 11th, 12th month and 13th-15th months where needed3. At the end of the Red Flag call, determine if a thorough Compliance/

Survey Readiness call is needed and schedule accordingly.

Step III: The Crandall Corporate Office will summarize the Red Flag calls for the week and review with Crandall CEO or COO. Upon approval, the summary of the Red Flag call will be sent weekly to the following:

1. Appropriate Corporate Leaders2. Linda Crandall, CEO3. Jon Williams, COO4. Divisionals5. Regionals6. Compliance RD’s7. Will be posted on the CWC RD page and also under Red Flag Audit

Report

Step IV: The responsible Regional and Divisional Dietitian noted in the Red Flag Summary report may (if requested) call the Community RD and help them with their corrective actions.

Step V: When it is determined that a site visit is required as follow-up to the corrective action, the Compliance RD will be called upon to fulfill this requirement.

Step VI: Mock Survey Reports should be completed by the Compliance RD’s and forwarded to Crandall Corporate Dietitians. Compliance RD should email and report the visit to Divisional, Regional, Linda Crandall and Jon Williams. “Red Flags” in Mock Surveys should be elevated to a phone call to Linda Crandall.

Step VII: On the Monthly Divisional/Regional Management Team calls the Red Flag Summary report will be reviewed as well as the Mock Survey results.

Doc 608 LTC – Red Flag & Compliance (4/15) Page 1 Copyright © 2015 Crandall Corporate Dietitians

dwilliams

Highlight

dwilliams

Highlight

dwilliams

Highlight

dwilliams

Highlight

dwilliams

Highlight

dwilliams

Highlight

dwilliams

Highlight

Most Common Challenges

February to June 2015

Section Group Item

Count (%)

Staff Development QA's not done: Sanitation weekly

50 (41.7%)

Staff Development QA's not done: Meal Inspection at least 3 times per month 48 (40%)

Staff Development QA's not done: Satisfaction Surveys QTR

45 (37.5%)

Staff Development QA's not done: Dining Room Monitor and Room Tray Monitor done on each DR at least once per month

43 (35.8%)

Nutritional Assessment

Nutritional Systems not in compliance: Chart Audit is done quarterly or at least pre-survey

37 (30.8%)

Sanitation Storage of food not correct in these areas: Labeling, dating, use by dates

35 (29.2%)

Sanitation Temperature records are not current and accurate on the following: Refrigerators/Freezers in all units with resident food

33 (27.5%)

Meal Service Meal Service systems not in compliance: Spreadsheets on trayline and followed

33 (27.5%)

Staff Development Competency Checklists not correct: Managers completes on all employees

33 (27.5%)

Staff Development Competency Checklists not correct: RD completes on Managers

31 (25.8%)

Sanitation General Sanitation not meeting standards in: Main Kitchen 30 (25%)

Staff Development Staff Development Systems not in Compliance: Inservices up-to-date 30 (25%)

RD TIME REQUIREMENT FORM LTC

Itemized Tasks Estimated Time Needed

Actual Time Spent

1. Entrance and Exit Meeting with Executive Director orAdministrator, Dietary Director, DT, DON (copy of reportto all attending)

30 min – 1 hour

2. Review/Chart on all referred residents in priority order

a) Pressure Ulcers (Check against weekly skinreports)

b) Weight Variance (gradual, weekly, 1 month, 3month, 6 month – check against calculations orcomputer printouts)

c) Tube feedings / TPN / Ventilator (get list fromcomputer or from DT)

d) Abnormal labs / Dialysis / Dehydratione) Initial Assessmentsf) Annual Reviewsg) Change in Condition Reviewsh) < 90% of IWR if noted at riski) Eating < 50% × 1 week (If estimated calorie needs

are greater than 50% of meals)j) Quarterly Reviews if high risk or required by your

state

If DT has completed charting:

* 15 – 20 min perreferral

___ min x ___ referrals

= ____ time needed

* depends on skill ofDT

If RD does all charting:

30 – 45 min per referral


= ____ time needed

3. Review current clinical recommendations with DON orADON and DM or DT and give copies to them 15 - 30 min

4. Review previous clinical recommendations and actionplans specified on last consultant report and assure followthrough

15 - 30 min

5. Inservice quarterly, monthly for LifeCare 30 – 60 min

6. Complete Quarterly Report in January, April, July, andOctober 3 – 4 hours

7. Complete Monthly Report in February, March, May, June,August, September, November, and December 1 ½ – 3 hours

8. Other:

Total Actual Time per community

Name of Community: Census: # of admits # of high risks

Type of Community: Typical LTC Rehab

Other Specialty Unit: RD:

Form 611 LTC (05/13) Copyright © 2013 Crandall Corporate Dietitians

Form 611 AL (05/13) Copyright © 2013 Crandall Corporate Dietitians

RD TIME REQUIREMENT FORM AL

Itemized Tasks Estimated Time Needed

Actual Time Spent

1. Entrance and Exit Meeting with Executive Director or Administrator, Dining Director, Health Care Coordinator (copy of report to all attending)

30 min

2. Chart on all referred residents in priority order:

a) Weight Variance (gradual, weekly, 1 month, 3 month, 6 month – check against calculations or computer printouts)

b) Pressure Ulcers c) Hospice/Consult d) Dialysis & Tube feedings e) Poor po intake / Decreased intake due to

medications f) Therapuetic Diets (OH/VA/MS)

15 – 20 min per referral


= ____ time needed

3. Review current clinical recommendations with Health Care Coordinator and Dining Director and give copies to them 10 min

4. Review previous clinical recommendations and action plans specified on last consultant report and assure follow through

15 min

5. Inservice quarterly 20 – 30 min

6. Complete Quarterly Report by: March 15th for 1st quarter June 15th for 2nd quarter September 15th for 3rd quarter December 15th for 4th quarter

1 ½ – 3 hours

7. Other:

Total Actual Time

per community

Name of Community: Census:

Type of Community:

Typical AL Personal Care

Independent Living Other RD:

Memory Care / Reminiscence

5. NUTRITIONAL ASSESSMENT

Charting/Follow Up, Per Referral: 1. Dining Service Director or designee visits newly admitted residents timely to obtain dining

preferences / Preferences documented on Diet Board or in Diet Book.a. Within 72 hours of admission, the Food Service Director visits resident and obtains food preferences.b. These preferences are noted on a master serving list or the Dietary Interview (FORM 101 AL) or on

diet board or in a diet book.c. Resident preferences must be honored.d. Height obtained upon admission and per Corporate Policy thereafter.

Scoring: All items in compliance = 3; 1 item out of compliance = 2; Any item out of compliance = 0;Repeated problem = -1

2. Dietitian Referral Lists completed and provided to RD / Initial assessments completed per referral.a. Check Dietitian Referral List (FORM 151 AL) for Initial assessments referred to the RD.

Note: If the community does not have the referral form ready, the dietitian should complete the formon this visit and provide instructions to the nursing or designee on how to complete the form for the next visit.

b. RD to complete Nutrition Assessment (FORM 103 AL).c. Additional comments to be indicated on Dietary Progress Notes (FORM 101).

H Scoring: All items in compliance = 3; Any item out of compliance = 0; Repeated problem = -1

3. Weights Assessed per Corporate Policy and State Regulations.a. Residents weighed monthly, if corporate policy or regulation.b. Residents living in memory care should be weighed at least monthly.c. Reweighs are obtained on those residents that have +/- 5 lbs variances or per corporate policy.d. Insidious weight changes should also be assessed by the dietitian.


4. High Risk residents charted on per referral: Wts / PU / TF / Dialysis / Labs / poor intake.a. Check FORM 151 AL for a list of residents with weight loss/gain, pressure ulcers, TF/TPN, dialysis,

abnormal labs and poor PO intake.b. These high risk residents should be charted on FORM 103AL or on a Dietary Progress Note (FORM

100). c. Significant weight variances are 2% in 1 week, 5% in 30 days, 7.5% in 90 days and 10% in 180 days. In

addition, insidious weight changes should be assessed. Note: If weight change percentage is not calculated, assist the community in calculating the

percentages so that residents with significant or insidious weight changes are identified and interventions put in place.

d. Residents on hospice, if referred, should be assessed by the dietitian with nutritional concernsaddressed.

e. The RD must review and assess each of these residents.


Doc 603 Criteria – Nutritional Assessment (6/15) 18 of 19 Copyright © 2015Crandall Corporate Dietitians, Inc.

