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    Nutr 303 Project

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    Ana P.

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    © All Rights Reserved
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    GREEN HILLS Lourdes Bautista Adriana Bautista Ana Maria Pelcastre Marisol Perer, Dominga Cuevas Giancarlo Ricasata Nutrition 303: Lecture Project December 11, 2013 Part L: section A: Purpose of Operation Growing olds stage in ie that symbolizes wisdom and fragility; therefore, society should value and care for the elderly since they are in need of special assistance According to the 2010 Census, the non-Hispanic white population age of 65 years and older is expected to more than double between 2012 to 2060, from 43.1 million to 92 million, making them. the largest single group. As a result, with the increase number of elderly, complications also arise, as well as the need for special assistance, For example, senior citizens experience difficulties acquiring adequate nutrition due to physical restrictions, medical complications, financial hardships, or mental health. Although there are several facilities that elderly and their families can choose from, most facilities have a large number of residents, which limits the staff full commitment to the individual. For example, elderly who need encouragement and reminders to begin their meal, continue eating, or simply assistance with the use of utensils, can have a negative impact in their health, if otherwise [1]. To illustrate, in the study conducted by Woods, 19.4% of the residents were found to be malnourished and 38.7% were at risk for malnutrition, with 75.6% of the residents having cognitive problems. This should be alarming to society who are putting themselves or their loved ones into facilities that are perceive as being safe and nurturing, especially when diagnosed with a mental disorders, such as Alzheimer’ disease (AD). For instance, individuals that suffer from Alzheimer’s disease are in need of close attention when they eat since this disease affects the mechanies of eating and ability to swallow food, which then leads to malnutrition, dehydration and decreased immune function. The resulting factors can evolve into secondary complics (3). jons like aspiration pneumonia and elevated mortality rates As a result, Green Hills Care is a new nursing home facility located in the outskirts of La Mesa, California, whose purpose is to help residents obtain adequate nutrition. According t/study conducted by Esmee Doct, individuals who suffer ftom dementia are associated to have deficiency in caloric and protein intake, which may lead to malnutrition; thus, Green Hills will focus on providing resident with delicious energy and protein-dense meals, Green Hills will have 15 residents in its facility to promote individual attention and offer personalized needs. This will allow staff to bond with the residents on a more personal level, which will make their stay at our facility enjoyable. By making mealtime pleasant it will positively affect their eating habits since studies have proven that enjoyable eating is correlated with increased food consumption [3]. Also, with less patients, staff members can dedicate their time in making sure that individuals eat their food or get the aid necessary to start and finish their meals, in turn, this will help residents stay healthy and strong. Moreover, since our facility is composed of a small number of residents, we are able to place one person per room, which allows resident’s privacy and the opportunity to wre decorate it as they wish. Doing so will create a sense of empowerment, promote individuality, as well as make them feel at home rather than a nursing home setting, Daily activities are included within the facility by staff and volunteers, such as games that stimulate critical thinking like crossword puzzles, card games, and board games, ultimately encouraging collapse of tenant’s cognitive skills. In order to maintain their social skills dancing classes, arts and crafts, and physical activity is also provided. Also, the overall goal of our facility is to prevent dehydration and malnourishment with our residents by providing meals that meet appropriate consistency, calories, nutrients, and fluids. Food Service Svstem Classification At Green Hills Care, the food is prepared in a conventional (traditional) method of preparing meals, Since the food is made onsite, residents receive high-quality food that meets adequate temperature, texture, mouthfeel, and