5. Per referral, Resident Service Plan current, with appropriate problem, goal, approaches, as available. a. On every chart that the RD reviews, the Service or Care Plan should be checked for current status and

appropriateness of problem statement, goals and approaches. Recommendations for Service Plan updates should be provided to nursing or designee. Note: Nursing or designee is responsible for updating Service Plans. The dietitian may update the

Service Plan if requested by community or corporate leader. b. Make sure all high risk residents that are referred to RD have a Service or Care Plan, i.e. weight

loss/gain, pressure ulcers, TF/TPN, dialysis, abnormal labs, and resident scoring high risk for weight loss/gain, dehydration, pressure ulcers and residents receiving hospice care.

c. On every chart that the RD reviews, physician ordered supplements appear on the Medication Administration Records (MARS) and the resident is accepting them.


6. Recommendations promptly followed up on / Diets liberalized per Corporate Policy.

a. Dietary Recommendations (FORM 107AL or FORM 111) should have been made per Best Practice Guidelines and implemented with a physician’s order within 72 hours of recommendation. Check to be sure there are no outstanding, overdue recommendations. Nursing should return recommendation form indicating follow-up within 72 hours. Dietitian Fax Consultations should be completed on Dietitian Fax Consultation (FORM 127). Note: For Assisted Living, most corporations prefer the RD write Service Plan update recommendations on a Dietary Recommendation (FORM 107 AL or FORM 111).


Doc 603 Criteria – Nutritional Assessment (6/15) 18 of 19 Copyright © 2015 Crandall Corporate Dietitians, Inc.

MEA

L IN

SPEC

TIO

N

Dat

e:

M

eal i

nspe

cted

:

Tim

e m

eal s

erve

d:

C

hef:

Tim

e la

st m

eal s

erve

d to

resi

dent

: Se

rver

s:

Not

e: M

eal I

nspe

ctio

n to

be

done

1 b

reak

fast

/ 1

lunc

h /

1 di

nner

per

mon

th

S =

3 pt

s

U =

0 p

ts

(Tot

al P

oint

s A

vaila

ble

45)

S =

6 pt

s

U =

0 p

ts

(Tot

al P

oint

s A

vaila

ble

= 60

)

Food

s Se

rvin

g Te

mps

Ta

ste

App

eara

nce

(Gar

nish

) D

iet B

oard

A

ccur

acy

with

D

iet B

oard

D

iet B

oard

A

gree

s w

ith D

R

1.O

ne re

gula

r col

d fo

od1.

2.O

ne v

eget

able

hot

food

2.

3.O

ne g

roun

d ho

t foo

d3.

4.O

ne p

uree

d ho

t foo

d4.

5.O

ne e

ntré

e ho

t foo

d5.

TOTA

L PO

INTS

TO

TAL

POIN

TS

(Min

us 2

poi

nts

if no

gar

nish

)

1.Pr

oper

han

dlin

g of

food

s (p

last

ic g

love

s)?

Y

es

No

2.Pr

oper

sco

ops

and

port

ions

of m

eat?

Y

es

No

3.D

oubl

e /

Larg

e /

Smal

l por

tions

acc

urat

e?

Yes

N

o

4.D

islik

es a

nd a

llerg

ies

adhe

red

to?

Y

es

No

5.Pr

oper

am

ount

s of

milk

giv

en to

dia

betic

s,lo

w s

odiu

m a

nd re

nals

?

Yes

N

o

6.C

orre

ct c

ondi

men

ts g

iven

?

Yes

N

o

7.D

id y

ou o

bser

ve e

ach

area

of m

eal s

erve

d?

Yes

N

o

8.D

id y

ou in

terv

iew

(5) p

atie

nts

duri

ng m

eal s

ervi

ce?

Y

es

No

9.Fo

od te

mpe

ratu

re re

cord

ed e

ach

mea

l?

Yes

N

o

Obs

erva

tions

:

Tota

l Poi

nts

Ach

ieve

d /A

vaila

ble:

/

105

Perc

enta

ge o

f Com

plia

nce:

Din

ing

Serv

ice

Man

ager

:

Exec

utiv

e D

irec

tor:

Die

titia

n:

Form

526

AL

(5/1

5)

Cop

yrig

ht ©

201

5

Cra

ndal

l Cor

pora

te D

ietit

ians

DWilliams

Highlight

DWilliams

Highlight

DWilliams

Highlight

DWilliams

Highlight

DWilliams

Highlight

DWilliams

Highlight

Memo To: Crandall LTC Dietitians From: Linda Crandall, Chairman / CEO Date: June 4, 2015 Re: LTC reporting requirements

Recently we received a deficiency in a LTC survey because the RD did not write a report noting the hours of service and also the residents documented on during each visit. In order to prevent this from happening in another community please do the following:

1. Monthly write the Web Based “Dietitians Monthly Report” (Form 602 LTC) and notethe hours in the community and submit to Crandall Corporate Dietitians.

2. If more than one visit is made per month fill out the Web Based “Nutrition ConsultantReport” (Form 604) on the days of each visit, except when a monthly report orQuarterly Report has been written on one of those days. Note the number of hours ofRD service on each visit and submit to Crandall Corporate Dietitians.

3. Quarterly in January, April, July and October, complete Web Based “Long Term CareQuarterly Audit” (Form 601) and submit to Crandall Corporate Dietitians.

4. Keep a * Nutrition Intervention Manual or file from survey to survey with referralforms noting residents the RD has documented on. This is proof of residents seen! Besure the following forms are being used to document residents to be seen by an RD:

a. Nutrition Intervention Request (Form 151 LTC) for New Admits, Initials,Change of Condition and Quarterly.

b. Nutrition at Risk / Quality Indicator Tracking (Form 105) see examples 105A,105B, 105C, 105D and attached policy.

5. Initially you were all given a Monthly Consulting Checklist (Form 608 LTC) to follow.Note number 7 on this checklist for reports that are to be sent to Crandall and given tothe communities. THIS IS NOT A NEW PROCEDURE AND IS MANDATORY.MOVING FORWARD THIS WILL BE TRACKED LIKE QUARTERLY REPORTS.

*A Nutrition Intervention Manual should have been purchased by communities initially,however if you need a new one please contact our corporate office at 1.888.546.3273.

1

CRANDALL CORPORATE DIETITIANSDIETITIANS MONTHLY REPORT FOR LONG-TERM CARE

Community: Concerned Villa (LTC) [Demo Corporation] Community ID: NV-00-0232

Date(s) of Visit: 06/11/2015 Entrance With: Adm / ED Last Survey Date: 04/26/2015

Month / Year: June 2015 Entrance Other: LTC Adm / ED: Joe Smith

Exit With: Adm / ED DM / Clinical Manager: Kate Wilson

Time in Community: 8 Hours Exit Other: Consultant: Darlene Williams

IN MY PROFESSIONAL OPINION AS A REGISTERED DIETITIAN

In my professional opinion as a Registered Dietitian, had federal survey been conducted today, this community would have most likely:

Had multiple or repeat major findings (2 or more "H" items observed)

SUMMARY OF HAZARDOUS CONCERNS AND REPEATED PROBLEMS

SANITATION

# Hazardous concerns identified from Sanitation Section: 2

# of Repeated Problems: 1

NUTRITIONAL ASSESSMENT

# Hazardous concerns identified from Nutritional Assessment Section: 4


MEAL SERVICE / DINING ROOM OBSERVATION / MENU COMPLIANCE

# Hazardous concerns identified from Meal Service Section: 4


STAFF DEVELOPMENT

# Hazardous concerns identified from Staff Development Section: 0


BUDGET CONTROL


MONTHLY AUDIT OVERVIEW NOTE SUMMARY

SANITATION OVERVIEW NOTE

Trayline Leftover policy not posted and staff did not understand the importance of the policy. - Inservice on use of Trayline Leftover Policy - follow policy. (Repeat) Nursing refrigerator temps not recorded on Station I. - Discuss with DON who is to record temperature in Refrigerator in Station Is pantry

MEAL SERVICE OVERVIEW NOTE

Cold food, i.e., milk was not on ice. - Ice down milk cartons to hold temps on trayline Scoops on puree foods incorrect. - CDM check scoops before trayline for accuracy with menu. Resident (Room 100) slouched in wheelchair - hard to eat. One Resident (Room 200) sat 1/2 hour before receiving tray. - Discuss with DON proper positioning of resident and review seating chart for main dining room. Menu was changed 10 times in past week - no documentation of substitutions. - Keep menu changes > 2 per week. Document changes on substitution form.