taste, Also, to avoid residents from discarding their food, they have the opportunity to substitute their main course to an alternative, on most days. Labor/production hours! he of service/methods of service Green Hills Care consists of a momning shift and evening/ovemight shift. In the moming shift, the cooks and volunteers are responsible for preparing breakfast for the residents. Most of the food being prepared will be done by scratch, with a few exceptions such as orange juice, ham, bread, and yogurt, for example. Cooking is performed on an onsite kitchen. Not only is the morning shift responsible for preparing breakfast, but also they are also responsible for preparing materials for early snacks and lunch. For example, if he the lunch item requires vegetable soup, the moming staff willleaning, cutting, and storing the proper items. On the other hand, the evening/overnight shift will be responsible for cooking and serving dinner as well as, preparing items for breakfast and early snacks, To illustrate, ifthe ‘morning snack requires Jell-O then the cooks or volunteers are required to make the item before hand. When all the food preparation is complete, the eveninglovernight staf is responsible for cleaning the kitchen and inspect inventory. One requirement that should be obtained by any faculty member dealing with the handling of food is the food handler’s i certification. Thus, anyone who fails ¥6 acquire the food handler’s card is not allowed to handle food. Moreover, breakfast is serve/t 8:00am, lunch at 12:30pm, and dinner at 6:00pm. Two snacks are provided in between meals to avoid residents from feeling hungry. For instance, the early snack will be offered at 10:00 am while the aftemoon snack is provided at i 3:00pm, Meals are scheduled at this time to avoid patients from experiencing more than 14 (17 hours without food from their last meal and breakfast the following day [6] In order to get their meal, residents have to sit at the dining room table and wait to be served, Volunteers and staff are responsible for placing the homemade plates to each resident, However, when residents refuse to have dinner with the rest ofthe group, they ae “b allowed to eat their meal in their room with supervision by one AE volunteers. Because the residents have a potential risk for choking, there is always a total of one volunteer or be Ged | staff members for every two residents. As a result, volunteers have to be CPR certified as well as complete 16 hours of initial training, which includes hands-on shadowing training, as stated by the Assisted Living State Regulatory Review 2013 [4]. One of the main duties for volunteers is to monitoring and assist patients with eating. For example, when volunteers notice that a resident has not started to eat, encouragement is given to individuals, as well as assistance, if they are having trouble using utensils, as well as remind them to drink all their fluids to prevent dehydration. For each meal, residents have forty-five to 60 minutes to finish their food since some may initiate eating a few minutes after their meal has been given to them or because they need extra time eating due to their cognitive impairment [5] 5 Purchasing and Inventory The predominant ethnicity that constitutes Green Hills Care is Caucasian; therefore, food mostly consist of traditional American homemade meals that fulfill the nutrient 1 requirements as noted by Myplate for Older Adults and Academy of Nutition and Dieteticd™ (AND). Also, to promote sustainability, Green Hills Care follows the program harvest of the ‘month, which promotes cooking with fiuits and vegetables that are in season. One of the rain food distributor's is our local Farmers’ Market in La Mesa, El Cajon, and North Park Fresh produce is purchased weekly in order to preserve nutrient content, palatability, and texture, Also, Green Hills Care takes advantage of specials from local stores such as, Smart and Final, so that the most savings can be aecomplished. Because these sites do not provide food transportation, the person in charge for the financial does the shopping with the help of volunicers who have been trained, ai du! Frosh fruit and vegetables thatthe facility cannot get from the farmers market are be purchased by Jimbo's Naturally located in San Diego, as well as meat, fish, and poultry which is purchased in pounds every month, divided to smaller portions, and stored in large freezers with a temperature of -10 to 0 F [6]. To prevent food spoilage or contamination, food is stored immediately after purchase while