NUTRITIONAL ASSESSMENT OVERVIEW NOTE

Repeat) Weight loss was not charted on for two weeks after identification. - Weight loss must be charted on within 72 hours of identification.Tracking Forms not used in NAR - need list for RD and record of who was reviewed. - Use NAR Tracking Forms for NAR meeting.One fluid restriction had unlimited fluids at bedside. - Inservice nursing on Fluid Restriction Policy.Bowel Care Program not implemented. - Implement Bowl Care Program.

STAFF DEVELOPMENT OVERVIEW NOTE

Could not find Inservice documentation. - Bring all Inservice documentation up-to-date.Satisfaction Surveys overdue. - Complete the QTR Satisfaction Surveys.

BUDGET CONTROL OVERVIEW NOTE

Supplement budget over by $500 this month. - Complete Inservices 233 - Managing Your Budget and 266 - Maintaining a Healthy Budget

Copyright 2015 - Crandall Corporate Dietitians, Inc. Page 1 of 2 Form 602 - Created: June 12th, 2015 at 9:56am

CRANDALL CORPORATE DIETITIANSDIETITIANS MONTHLY REPORT FOR LONG-TERM CARE

SANITATION

1. General sanitation good / Sanitizing buckets correct / Personal hygiene good / Proper handwashing / No ill associates (S) Satisfactory

2. H Pest control in place with no sign of rodents or insects (S) Satisfactory

3. H Tray Line Leftover policy & Food Code Temperatures available and followed (R) Repeated Problem

4. H All food stored properly / Use by Dates marked / Cooling Monitor form correct (S) Satisfactory

5. H All refrigerator and freezer temperatures correctly recorded / Hazardous Food Temperatures taken and appropriate (U) Unsatisfactory

6. H Meat thawed in refrigerator <= 41° on tray bottom shelf with pull dates (S) Satisfactory

7. H Eggs stored on bottom shelf / under refrigeration <= 41° / Pasteurized eggs used / Eggs cooked correctly (S) Satisfactory

8. Equipment clean and working / Cleaning schedules followed and initialed (S) Satisfactory

9. H Dishmachine temps and ppm correct and recorded (S) Satisfactory

10. H Pots & pans sanitized correctly and recorded (S) Satisfactory

MEAL SERVICE

1. H Menu posted, dated, followed, and on tray line / Diets ordered match menu program (S) Satisfactory

2. Steam table holding time correct (S) Satisfactory

3. H Food temperatures accurate, recorded, and cold food is on ice (U) Unsatisfactory

4. H Portion control equipment used and correct / Production Records used (U) Unsatisfactory

5. Recipes followed for consistencies and therapeutics (S) Satisfactory

6. H Therapeutic diets served accurately / Thickened liquid correct / Diets liberalized / Residents allowed informed refusal of diets (S) Satisfactory

7. H Residents positioned correctly, assisted promptly and properly / Residents allowed choices / Food not served in paper or styrofoamunless requested or on care plan

(U) Unsatisfactory

8. Room trays served in 20 min. / No residents observed sitting without food or fluids while tablemates are eating (S) Satisfactory

9. Alternate posted and offered in 15 minutes (S) Satisfactory

10. When meal and alternates refused, a meal replacement offered (S) Satisfactory

11. H Menu followed with less than 2 temporary changes per week / Changes approved by RD and noted on Substitution Form / ResidentChoice Meal Extended / Disaster Menu available

(U) Unsatisfactory

NUTRITIONAL ASSESSMENT

1. H Initial / QTR / Annual / PPS / MDS assessments current / Care plans accurate and current (S) Satisfactory

2. H Prescreening done with choices noted and high risk screened and assessed by day 3 (S) Satisfactory

3. H Weight variances 1 mo, 3 mo, 6 mo, gradual, weekly calculated, accurate and charted on in 72 hours (R) Repeated Problem

4. H Pressure ulcer reports received weekly, accurate and charted on in 72 hours (S) Satisfactory

5. H Labs received, accurate and charted on in 72 hours (S) Satisfactory

6. H TF / Dialysis accurate and charted on in 72 hours (S) Satisfactory

7. H Recommendations followed up on within 72 hours (S) Satisfactory

8. H NAR meeting held, tracking forms used and minutes taken (U) Unsatisfactory

9. Nourishment / SNP with 2 cal Med Pass accurate and followed / % intake of supplements documented on MARS (S) Satisfactory

10. H Hydration protocol with carts or other system effective / Fluid Restrictions correct (U) Unsatisfactory

11. H Bowel care program in place / Informed Refusal of Treatment Documentation in place (U) Unsatisfactory

12. Where appropriate physician note states: Unavoidable Decline, i.e. weight loss, pu, labs (S) Satisfactory

STAFF DEVELOPMENT

1. Monthly inservice held and documented / RD gives 4 each year (U) Unsatisfactory

2. H Supervisor and Staff reflects adequate training / HIPAA adhered to (S) Satisfactory

3. Competency checklists completed (S) Satisfactory

4. Quality Assurance program current with action taken, i.e. (Meal Inspection/Test Trays) / Dining Room / Room Monitor / ResidentCouncil / Satisfaction Survey / Clinical chart audit / Weekly Sanitation / TFQA / Pre-Survey POC / QTR Report POC

(U) Unsatisfactory

BUDGET CONTROL

1. Spend down sheets current on each category (S) Satisfactory

2. In budget raw food (S) Satisfactory

3. In budget supplements (S-) Needs Improvement

4. In budget supplies (S) Satisfactory

5. In budget labor (S) Satisfactory

Copyright 2015 - Crandall Corporate Dietitians, Inc. Page 2 of 2 Form 602 - Created: June 12th, 2015 at 9:56am

NUTRITION CONSULTANT REPORT

Community: Community ID:

Date(s) of Visit: Last Survey Date:

Month / Year:

Entrance With: Adm / ED

Entrance Other: Adm / ED:

Exit With: Adm / ED DM / Clinical Manager:

Time in Community: Exit Other: Consultant:

NOTES

Consultant Signature:

Copyright 2015 - Crandall Corporate Dietitians, Inc. Page 1 of 1 Form 604 - Created: June 10th, 2015 at 3:44pm

ADDITIONAL HOURS PRE-APPROVAL FORM

is approved to work an additional Dietitian’s Name

hours per [week / month / one time only] for Number of hours Circle One Number of Periods

at beginning on . Community Name Start Date

Administrator’s Signature:

Date:

Form 915 (12/14) Copyright © 2014 Crandall Corporate Dietitians, Inc.

Crandall’s Country Faire

Crandall Corporate Dietitians Hosted by: www.consultingrd.com

888.546.3273 Linda Crandall RD, LD, President/CEO

Presenters: Jon Williams RD, LD, Chef, COO Sue Bair CDM, VP of Staff Development

sCHedULe

8:00 Introduction of the Theme and of Attendees 9:00 Food Festival Events with Meal Service 10:00 A Whole Lot of Happy with Competent Staff 11:00 Imagine a ‘Blue Ribbon’ Sanitation Inspection A-Z 12:00 Lunch – CArnIvAL oF ProdUCts 1:00 requires ‘Catching the Fare Fever’ with Nutrition Compliance (Tic-Tac-Toe) 2:00 engage in a ‘Cake Walk’ by Being in Budget 3:00 Stirrup Some Fun by Having a Deficiency-Free Survey (Jeopardy) 4:00 Blue Ribbon / Go for the Gold Event (Awards)

J O I N U S F O R A CRANDALL

Select which

2015 – 2016 Regional Conference you will be attending:

August 14, 2015 Los Angeles CA

August 28, 2015 Salt Lake City UT

September 25, 2015 Long Island NY

October 16, 2015 Columbus OH

November 5, 2015 Mesa AZ

January 29, 2016 San Francisco CA

February 19, 2016 Orlando FL

March 11, 2016 Knoxville TN

April 22, 2016 Boston, MA

Please Type or Print Clearly: Community:

Name: Title:

Address:

City: State: Zip:

Phone:

Additional Attendees: Name: Title:

Name: Title:

Name: Title:

Name: Title:

For Questions or Assistance, Contact Us: Email [email protected] Phone 888.546.3273

Community Pre-Registration One-Day Conference includes:

Food Festival Events in MEAL SERVICE A Whole Lot of Happy with COMPETENT STAFF Imagine a Blue Ribbon Inspection SANITATION Requires Catching the Faire Fever with NUTRITION COMPLIANCE Engage in a Cake Walk by being in BUDGET

Community Showcase Contest

Carnival of Products

First Attendee $75 =

Additional Attendees $70 each x =

Total Registration Fee: $

Registration fee includes Lunch and Materials

Payment Information

Send form and payment to: -or- Fax to: Crandall Corporate Dietitians 480.291.9136 PO Box 31060 Mesa, AZ 85275-1060

Check Payable to Crandall Corporate Dietitians

Charge: Visa MasterCard

Bill my community

Total Payment: $

Card#:

Exp. Date: V-Code: (3-digit code on back of card)

Name on Card:

Card billing address:

Approval Signature:

mailto:[email protected]


Select which one-day











Please Type or Print Clearly: Name: Title:

Address:

City: State: Zip:

Phone: Name: Title:

Address:

City: State: Zip:

Phone:

Name: Title:

Address:

City: State: Zip:

Phone:


RD Pre-Registration One-Day Conference includes:




Crandall RD no cost Non-Crandall RD or Manager $75 each x =



Payment Information




Total Payment: $

Card#:


Name on Card:


Approval Signature:



Select which one-day











Please Type or Print Clearly: Name: Title:

Address:

City: State: Zip:

Phone: Name: Title:

Address:

City: State: Zip:

Phone:

Name: Title:

Address:

City: State: Zip:

Phone:


Corporate Leader Registration One-Day Conference includes:




Corporate Leader no cost Non-Crandall RD or Manager $75 each x =



Payment Information




Total Payment: $

Card#:


Name on Card:


Approval Signature:


Community ShowCaSe

Contest Details To increase awareness of the need for enhanced dining services, we invite your dietary department to participate in our Community ShowCaSe poster or tabletop contest.

The purpose of this contest is to encourage your dietary department to enhance any aspect of dining services, above and beyond the current standard approach. Qualifying enhancements include any enhanced dining service successfully implemented in 2014, 2015, or yet to be implemented, as long as it is before the submission deadline of 30 days prior to your Regional Conference (see attached schedule). EXAMPLES:

1. Continental Breakfast 6. Creative Snacks or Plate Presentations 2. Restaurant Style Service 7. Resident Involvement 3. All-day Dining 8. Upscale Dining Décor 4. Open or Extended Dining 9. Theme Meals 5. Creative Use of Soup Kettles, Dessert

Carts, Breakfast Carts 10. Selective Menus and/or Always Available

Menu Items

SUBMISSION:

• Email a detailed description of your enhancement(s) 30 days prior to your Regional Conference to [email protected].

• Bring a poster or tabletop display to the conference during registration. • All presentations will be judged during lunch. • Posters or Table-top Displays should include pictures and list key points

of what enhancements were made and how they were implemented.

WINNERS:

Determined by Crandall Corporate leaders in addition to conference attendee votes during lunch.

PRIZES: 1st place - $50 2nd place - $30 3rd place - $20

Winners will be featured in our Crandall Connection Newsletter and on our website www.consultingrd.com

Community: ______________________________________________________________ Submission Date: __________________ Contact Person: __________________________________ Email: __________________________________ Phone: _____________ Showcasing: _________________________________________________________________________________________________ Poster Table-Top Needed for displaying our entry: ________________________________________________________________________________

*COMMUNITIES: A REPRESENTATIVE OF YOUR DIETARY DEPARTMENT MUST BE PRESENT TO WIN*

*DIETITIANS: PLEASE SHARE THIS INFORMATION WITH YOUR COMMUNITIES*

http://www.consultingrd.com/

Pursuit of Excellence - Go for the Gold For Long Term Care Dietary Department of the Year

Community Name: Community ID:

Criteria

(see back for more specific criteria details) Points

Available Points

Achieved 1. Certified Dietary Manager or Completed DM Course or 5

consecutive years as a Director of Dietary 300 _____

2. Score > 90% on Consultant QA Report 75 ea. QTR 300 _____ 3. In Budget for Raw Food, Supplies, Supplements, & Labor 25 ea. mo. 300 _____ 4. Complete Fine Dining and/or Open Dining Program in

place with Resident Choices Honored 200 _____

5. Resident Satisfaction Surveys > 85% Each Quarter 50 ea. QTR 200 _____ 6. Tube Feedings/TPN Appropriately Addressed 25 ea. mo. 300 _____ 7. Unplanned Weight Variance Appropriately Addressed 25 ea. mo. 300 _____ 8. Pressure Ulcers Appropriately Addressed 25 ea. mo. 300 _____ 9. The new Dining Practice Standards implemented 300 _____ 10. Inservices Given Monthly / Staff well trained 25 ea. mo. 300 _____ 11. Deficiency-Free Survey in Dietary Department or 350

Points if Deficiency is on an A, B, or C Level. 500 _____

Total Points Achieved 3300

Award Levels:

Gold – 3135 – 3300 points 95 - 100% Silver – 2970 – 3134 points 90 - 94%

Bronze – 2805 - 2969 points 85 - 89% Platinum - 5 years straight of 100% Gold

Procedure:

1. Dietary Manager must apply 30 days preceding the Crandall Regional Conference. See attached schedule.) • If your Regional Conference is in 2015, your Go for the Gold time period is June 2014 – June 2015. • If your Regional Conference is in 2016, your Go for the Gold time period is January 2015 – December 2015.

2. Administrator and RD must certify points are correct. 3. The Platinum award is earned by those Dietary Departments achieving 100% Gold awards for five or more

consecutive years. 4. Awards will be presented at Crandall Corporate Dietitians’ Regional Conference.

Additional RD Instruction: If any section of the “Go for the Gold” does not apply, place an N/A next to the number and remove the possible points for that section form the total points.

I certify that community and ______________________, dietary manager, have accomplished the above stated achievements and applies for the Gold/Silver/Bronze Award with Crandall Corporate Dietitians. Dietary Manager: ________________________________ ___________________________________ Date: __________________ Print Signature Administrator: __________________________________ ___________________________________ Date: __________________ Print Signature Registered Dietitian: _____________________________ ____________________________________ Date: __________________ Print Signature

Form 707 LTC (6/19/15)

dwilliams

Highlight

dwilliams

Highlight

Outline of Long Term Care Criteria

1. Certified Dietary Manager or Completed DM Course or 5 consecutive years as a Director of Dietary A Certified Dietary Manager has completed a Dietary Manager’s course and has taken the Certification

Exam offered by the Dietary Manager’s Organization to certify them. It is acceptable if they have completed a dietary manager’s course and have not taken the Certification

Exam. Or has served 5 consecutive years as a Director of Dietary.

2. Score > 90% on Consultant Quality Assurance Report Be strict on each report. Give credit (75 points) for each quarter the report has been > 90%.

3. In Budget for Raw Food, Supplies, Supplements, and Labor Ask the administrator what the community’s actual budget is and their compliance with the budget. They must be in budget in each category in the month in order to receive credit. They receive 25 points for each month they are in budget in all areas.

4. Complete Fine Dining or Open Dining Program in Place with resident choices honored There must be tablecloths and centerpieces in the main dining rooms. Restaurant-style service must exist in the main dining areas (no trays or tower racks in the dining room). Preferably, cold food is preset and hot food is served restaurant style. Salad bars, soup kettles, desert carts, or breakfast specialty carts are used. Residents offered options of what, how much, where, when, and with whom to eat.

5. Resident Satisfaction Surveys > 85% Each Quarter Resident Satisfaction Surveys completed on 10% of residents – score > 85%. Problems noted are corrected.