meeting proper requirements The method of purchasing food products is based on what is needed and what is in season, For example, during summer the facility purchases frequent small quantities of avocados, corn, cucumbers, cherries, and blueberries. However, when the food items are out of season, bulk purchasing and freezing is the best option. The same method is applied to poultry and meat products buy in bulk, cut and separate in small portions, and stored. To prevent food shortages, employees perform a physical inventory each week, for fruits and vegetables, and physical inventory monthly on frozen meat, fish, and poultry [6] Section B: menu type and output volume The menu type is a semi-selective, monthly cycle menu because it allows individual J ie aul freedom on food selections on the resident’s behalf as well as, eliminates any anxiety that an expanded list may present. The menus for each week will be posted in the kitchen dining : room, It wll consist ofa 7-day meal plan prepared by our expetienced registred dieticians.” Each day we will have an altered prearranged meal for each period as to enhance the food variation, Breakfast, lunch, dinner, and two snacks will be served daily, totaling 75 meals per week. Beverages choices will be tea, coffee, hot chocolate, milk, or orange juice, or apple juice, with water always being offered to promote adequate fluid intake. However, to limit the consumption of added sugars, residents will not be allowed to consume more than two sugary beverages. Grek Woe On the other hand, breakfast options will include favorites such as beagles, pancakes, eggs (different varieties), and hot and cold cereals. Also, fo encourage eating among residents, we will cook traditional homemade dishes such as spaghetti with meatballs, grill cheese sandwiches, soups, pizza, and meatloaf for lunch and dinner, The meals will follow Residential Care Home Licensing Regulations by state; all diets shall be planned and written at least one week in advance, provide 100% of the RDA, and maintain sufficient food supplies at hand on the premises. To further increase food choices, our meals will be recreated at the end of each month, Residents will be encouraged to offer feedback on their “4 i t 04 : ‘entrees using a verbal or written hedonic scale. “Pld he elder 2, LV hediwie Stale! For residents that have a challenging time rating the food, staff will aid in assistance by illustrating a happy gesture with the saying “yummy” as to symbolize palatable food. Similarly, an unsatisfied face expression is presented while saying “ugh” to symbolize a dislike. Our dieticians will then tally up responses and plan new dishes according to ve feedback results. Moreover, infeffort to maintain a green environment, our facility will strive to prevent food waste by incorporating a leftover-Friday. Grok, ‘ if (Two-day complete sample menu located in Appendix A) Patron and Nutrients Needs Nutrition requirements for the elderly are the same as the average Americans, with the exception that elderly require less caloric intakes duc to loss of lean muscle and decreasech- physical activity [5] ‘Aecording!te National Institution on Aging, mentions that women, who are over the age of 50 and are inactive, should consume about 1,600 calories, whereas ‘women who are somewhat physically active should consume about 1,800 calories. On the other hand, men are recommended to consume 2,000 calories if inactive or about 2,300 calories, if active. Because Green Hills Care will be promoting physical activity among, residents, meals offered provide an average of 1,800-2,300 calories. Although some meals will be high on calories, for some individuals, overconsumption of energy will not be a ‘major risk factor since the main concem for elderly with AD is the malnutrition related to Spee wd inadequate energy intake [2,7] : Moreover, recommendations for fruits and vegetables for older adults are about 1% and 2 % servings per day, respectively. Adequate consumption of fruits and vegetables is detrimental in this stage of life since food provides excellent sources of phytochemicals, Vitamins, minerals, and fiber [5,8]. The 2010 Dietary Guidelines for Americans also recommends three cups of dairy daily, 1,200 mg of calcium. To meet the recommendations, orange juice, milk, yogurt, low-fat cheeses will be offered throughout each meal. Vitamin D is also important to enhance the absorption of calcium; therefore, besides providing milk and orange juice fortified, residents will be taken out daily to the garden so they can be exposed ‘to