6. Tube Feeders / TPN Appropriately Addressed Charted and intervened on within 72 hours of identification Charted on correctly every month Care planned correctly Best Practice Guidelines followed

7. Unplanned Weight Variance Appropriately Addressed Charted and intervened on within 72 hours of identification Charted correctly monthly Care planned correctly Best Practice Guidelines followed

8. Pressure Ulcers Appropriately Addressed Charted and intervened on within 72 hours of identification Charted correctly monthly Care planned correctly Best Practice Guidelines followed

9. The new Dining Practice Standards implemented Individualized nutritional care given each resident Resident directs their nutritional care Less restrictive diets are the norm and restrictive diets are the exception in your community Staff reflects excellent training

10. Inservices Given Monthly The Crandall Corporate Dietitians Yearly Inservice Plan is followed correctly and quizzes are given Sign-in sheets are used RD Inservices and Pre-Survey Inservices are given

11. Deficiency-Free Survey in Dietary Department or 350 points if Deficiency is on an A, B, or C Level. Form 707 LTC (6/19/15)

Pursuit of Excellence - Go for the Gold For Assisted Living Dietary Department of the Year

Community Name: Community ID:

Criteria

(see back for more specific criteria details) Points

Available Points

Achieved 1. Certified Chef, Manager, Completed DM Course or has 5

consecutive years as a Director of Dietary 300 ______

2. Score > 90% on Consultant QA Report 75 ea. QTR 300 ______ 3. In Budget for Raw Food, Supplies, Supplements, & Labor 25 ea. mo. 300 ______ 4. Menus complied with and served with style 75 ea. QTR 300 ______ 5. Complete Fine Dining Program in Place 200 ______ 6. Soup Kettles / Salad Bars / Dessert Bars utilized 75 ea. QTR 300 ______ 7. Resident Satisfaction Surveys > 85% Each Quarter 50 ea. QTR. 200 ______ 8. Always Available items offered 75 ea. QTR 300 ______ 9. The new Dining Practice Standards implemented 300 ______ 10. Dietitian Referrals ready for RD 75 ea. QTR 300 ______ 11. Inservices Given Monthly/Staff well trained 25 ea. mo. 300 ______ 12. Deficiency-Free Survey in Dietary Department 500 Total Points Achieved 3600

Award Levels:

Gold – 3420 – 3600 points 95 - 100% Bronze – 3060 - 3204 points 85 - 89% Silver – 3240 – 3384 points 90 - 94%

Procedure:

1. Director of Dietary must apply 30 days preceding the Crandall Regional Conference. See attached schedule.

• If your Regional Conference is in 2015, your Go for the Gold time period is June 2014 – June 2015. • If your Regional Conference is in 2016, your Go for the Gold time period is January 2015 – December 2015.

2. Administrator and RD must certify points are correct. 3. The Platinum award is earned by those Dietary Departments achieving 100% Gold awards for 5 or more consecutive years. 4. Awards will be presented at Crandall Corporate Dietitians’ Regional Conference . Additional RD Instruction:

If any section of the “Go for the Gold” does not apply, place an N/A next to the number and remove the possible points for that section form the total points.

I certify that community and , dietary manager, have accomplished the above stated achievements and applies for the Gold/Silver/Bronze Award with Crandall Corporate Dietitians.

Director of Dietary: _______________________________ ____________________________________ Date: _____________________ Print Signature Administrator: ___________________________________ ____________________________________ Date: _____________________ Print Signature Registered Dietitian: _______________________________ ____________________________________ Date: _____________________ Print Signature

Form 709 AL (4/30/14)

dwilliams

Highlight

dwilliams

Highlight

Outline of Assisted Living Criteria

1. Certified Chef, Dietary Manager or Completed DM Course

A Certified Dietary Manager has completed a Dietary Manager’s course and has taken the Certification

Exam offered by the Dietary Manager’s Organization to certify them.

Chef has completed culinary education or served 5 consecutive years as Director of Dietary.

Award full points if the Dietary Manager has held the dietary manager position for 5 or more consecutive years.

It is acceptable if they have completed a dietary manager’s course and have not taken the Certification Exam.

2. Score > 90% on Consultant Quality Assurance Report

Be strict on each report.

Give credit (75 points) for each quarter the report has been > 90%.

3. In Budget for Raw Food, Supplies, Supplements, and Labor

Ask the administrator what the communities’ actual budget is and their compliance with the budget.

They must be in budget in each category in the month in order to receive credit.

They receive 25 points for each month they are in budget in all areas.

4. Menu compiled with and served with style.

Appropriate changes made when necessary.

Plates garnished and food served attractively.

Choices available.

5. Complete Fine Dining Program in place.

There must be tablecloths and centerpieces in the main dining rooms.

Restaurant-style service must exist in the main dining areas (no trays or tower racks in the dining room).

Preferably, cold food is served first and hot food is served restaurant style.

6. Soup Kettle / Salad Bar / Dessert Cart utilized

Choices need to be offered to Residents through this system.

7. Resident Satisfaction Surveys > 85% Each Quarter

Resident Satisfaction Surveys completed on 10% of residents – score > 85%.

Problems noted are corrected.

8. Always Available items offered.

In addition to the menu items, Always Available menu items are offered to meet the needs of the residents.

9. The new Dining Practice Standard implemented

Individualized nutritional care given each resident

Resident directs their nutritional care

Less restrictive diets are the norm and restrictive diets are the exception in your community

Staff reflects excellent training

10. Dietitian Referrals ready for RD

Referral form completed and ready for RD.

11. Inservices Given Monthly

The Crandall Corporate Dietitians Yearly Inservice Plan is followed correctly and quizzes are given

Sign-in sheets are used

RD Inservices and Pre-Survey Inservices are given

12. Deficiency-Free Survey in Dietary Department.

Form 709 AL (4/30/14)

Pursuit of Excellence - Go for the Gold For Sunrise Assisted Living Dietary Department of the Year

Points Achieved

Criteria (see back for more specific criteria details)

Points Available

1. Certified Chef, Dietary Manager or Completed DSC

Course 300

2. Score > 90% on Consultant QA Report 75 ea. QTR 300 3. In Budget for Raw Food, Supplies, Supplements, & Labor 25 ea. mo. 300 4. Menus complied with and served with style 75 ea. QTR 300 5. Complete Fine Dining Program and/or Open Dining in

Place 200

6. Residents have a choice of soup, salad and dessert 75 ea. QTR 300 7. Resident Satisfaction Surveys > 85% Each Quarter 50 ea. QTR 200 8. Always Available items offered 75 ea. QTR 300 9. The new Dining Practice Standards implemented 300 10. Dietitian Referrals ready for RD 75 ea. QTR 300 11. Inservices Given Monthly 25 ea. mo. 300 12. Deficiency-Free Survey in Dietary Department. 500 Total Points Achieved 3600 Award Levels:

Gold – 3420 – 3600 points 95 - 100% Silver – 3240 – 3134 points 90 - 94%

Bronze – 3060 - 3204 points 85 - 89%

Procedure:

1. Director of Dietary must apply 30 days preceding the annual Crandall Regional Conference. See attached schedule. • If your Regional Conference is in 2015, your Go for the Gold time period is June 2014 – June 2015. • If your Regional Conference is in 2016, your Go for the Gold time period is January 2015 – December 2015.

2. The executive director and RD must certify points are correct. 3. The Platinum award is earned by those Dietary Departments achieving 100% Gold awards for 5 or more

consecutive years. 4. Awards will be presented at Crandall Corporate Dietitians’ Regional Conference. I certify that community and ______________________, dietary manager, have accomplished the above stated achievements and applies for the Gold/Silver/Bronze Award with Crandall Corporate Dietitians. _____________________________________________________________ _________________________

Dining Services Coordinator Date

_____________________________________________________________ _________________________ Executive Director Date

_____________________________________________________________ _________________________ Registered Dietitian Date

Form 709 Sunrise (04/14)

dwilliams

Highlight

dwilliams

Highlight

Outline of Sunrise Assisted Living Criteria

1. Certified Chef, Dietary Manager or Completed DM Course A Certified Dietary Manager has completed a Dietary Manager’s course and has taken the Certification

Exam offered by the Dietary Manager’s Organization to certify them. Chef has completed culinary education or served 5 consecutive as Director of Dietary. It is acceptable if they have completed a dietary manager’s course and have not taken the Certification

Exam. 2. Score > 90% on Consultant Quality Assurance Report

Be strict on each report. Give credit (75 points) for each quarter the report has been > 90%.

3. In Budget for Raw Food, Supplies, Supplements, and Labor Ask the executive director what the community’s actual budget is and their compliance with the budget. They must be in budget in each category in the month in order to receive credit. They receive 25 points for each month they are in budget in all areas.

4. Menu compiled with and served with style. Appropriate changes made when necessary. Plates garnished and food served attractively. Choices available.

5. Complete Fine Dining Program and Open Dining in place. There must be tablecloths and centerpieces in the main dining rooms. Restaurant-style service must exist in the main dining areas (no trays or tower racks in the dining room). Preferably, cold food is served first and hot food is served restaurant style. Residents offered options of what, where, when, how much and with whom to eat.

6. Residents have a choice of soup, salad or dessert Residents offered a choice of soup or side salad; desserts choices are also available.

7. Resident Satisfaction Surveys > 85% Each Quarter Resident Satisfaction Surveys completed on 10% of residents – score > 85%. Problems noted are corrected.

8. Always Available items offered. In addition to the menu items, Always Available menu items are offered to meet the needs of the residents.

9. The new Dining Practice Standard implemented Individualized nutritional care given each resident Resident directs their nutritional care Less restrictive diets are the norm and restrictive diets are the exception in your community Staff reflects excellent training

10. Dietitian Referrals ready for RD Referral form completed and ready for RD.

11. Inservices Given Monthly The Crandall Corporate Dietitians Yearly Inservice Plan is followed correctly and quizzes are given Sign-in sheets are used RD Inservices and Pre-Survey Inservices are given For all Sunrise communities inservice appealing purees (222) and Special Nutrition Program are required

per the Sunrise inservice schedule. 12. Deficiency-Free Survey in Dietary Department.

Form 709 Sunrise (04/14)

Crandall Corporate Dietitians 1930 N. Arboleda, Suite 101 Mesa, AZ 85213

P.O. Box 31060 Mesa, AZ 85275-1060 Menus: 855.286.7686 Fax: 480.835.8860 Office: 480.835.7072

[email protected]

Options for Decreased Egg Availability

The Avian Influenza outbreak has affected millions of laying hens in the Midwest. We are tracking reports in the media and have heard from distributors regarding the outbreak affecting their ability to supply some egg products. This may result in higher egg prices and changes in product availability of shell eggs and other egg products. The good news is that the Food and Drug Administration (FDA) has not identified any food safety concerns and has stated that it is unlikely eggs in the marketplace would be contaminated with the Avian Influenza virus in any way and no chance if eggs are handled and cooked properly.

So what does this mean for you and your community?

OPTION 1 Continue Serving Eggs on the Menus with Proper Handling and Cooking Procedures

As per Crandall best practice when using shell eggs, use PASTEURIZED shell eggs that have been treated to destroy Salmonella, as well as Avian Flu.

If product availability for pasteurized shell eggs or egg products changes due to supply issues and UNPASTEURIZED shell eggs are used, refer to proper egg handling and preparation guidelines. (See attached Egg Cookery and Storage (POL 78) policy based on 2013 Food Code)

OPTION 2 Review Menus and Recipes to Use Fewer Eggs

The key is to evaluate your particular situation and plan ahead. If your community faces egg availability issues due to supply constraints, the following are some options and steps to mitigate impact from cost and supply challenges.

How often are eggs offered at Breakfast? • If daily, consider serving eggs per resident request only and/or serving eggs on specific days.• Stretch those eggs. Menu egg bakes, scrambles, quiches or baked omelets more often.• Replace Choice of Egg with 1 oz Breakfast Meat of Choice (bacon, ham or sausage patty or link)

Try a Continental Breakfast option (see attached example) • Instead of an egg, substitute alternative protein choices: Cottage cheese, yogurt (Greek and

regular), ricotta cheese, other cheeses, nut spreads, beans, tofu and other soy based meat substitutes.

• NOTE: Renal diets may still require eggs, cooked properly, to meet daily protein parameters

Substitute eggs in certain recipe preparations and in baking • Experiment by substituting custard mix blended with milk to prepare French toast or bread

puddings (see recipe example attached) • Purchase a commercial egg substitute replacer to be used when baking from scratch recipes

only. Using egg replacer with commercial mixes is not recommended.

As this situation continues to unfold, we will pass any information along to you. If you have any questions, please feel free to contact us.

ATTACHMENTS (3): POL 78 - Egg Cookery and Storage, Continental Breakfast example, Cinnamon French Toast Recipe

EGG COOKERY AND STORAGE

POLICY

The Dietary Department should ensure that eggs are prepared in a manner to preserve quality, maximize nutritional retention, and to be free of salmonella and acceptable to the resident.

PROCEDURE

1. Store eggs in a dry, cool place (41 F or less).

2. Thoroughly wash hands with soap and water after handling eggs.

3. Do not use eggs with cracked shells.

4. Do not use raw eggs as an ingredient in the preparation of uncooked, ready-to-eat menuitems unless using pasteurized eggs.

5. Shell eggs must not be pooled. Pasteurized eggs should be substituted for shell eggs forsuch items as scrambled eggs, omelets, french toast, mousse, and meringue.

6. Individually prepared shell eggs that will be hot-held for service should be cooked to 155

F for 15 seconds.

Individually prepared shell eggs that will be served immediately should be cooked to

145 F for 15 seconds.

The following cooking times are recommended:

Scrambled - 1 minute at a cooking surface of 250

F Poached - 5 minutes in boiling water

Sunnyside - 7 minutes at a cooking surface of 250 F

Soft Cooked - 7 minutes in boiling water

Fried, over easy - 3 minutes at 250 F on one side, turn over and fry 2 minutes on other side.

7. Do not save leftover cooked eggs.

8. A soft egg should not be served unless the yolk and white are firm. Eggs that will be hot-

held for service must be cooked to an internal temperature of 155 F, no rest timerequired.

9. Pasteurized eggs in the shell may be cooked and served individually per resident’spreference.

POL 78 - Egg Cookery And Storage Copyright © 2013Revised: 12/01/2013 Crandall Corporate Dietitians

At a

ny ti

me,

this

repo

rt m

ay a

lso

be ru

n

from

you

r Cra

ndal

l Web

Cen

ter h

ome

page

fo

r upd

ated

resu

lts.

1

Darlene Williams

To: Darlene WilliamsSubject: RE: Communication Re: Repeat issues / low scoring reports

From: Theresa Arguello‐Thomas [mailto:[email protected]] Sent: Thursday, June 18, 2015 5:53 PM To: Linda Crandall; Kami Ratcliff ([email protected]) ([email protected]); Jon Williams; Michael Chandler Cc: David Chartier; Patty Ross; Janet Watkins; Roger Call Subject: Communication Re: Repeat issues / low scoring reports Importance: High Hi Linda, The RDCSs, Patty Ross and Janet Watkins and RDDS David Chartier in Region 4 CCRC Rental have requested that RD’s alert them of their exit with the ED/DDS for any communities who score low on the Crandall audit or have repeat violations. The RDCS and/or David will do their best to participate in the exit meeting via phone with the RD/ED and DDS. This will alert Patty, Janet and David about any issues immediately from the RD visit that same day. Will you please communicate this to the RDs for the communities listed below. We will want to start this ASAP. Thank you.

State Community Name New Branded EXTERNAL

Name RDCS RDDS

AZ Chris Ridge Brookdale Christown

Patty Ross [email protected] 623‐853‐6562

David Chartier [email protected] 719‐761‐3782

AZ Park Regency Brookdale North Chandler

Janet Watkins [email protected] (480) 390‐0955


AZ Santa Catalina Villas Brookdale Santa Catalina



CO Bear Creek, Emeritus at Brookdale Bear Creek



CO Green Mountain, Emeritus at Brookdale Green Mountain



CO Heritage Club at Greenwood Village Brookdale Greenwood Village



CO Heritage Club Mountain View Brookdale Mountain View



CO Roslyn, Emeritus at Brookdale Roslyn



CO Village at Skyline Brookdale Skyline



CO Meridian Englewood N/A



CO Meridian Lakewood N/A



2

UT Salt Lake City, Emeritus at Brookdale Salt Lake City



Please arrange a specific time to have an exit meeting. If the Administrator is not available request the DON attend. Be sure to confirm with the ED/DDS who will call the RDCS and RDDS.

Theresa Arguello-Thomas, BS, DTR, CDM, CFPP Divisional Director of Dining Services – CCRC Rental Division Brookdale Cell (480) 318-1751 | Fax (206) 357-7296 [email protected] | www.brookdale.com | www.emeritus.com

Follow Brookdale on: Facebook | Twitter | LinkedIn | YouTube

TO: All RD's

FROM: Linda Crandall, RD, LD, CEOJon Williams, RD, LDN, COO

PHONE: 888‐546‐3273DATE: 3/23/2015RE: Update to Clinical Charting Handbook

MEMO

Recently Nestle has reformulated IsoSource 1.5. Attached is a sidebyside comparison that will identify what areas of the formula changed. The most notable area of change is that the Volume to Meet 100% RDA for Vit/Min (ml) has been increased from 933 ml to 1000 ml. That means that the resident will meet 100%RDA for vitamins & minerals at 1 liter.