natural light. Because of its role in delaying osteoporosis, calcium and vitamin D will be reach in every meal. With regards to grains, older adults require a minimum of six ounces of grains each day, Out of the six ounces of total grains, half of those should be whole. Therefore, residents will obtain the adequate recommendations of grains through gold or hot brealkfast cereals, whole grain breads, rice, and pasta. On the other hand, since diets high in saturated fat and trans fat negatively affect individuals suffering with AD, Green Hills Care’s daily menu will contain less than 10% sat fat and less than 1% trans fat [5]. To void excess in fats, low-fat foods will be offered, excess fat will be trimmed from meats, as well as baked, broiled, and boiled methods will replace the frying of food. Section C: Facility space & equipment Equipment that will be necessary for the proper storage of food will be one restaurant refrigerator (2 door stainless steel with exterior dimensions 55” x 33.5” x 82”) and one commercial freezer. For heating and preparing food, one electric stove, one microwave, 2 meat thermometers, stainless steel counter tops, plates, bowls and utensils are a must. Aso, a three-compartment sink will be use to wash plates as well as 2 metal shelves for dry storage. To maintain maximum food quality, food and supplies are properly hold and stored after it's purchased. For instance, perishable foods that require immediate refrigeration or freezing such as dairy products, meats, and produced are stored in either reftigerators with a temperature below 40° F or storage freezer with temperature of -10° to 0° F. In order to monitor adequate low-temperature storage, thermometers are place inside the unit near the opening of the door. Proper humidity is also required to maintain food quality and appearance. Therefore, low-temperature storage humidity should be kept in a range of 75 to 95% [6] On the other hand, food such as breads, grains, cereals, cans, and condiments that do not require reftigeration will be placed in dry storage. Additionally, staff also monitors temperature and humidity. Temperature ranges from 50°F to 70°F with a humidity of 50 to 60%, To allow proper ventilation and cleanliness, the last metal shelf is six inches above ground and two inches away from the walls. To prevent pilferage, anyone who goes into storage needs to write down what item they retrieved as well as what it was used for. Moreover, storage is near the production area, which facilitates the cooks and volunteers from monitoring who is going in and out of the storage area. The kitchen area is approximately 225 square feet, which classifies it as a large kitchen and allows more than three people to prep, organize, and cook for the upcoming meals [9]. G ot f ¢ (See Appendix B) Part IL. Budgetary Go: ‘The total budget for Green Hills Care facility in 2013 is approximately $266,916. ‘The budget was determined based on the amount spent per meal in one day for each 10 resident. The total expenses include breakfast, lunch, dinner and two snack services. Our goal is to spend an average of $2.87 dollars per meal. The total budget for each day will be $718 dollars resulting, in monthly budget of $22,243 dollars. According to the calculations, the budget was met for all the menu days. The facility rates for each individual will be $4,300 monthly. Food, bathing, grooming, laundry, room. cleaning, and personalized help will all be included in the fee (Lakeside Manor Senior Facility rates). Moreover, Green Hills Care will accept not only personal checks, but also Medicaid insurance payments. See Apprendre C Nutritional Goal Green Hills Care will focus on providing patients with nutritious food options that will meet the 2010 Dietary Guidelines for Americans calcium (1,200mg) and fiber (at least 21g for women and 30g for men), as well as meet Adequate Macronutrient Distribution Ranges (AMDR) in carbohydrates (46-65%), total fat (20-35%), protein (10-35%) and saturated fat (<10%). Since elderly with dementia are at greater risk for. dehydration, they will be offered two beverages with every meal. In order to analyze nutrient intake, USDA database was used. ‘When interpreting nutrient intake for Tuesday, patients consume 1,751.2mg of calcium, exceeding the daily recommendations. Also, individuals were meeting fiber recommendations with a total intake of 30.8g. Moreover, AMDR recommendations were as follows: 59% carbohydrate, 22% fat, 20% protein, and 8% saturated fat, which all fall between guidance. i Unfortunately, patients were a