Please read the memo below from Nestle about this change and other changescoming in 2015. ________________________________________________________________________

Throughout 2015, Nestlé Health Science will be updating the adult standard tubefeeding formulas to meet current Institute of Medicine (IOM) nutrientrecommendations (DRI).

Isosource® 1.5 Cal will be the first formula to transition.

The key formula changes will include improved protein, fat, fiber, vitamin,and mineral blends.

One of the main changes is that the fiber amount in Isosource 1.5 Cal willincrease from 8g to 15g per liter.

Also, the protein will change from Sodium and Calcium Caseinates (Milk)to a blend of Sodium and Calcium Caseinates (Milk) and Soy ProteinIsolate

There will be no change to the caloric density, pricing, productnames, or any product codes.

Attached is the product comparison for specific nutrient changes.This product will flow into the market as inventory of the old formula is depleted.

We are estimating that we will start shipping the new formulation sometimein early to midMarch to distributors.It will all depend on how much inventory the distributors have on hand until youstart seeing it show up at your facilities.

Any questions please let me know.Thanks.

Regards,Pete

Peter PertaRegional Account [email protected]: 972.955.5771Fax: 972.298.5500www.nestlenutrition.com/uswww.nestlehealthscience.us

Attachments:New Isosource 1.5 Cal vs FORMER Isosource 1.5 CALUpdated page in the Crandall Clinical Charting Handbook

This email was sent to [email protected] by [email protected] | Update Profile/Email Address | Rapid removal with SafeUnsubscribe™ | Privacy Policy.

Crandall Corporate Dietitians | 1930 N Arboleda | Ste 101 | Mesa | AZ | 85213

http://visitor.constantcontact.com/do?p=un&mse=001E34NtkFyPqeaAHZK1KQLHM64WFFMSmPakjlgYQtcYiWqrrpXoNypYQ%3D%3D&t=001utJPVTbB2IwIuz5zQLcqxg%3D%3D&l=001FCSs65SMrsI%3D&id=001b-xBWU3VMkdOGWmpnR0CumWJ_j48KEX3&llr=pg9fapjab

https://ui.constantcontact.com/roving/CCPrivacyPolicy.jsp?id=preview

http://files.ctctcdn.com/fc8e20e5201/8aeb7b62-dbcf-4199-9d4a-2bcf8d99e888.pdf

http://visitor.constantcontact.com/do?p=un&mse=001E34NtkFyPqeaAHZK1KQLHM64WFFMSmPakjlgYQtcYiWqrrpXoNypYQ%3D%3D&t=001utJPVTbB2IwIuz5zQLcqxg%3D%3D&l=001FCSs65SMrsI%3D&id=001b-xBWU3VMkdOGWmpnR0CumWJ_j48KEX3&llr=pg9fapjab


http://visitor.constantcontact.com/do?p=oo&mse=001E34NtkFyPqeaAHZK1KQLHM64WFFMSmPakjlgYQtcYiWqrrpXoNypYQ%3D%3D&t=001utJPVTbB2IwIuz5zQLcqxg%3D%3D&l=001FCSs65SMrsI%3D&id=001b-xBWU3VMkdOGWmpnR0CumWJ_j48KEX3&llr=pg9fapjab

http://www.constantcontact.com/index.jsp?cc=news01&id=preview

http://files.ctctcdn.com/fc8e20e5201/4061c659-f12a-4cbc-82aa-10fc8cc6f9eb.pdf

SELECT APPROPRIATE TUBE FEEDING PROGRAM

Product Source Form Concen- tration

(kcal/ml)

Protein (g/1000

ml)

Volume to Meet 100% US

RDA for Vit/Min (ml)

% Free H2O

STANDARD INTACT PROTEIN FORMULAS FOR USE WITH NON-STRESSED INDIVIDUALS

Boost Nestle Liquid 1.0 42 1185 85

Compleat Nestle Liquid 1.06 48 1400 85

Ensure Nutrition Shake Abbott Liquid 1.06 37 948 80

Isosource HN Nestle Liquid 1.2 54 1165 82

Nutren 1.0 Nestle Liquid 1.0 40 1500 85

Osmolite 1 Cal Abbott Liquid 1.06 44.3 1321 84

INTACT PROTEIN FORMULAS WITH FIBER FOR BOWEL REGULATION IN LONG TERM TF Ensure Fiber with FOS Abbott Liquid 1.06 37 948 81

Fibersource HN Nestle Liquid 1.2 54 1250 81

Impact with Fiber Nestle Liquid 1.0 56 1500 87

Jevity 1 Cal Abbott Liquid 1.06 44.3 1321 84

Promote with Fiber Abbott Liquid 1.0 63 1000 83

Replete Fiber Nestle Liquid 1.0 62.4 1000 84

HIGH CALORIE (1.5 – 2.0) FORMULAS

Boost Plus Nestle Liquid 1.5 59 1185 78

Boost VHC Nestle Liquid 2.25 93 N/A 67

Ensure Complete Abbott Liquid 1.5 54 948 75

Ensure Plus Abbott Liquid 1.5 54 948 75

IsoSource 1.5 Nestle Liquid 1.5 68 1000 78

Jevity 1.5 Cal with FOS Abbott Liquid 1.5 63.8 1000 76

Med Pass 2.0 Hormel Liquid 2.0 80 N/A 69

Med Pass – No Sugar Hormel Liquid 1.6 80 N/A 74



Osmolite 1.5 Cal Abbott Liquid 1.5 63 1000 76

Pivot 1.5 Cal Abbott Liquid 1.5 93.8 1000 75.9

Resource 2.0 Nestle Liquid 2.0 84 948 62

TwoCal HN Abbott Liquid 2.0 84 948 70

HIGH PROTEIN FORMULAS

Boost High Protein Nestle Liquid 1.0 63 1185 85 Ensure Muscle Health (HMB-only (2) servings/day-recommendation) Abbott Liquid 1.06 55 N/A 83

Fibersource HN Nestle Liquid 1.2 53 1165 81 Isocal HN Nestle Liquid 1.06 44 1179 84

CHT 32 - Tube Feeding Copyright © 2015Revised: 04/28/2015 Crandall Corporate Dietitians

dwilliams

Highlight

HIGH PROTEIN FORMULAS (CONTINUED)

Product

Source

Form Concen- tration

(kcal/ml)

Protein (g/1000

ml)



% Free H2O

IsoSource HN Nestle Liquid 1.2 53 1165 82 Jevity 1.2 Cal with FOS Abbott Liquid 1.2 56 1000 81 Nutren 1.0 Fiber Nestle Liquid 1.0 40 1500 84 Optisource Very High Protein Drink Nestle Liquid 0.85 101 N/A 85 Osmolite 1.2 Cal Abbott Liquid 1.2 56 1000 82 Promote Abbott Liquid 1.0 63 1000 84 Promote with Fiber Abbott Liquid 1.0 63 1000 83 TwoCal HN Abbott Liquid 2.0 84 948 70

DISEASE SPECIFIC FORMULAS

CRITICAL CARE Immun-Aid Kendall McGraw Powder 1.0 80 2000 82 Impact or Impact with Fiber Nestle Liquid 1.0 56 1500 85 Impact Peptide 1.5 Nestle Liquid 1.5 94 1000 77 Impact Glutamine (Elemental) Nestle Liquid 1.3 78 1000 81 Impact Advanced Recovery Nestle Liquid 1.4 76 -- 77 Perative (Elemental) Abbott Liquid 1.3 67 1155 79 Peptamen AF Nestle Liquid 1.2 76 1250 81 Peptamen Bariatric Nestle Liquid 1.0 93 1500 84 Replete Nestle Liquid 1.0 62 1000 85