little over cholesterol recommendations since they consumed 319 mg; however, this is not significant since patients only exceeded by 19mg. This slight increase may have been inJluenced because patients consumed five animal products (egg, dairy, beef, poultry, and ham) for this day, with the exception of pasta, which also contributes to cholesterol Moreover, according to the 2010 Dietary Guidelines for Americans 1,500mg sodium is the recommendation for people over 51 years compared to 2,300mg sodium for the general healthy populations. When evaluating the patient’s sodium intake, they had consumed a total of 1,779.35mg sodium, which is 279.35mg higher; however, this is not alarming since the patients do not have health related problems. 4 When analyzing the vitamins, vitamin D intake was 346.13 TU, which is a bit low Ae, i oy since the recommendations is 600 TU/day. However, patients will also have the access to'be | oro a ost the outdoors to obtain sunshine, in order to increase vitamin D levels endogenously. Vitamin Pct i C intake was at 335.9 mg, which is considered high since the recommendation for elderly is & se 90 mg for men and 75 mg for women. Even though vitamin Cis high, itis under the e 6 Tolerable Upper Intake Levels (UL) and high consumption of dietary vitamin C is not oes , alarming since it is unlikely to be harmful [11]. + oho dpe Moreover, patients were able to meet RDA recommendations for vitamin B6 (1.7mg_ &* e for males and 1.5 mg for women) and BI2 (2.4 meg for men and women). Patients consumed 2.241 mg of vitamin B6 and 4.9 meg of vitamin B12, A second day (Wednesday) nutrient analysis had different ranges from that of nutrient analysis on Tuesday. On Wednesday, patients had the option to pick one of three food lunch choices. Patients that consumed option | for lunch had an intake of 1,532 mg of 32 calcium, exceeding the recommended amount. Patients consumed a total of 41.3g of fiber, which is plenty for elderly diets. The amount of cholesterol consumed for option 1 wasl09 mg, lower than day one nutrient analysis. Sodium had a range of 1,639 mg, a little higher than recommended and this could be due to the possible ingredients and cooking process of the recipe and ingredients. Part IN. FOOD SAFETY HACCP programming It is not uncommon for food outbreaks to reach the food supply, however, at Green Hills Care; we pride ourselves in providing our tenants with superior safe and sound quality products. There is plenty opportunity for biological, chemical or physical hazards to encounter the chain supply, weather at the initial sprouting step or at the time of production. HACCP was established to set specific criterion that must be satisfied in order to fulfill a preventative measure identified for a critical control point [6}, In other words, HACCP is intended to protect the consumer against food borne contamination that may potentially cause illness or death. Following simple regulatory procedures allow food to arrive safely to their designated destination Selection of suppliers is especially important to reduce potential outbreaks. Writing specific purchasing requirements that include suppliers who implement their own HACCP regulations and follow safe receiving and handling measures will be selected, Green Hills, Care consumers consist of an elderly population (ages 60 and over); thus, corrective aetion is strictly enforced. According to Ludmilla Muller, this population is at higher risk for 13 disease duc to the deciine in immunity functionality that aligns with aging; therefore, deeming them more susceptible to minimal bacterial exposure. As suggested by HACCP regulations, temperature control is imperative to the integrity of the food due to the high risk of rapid onset and progressive growth of intoxicating organisms. Bacteria such as Clostridium Perfrigens, Clostridium botulism, and Salmonella enteriditus can have severe detrimental effects on compromised individuals, Examples of high-risk foods that are closely monitored are milk, eggs, meat, poultry, fish, and soy. At Green Hills Care senior facility, employees will be intensely trained to ensure meals are fully cooked to proper temperatures. For example, poultry must reach 165°F internal temperature and pork 145°F internal temperature. Moreover, the temperature at which the food will be cooled will also be closely monitored and measured to ensure temperature meets 70°F within 2 hours, or 41°F within 6 hours [6,13]. Get é Additionally, when it comes to food safety, employees play key role in ensuring food is free from contamination. Sanitation is a vital safety factor, and trasmission of disease from poor personal hygiene can cause health complications such as Hepatitis A, Norwalk Virus or Shigella Species, to name a few, At green hills, employees will be strictly accountable for following the facility’s standard operating procedure (SOP) that will depict a step-by-step instruction for clean and safe routine tasks. All employees will also be required ne to complete the Food Handler's certification prior to their first day of employment, ‘The transport of foods is another potential source of food outbreak opportunity. ure to utilize the HACCP program during shipping and receiving can be harmful. In our senior citizen care facility our employees take great care of transporting and delivering of raw meats, raw produce, and other assorted items. Foods are checked upon arrival in the 14 food-receiving storeroom for any contamination, dirt, open packages, or inedible foods that may have been accidentally dropped. After clearance the groceries they are transported to appropriate areas for storage. A record sheet will be prepared for employees to fill out and receipts for all transactions filed. The record sheets are utilized to provide information, such as who did the grocery shopping for the day, the time, and who stored the food. Next, procurement of foods, which are stored for later use, are marked with labeling and date of creation, Any out of date of suspected spoiled foods are tossed out immediately. Foods that are served past their expiration dates can pose a serious risk on our clients due to a lowered immune system. Records of any leftover foods that are served are written down and stored in a separate location from fresh/raw foods. All stations that require employee's use of hands contain a standard of procedures to minimize risk of pathogenic growth and contamination, For example, each sink posted above has hand washing sanitizing procedures. Procedures for each kitchen equipment use must be cleaned and sanitize before/after cooking meals, A Disposal of trash is created to limit amount of unnecessary foods present [6]. A hazard analysis program is also created for each recipe. For example, dishes that IN fae require chicken breast/contain Salmonella an easily spreadable yet preventable bacterium. Cooking foods to high enough heat will eliminate the chance of acquiring salmonella. poisoning, but often times cooking isn’t the problem. Usually people who handle raw chicken breasts improperly are the culprit and may contaminate other sources of food by accident. Those especially with weakened immune systems, such as the elderly, must be served food in clean sanitized conditions at all times to avoid any unnecessary illness [13] During the cooking process of recipe comflake chicken nuggets, many potential hazardous points are identified. First, employees who shall handle chicken breast from receiving to storing and prep require maximal amount of care to avoid cross contamination to other products. Second, it is imperative that employees wash all utensils, equipment and anything else raw chicken breast may come into contact with the proper sanitizing solutions available, Thirdly, temperatures must reach equal to or above 165°F before serving to customers, And lastly, storage of any leftovers or precooked nuggets should be allowed to cool within 2 hours. ‘The primary hazardous critical control point is the cutting board and knives/equipment used to prepare chicken breasts. To circumvent contamination there will be an employee cach responsible for each task. One will be preparing the chicken and the other will be focused on washing and sanitizing cutting boards, knives and grinders as needed. Once all foods are placed into oven employces must wash their hands and record on a sheet of completion for the dated recipe before serving to customers or for storage. In an event that any suspected cross contamination were to occur the entire cooking process will immediately stop and foods contaminated will be thrown out. Moreover, records will be noted by managers to prevent future incidences and reduce food wastes. Part IV Recipe Development Standardization Standardized recipes are followed to ensure that the most cost effective procedures are utilized. Most of our patients are be over the age of 60 to 65. This calls for high focus on proper amount of nutrients to calorie intake as well as meeting appetite needs and 16 preference. The menu will encompass a well balanced diet, with a deliberate on calcium intake, which is essential to fight