GLUCOSE INTOLERANCE Boost Glucose Control Nestle Liquid 1.06 59 1180 84 DiabetaSource AC (Blenderized) Nestle Liquid 1.2 60 1250 82 Glucerna 1.0 Cal Abbott Liquid 1.0 42 1420 85 Glucerna 1.2 Cal Abbott Liquid 1.2 60 1250 81 Glucerna 1.5 Cal Abbott Liquid 1.5 83 1500 76 Glytrol Nestle Liquid 1.0 45 1500 84

HEPATIC Hepatic Aid-II Kendall McGaw Powder 1.2 38 N/A 80 NutriHep Nestle Liquid 1.5 40 1000 76

PULMONARY Nutren Pulmonary Nestle Liquid 1.5 68 1000 78 Oxepa Abbott Liquid 1.5 63 946 79 Pulmocare Abbott Liquid 1.5 63 947 79

RENAL Nepro with Carb Steady (on dialysis) Abbott Liquid 1.8 81 944 73

Novasource Renal Nestle Liquid 2.0 91 1000 72 Renalcal Nestle Liquid 2.0 34 1000 70 Suplena with Carb Steady (pre dialysis) Abbott Liquid 1.8 45 944 74

ELEMENTAL FORMULAS FOR USE WITH MALABSORPTION

Critcare HN Nestle Liquid 1.06 38 1890 85 f.a.a. Nestle Liquid 1.0 50 1850 82


ELEMENTAL FORMULAS FOR USE WITH MALABSORPTION (CONTINUED)

Product

Source

Form Concen- tration

(kcal/ml)

Protein (g/1000

ml)



% Free H2O

Glutasorb Hormel Labs Liquid 1.0 52 1800 73 Peptamen Nestle Liquid 1.0 40 1500 85 Peptamen with Prebio Nestle Liquid 1.0 40 1500 85 Peptamen 1.5 Nestle Liquid 1.5 68 1000 77 Peptamen 1.5 with Prebio Nestle Liquid 1.5 68 1000 77 Tolerex Nestle Powder 1.0 21 1800 84 Vital 1.0 Cal Abbott Liquid 1.0 40 1422 84 Vital 1.5 Cal Abbott Liquid 1.5 67.5 1000 76 Vital AF 1.2 Cal Abbott Liquid 1.2 75 1185 81

Vital High Protein Abbott Liquid 1.0 88 1422 84 Vital HN Abbott Powder 1.0 42 1500 85 Vivonex Plus Nestle Powder 1.0 45 1800 83 Vivonex RTF Nestle Powder 1.0 50 1500 85 Vivonex TEN Nestle Powder 1.0 38 2000 83

LOW CALORIE FORMULAS

Equalyte (Rehydrater) Abbott Liquid .1 -- -- -- Introlite Abbott Liquid .53 22 1321 92

PEDIATRIC FORMULAS

Boost Kid Essentials Nestle Liquid 1.0 30 1-8 yr 1000 9-13 yr 1500 84

Boost Kid Essentials 1.5 Nestle Liquid 1.5 42 1-8 yr 750 9-13 yr 1000 72

Boost Kid Essentials 1.5 with Fiber Nestle Liquid 1.5 42 1-8 yr 750 9-13 yr 1000 71

Compleat Pediatric Nestle Liquid 1.0 38 1-8 yr 1000 9-13 yr 1500 82

Compleat Pediatric Reduced Calorie Nestle Liquid 0.6 30 1-8 yr 1000 9-13 yr 1200 87

EleCare

Abbott

Powder

1.0

31

1-3 yr 1000 4-6 yr 1425

7-10 yr 2025

84

Enfamil Kindercal Nestle Liquid 1.06 30 1-3 yr 946 85

Enfamil Kindercal with Fiber Nestle Liquid 1.06 30 1-3 yr 1300 7-10 yr 946

85

Neocate One +

SHS North America

Powder

1.0

25

1-3 yr 1300 4-6 yr 1800

7-10 yr 2000

80

Nutren Junior Nestle Liquid 1.0 30 1-8 yr 1000 9-13 yr 1500 85

Nutren Junior with Fiber Nestle Liquid 1.0 30 1-8 yr 1000 9-13 yr 1500 85

Pedisure 1.5 Cal Abbott Liquid 1.5 59 1-8 yr 1000 9-13 yr 1500

78

Pedisure 1.5 Cal with Fiber Abbott Liquid 1.5 59 1-8 yr 1000 9-13 yr 1500

78


ELEMENTAL FORMULAS FOR USE WITH MALABSORPTION (CONTINUED)

Product Source Form Concen- tration

(kcal/ml)

Protein (g/1000

ml)



% Free H2O

Pedisure Enteral Formula 1.0 Cal Abbott Liquid 1.0 30 1-8 yr 1000 9-13 yr 1500

84

Pedisure Enteral Formula 1.0 Cal with Fiber

Abbott Liquid 1.0 30 1-8 yr 1000 9-13 yr 1500

85

Pediasure (1-13 years) Abbott Liquid 1.0 30 1-8 yr 1000 9-13 yr 1500

84

Pediasure with Fiber (1-13 years) Abbott Liquid 1.0 30 1-8 yr 1000 9-13 yr 1560

84

Pediasure Peptide 1.0 Cal Abbott Liquid 1.0 30 1-8 yr 1000 9-13 yr 1500

85

Pediasure Peptide 1.5 Cal Abbott Liquid 1.5 45 1-8 yr 667 9-13 yr 1000

77

Pediasure Side Kicks 0.63 Cal Abbott Liquid 0.63 30 1-8 yr 1000 9-13 yr 1500

90

Peptamen Junior (elemental) Nestle Liquid 1.0 30 1-8 yr 1000 9-13 yr 1500

85

Peptamen Junior 1.5 Nestle Liquid 1.5 45 1-8 yr 750 9-13 yr 1000

77

Peptamen Junior with Fiber Nestle Liquid 1.0 30 1-8 yr 1000 9-13 yr 1500

84

Peptamen Junior with Prebio Nestle Liquid 1.0 30 1-8 yr 1000 9-13 yr 1500

84

Vivonex Pediatric (elemental) Nestle Powder 0.8 24 1-8 yr 1000 9-13 yr 1500

89

CLEAR SUPPLEMENTS

Arginaid Extra Nestle Liquid 1.06 44 -- 83 Ensure Clear (Therapuetic Nutrition Drink ) *Institutional*

Abbott Liquid 1.0 35 -- 84

Pediasure Side Kicks Clear Abbott Liquid 0.6 30 -- 90 Resource Breeze Nestle Liquid 1.06 38 -- 83 Resource Broth Plus Mix Nestle Powder 0.67 39 -- 84 Resource Diabetishield Nestle Liquid 0.63 30 -- 89 Resource Nutritious Juice Drink Nestle Liquid 1.18 34 -- 79


Section 2: Personnel Management Page 2-31

GUIDE FORMANAGING GASTROENTERITIS OUTBREAK

(With possible Food Borne Illness Outbreak)

POLICY

Dietary Managers and Dietitians should help in managing a Gastroenteritis Outbreak (withpossible Food Borne Illness Outbreak). They should do this by working carefully withAdministration, Nursing and the Medical Director.

PROCEDURE

1. Develop a tool to collect and graph community data:

a. Dates of onset

b. Duration of illness

c. Number of diagnosed cases

d. Number of symptomatic cases

e. Types of exposures, i.e. residents, staff, vendors and outside personnel

2. Work with county environmentalists to determine what cultures will be taken i.e. food, water, ice.

3. Work with the Medical Director to determine what labs and stools are to be taken.

4. Look for common sources/sites

5. Evaluate water and ice sources; any outsource.

6. Evaluate the distribution from preparation to service.

7. Evaluate any deviation from menu or routine, such as holiday or cultural meal, foodsbrought in, vendor changes and non-dietary staff handling of food service.

8. Evaluate any recalls of food, devices, or nutritional products.

9. Evaluate any unsafe practices like dish machine or pot and pan washing used for other purposes.

10. Evaluate recent equipment, pipe or sewage problems.

11. Evaluate the Activities Center and food related therapy.

12. Evaluate the Laundry for dedicated machines and changes.

13. Evaluate pest control and evidence of animal exposure.

14. Implement control measure without waiting for diagnostic confirmation:

a. Review appropriate sanitation policies

b. Inservice staff in these policies

c. Monitor staff practices to determine effectiveness of policies and training

POL 113 - Guide For Managing Gastroenteritis Outbreak LTC Copyright © 2006Revised: 03/01/2006 Crandall Corporate Dietitians

dwilliams

Highlight