off osteoporosis. Additionally, nutrients such as vitamin B6 and zine will be considered when creating new recipes to further promote e stronger, healthier lifestyle and immunity The recipes created have strong emphasis on finger foods such a, fish sticks, and vegetables with dip, healthy homemade pizzas, and fresh sandwiches, For occasions when a meal cannot be served finger food-style, itis prepared in a manner that is casily to pick up. For example, soups are served in a cup instead of a spoon and bowl style. In addition, large pieces of meats will be pre-diced by our chefs to smaller portions, resulting in « much more enjoyable cating experience for our seniors. Decreased use of utensils during meals has shown preference with patients, partly because of the ease that comes with eating with fingers. A challenge that may arise amidst the creation of recipes might be that of diabetes patients; specifically type-2 due to the nature of the condition being an age related disease. Menus are modified to include starchy carbohydrate, and limit simple carbohydrate grains. Fruits and vegetables for snacking are integrated to help stabilize blood glucose levels and to further reduces the chance of developing diabetic conditions. ‘The amount of cost per meal is observed closely. Purchasing foods at the local market in bulk and freshest ingredients, we lower the cost of meals significantly which opens up a budget that allows more choices for our clients in the future. Cross-utilization of ingredients is also noted while considering new options for meal creation. For example, yogurt bought in bulk will be used in certain recipes and as a dip or a snack by itself to reduce waste and spoilage 17 Each new dish made will follow e: instructions that yield appropriate sizes, which stay within a range of 400-500 keals for breakfast, lunch and dinner. Snacks will be adjusted to around 200-300kcals. For example, the recipe shown in App F. is simplified recipe of Corn flake Chicken Nuggets. It includes the amount of each ingredient to feed at least feed ( 50 individuals, nutrient content, preparation procedures, and critical points. f i oe Appendix F: Recipe Standardization Appendix A: = 7 ehh : cl ee GREEN HILLS Monday Breakfast Whole wheat Fluffy French toast with strawberries toppings Scrambled Eggs Turkey sausage Please pick a beverage of your choice: 1 %milk, Green Tea, Orange juice, Coffee *Waier will be offered with every meal Snack Sliced apples with peanut butter Lunch Whole wheat grilled cheese sandwich Chunky Lentil soup Cranberry juice Snack Julienne cut Cucumber and Jicama Vegetable dip Dinner Please pick one: Tilapia or Chicken breast Green salad with light ranch Cilantro-lime rice Jell-O Green Tea OR 1% mitk GREEN HILLS Tuesday Breakfast Whole-wheat pancakes Slice of honey ham Scramble eggs Please pick a beverage of your choice: 1 %milk, Green Tea, Orange juice, Coffee “Waiter will be offered with every meal Snack Multigrain crackers with cream cheese Sliced grapes Lunch Grilled Rosemary chicken breast Herb roasted potatoes Green beans Whole wheat dinner roll Light Margarine 1% Milk ‘Snack String cheese Diced melon Apple juice Dinner Spaghetti with meatballs Garlic whole wheat bread Orange slices Please pick one: Greek salad OR Ceasar salad Orange juice OR Prune juice GREEN HILL Wednesda‘ Breakfast Quaker quick oats cereal with cinnamon and raspberries toppings Please pick a beverage of your choice: 1 %milk, Green Tea, Orange juice, Coffee “Water will be offered with every meai Snack Peanut butter & jelly sandwich 1 Ysmilk OR Orange juice Lunch Please choose one of the 3 items: Vegetable soup with shredded chicken breast and whole wheat roll OR 2 Shredded Chicken soft tacos OR 2 Vegetable soft tacos Orange juice Snack Poach pear with cinnamon Dinner Cheese enchiladas ‘Steamed broccoli 1% milk OR Orange juice GREEN HILLS Thursday Breakfast Please pick one: Veggie omelet OR Meat omelet Mix fruit cup Please pick a beverage of your choice: 1 %milk, Green Tea, Orange juice, coffee “Water will be offered with every mea Snack Please pick one: Vanilla OR Chocolate Pudding Julienne Cucumber with Light Ranch Lunch Please pick one: Tuna sandwich OR Turkey sandwich Tomato Soup Multigrain Crackers Mandarin Orange Prune Juice ‘Snack Oatmeal raisin cookies. 1% milk Dinner Turkey Lasagna Garlic whole grain toast, Veggie Kebab Gelatin Parfait Green Tea OR Orange juice GREEN HILLS Friday Breakfast Whole wheat bagel with cream cheese Banana Please pick a beverage of your choice: 1 %milk, Green Tea, Orange juice, Coffee “Water will be offered with every meal Snack Roasted turkey sandwich Orange Juice Lunch Baked Salmon Fish sticks with ranch Beans and rice Yellow com meal Boiled broccoli Prune juice ‘Snack Baked Sweet Potato Fries Low Fat Greek Yogurt Dinner Com flake Chicken Nuggets with ranch Steamed carrots and corn kernel Green Tea OR Coffee GREEN HILLS Saturday Breakfast Whole wheat grilled cheese sandwich Mixed fruit cup Please pick a beverage of your choice: 1 %milk, Green Tea, Orange juice, coffee “Water will be offered with every meal Snack Unsalted popcorn Orange juice Lunch Homemade chicken nuggets with ranch or ketchup Mac and cheese yy Broceot Prune juice OR Orange juice Snack Hummus Multigrain crackers Prune juice OR Green Tea Dinner Meat loaf Mashed potatoes with gravy Com bread Green Tea OR Coffee Appendix B: Equipment al f ors Green Hills Care Equipment Needed : Equipment Funetion Pertaining Food Items Restaurant Store produce at according | Perishable, fruits, vegetables, dairy reftigerator temperature products, beverages, meats Commercial freezer | Storage for frozen products Meats, vegetables, fruits | 1 Blectrie stove | Cook food, boiling, broiling Pasta, soups, oatmeal | or steam 1 Convection oven Cook, bake 7 Pizza, chicken, meatloaf Microwave Heat food Soups Plastic plates, bowls, utensil Consume food As applicable 2 Blenders Prepare mixture of fruit Smoothies, shakes smoothies Three compartment | Clean, wash, rinse, and Plates, bowls, and utensils sink sanitize 2 metal shelves | Dry ingredients and canned Breads, grains, canned items (ary storage) goods Stainless steel | Prepare uncooked, cooked, Sandwiches, salads, snacks countertops and cold items Appendix C: Budgetary Goals HeROL orts scvss | asepeaa z90'0$ eres oor | zrvs | s166 (5880 21 $88 05 B30 380 ajquieios ¥EETOS 761s, oor | zetts| 867 /700s 70002 (eo pan x ones addy (west) 99°05 oo'ees Oot | _ooees 861/209 "20001 apis 207 wey AeuoH ose) £00°08 8108 oot| _stos| _ape/zogy| deze yes -ds1 % (20 8072) Epos ¥200°0$ zros oor zros 8296/2091 ds S'7T Bupjeq “ds % (20 9T'p) Japmod zoos oots oor| cots B6'T/201'8 dno Bupjeg “ds 4 Far s9°0) eins 900'0$ OE 0S oot OE 0S BLT Hy | sdno 0¢'T aug -dsa xT Cat z2t) anoy asodind zzt0'0$ 19'0$ oor | _ 190s ects | _sdnosz9 ne -dsqu z taiss'é) nop eau ayeaueg 8040'0$ ses oor | yses g6'v/¥s | sdnas7T aloum dna 4 3e24M 21OUN sBuymsas sBuysas 05/1509 _ 05/3509 3 sBuyuas OS }S09D 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| 8zT/SBA0P se saad oot | _‘ayse8 sanoj> z 5e8q UPD ‘Arewasoy pan | (Bee) vst0r0s z60s oor 2605 s7tHBevp “dsqi os ‘dsa1 t | auyesiew aya Hos z9uup wsvt0s wes oot US |_6r'e [$0218 vz saoaid os aoaid t | _ye84m ajoun (20 €€1) saoqejod EL0'05 wes “9 gues 8Y'T/ 2008 sdnp sz dng % | _parseou qaH (20 ost} s10z'0$ sorors %6 86S |__ $1966'0/209T sing sz dng | sueea uaa Tenpiaipui/asoy Sfujntas sdumsas a 05/3509 43 PIOIA % Os/isor dv | 1509 poosmey | —_suntas os quaypasduy wan poo yeror v9.06 So'ZES | yoeus JoUy PIN, JEM 10707 ‘gm pax, ozos e00r$ oot sors | asst /ssinest | (1zt)sdna0s at apinr aiddy ot) az0s wcers res oo'as s30s'/a1t sang os at uojow ‘winypos moj ot-0s szes oor sv9s | _ g6t/sanad zr saraid os west | ‘assay suns TenpIAIpUY uses ‘Hulnies 1 [1809 43 05/3809 43 PIA 0s A809 dv | _ 3502 pooy Mey sduyuas os | sworpos3ut way poos | (o6et) seq 8850°0 6% oot | wees s1og6/zoevo ‘dsqi9 | _paup dsqu x t 170550) zrvo'0s 90% oor] soz gv 0/zoEr'o yea 301 he 4 2 ean Z00'0$ ors oot ores Be T/'dsqL Bet ‘dsqu £ enum “dsq Z (se) 920005, e105 oot | eros ay'e/208y sane yes -dsqu Z saoTeUIOy zszv'os oes veL| e885 | sige /sazaid zt | —_sadaidzor pajaad ze (oy sor) 8850'0$ ves oot | vers} s6:41/20-y tor sai €€ | Ho anyo dsqu ot paddoys z9to'0s 180s ves] wos) set/senop sz Seno ty | 21He8 sano % zr woo g9t0'0s e808 gyo6| _ svos SPOS O/HT paddouy 9% 1 aones | z9'0$ artes | eioL ZELOOS 99°05 oor] 990s 660/889 cr wayeaq 985 17 (41 €0°0) 2apmod TTO0'0$ £50°0$ Oot | esos aLe/saz “ds £80. 2yse8 -dsy (07-0) aaddad 95e|q oTO0'OS zs0°0$ oot | zs0°05 $1286 /20S7'% 433 °T punous “dsy 4 (209) | sssaqp uesaILIeg 90€0'0S ESS oT ests 86'9/2091 ‘dsqL.c paresd dsqi z. (0 Fajsied z90'0 ores oor| ores spge/zozs'0 | siz) 'dsai zt | _paup-dsqu se (709999) | Squinis peaiq g6rr' 0s ers oor | __9ves 89/2057 anoge'g | _ysou dno 47 y9aq punois 8S9€'05 ezers oor | _svers georras ea} wear a1 Z si1eq OW {sBuyntas sBuyias $1 10) ad1304) sBuymios 0s lenpuput /1509 43 | os /A809 43 PIIA% | [A809 dv| 3509 pooymey | sBunsos og s1u1p018u) wan pos FILO | 98°98 qstvss | saw TY e7s BE ents | Heo souUIa Sz0s sez1s (Or setr ‘s6t/16st | (zt) sdn2 05 7 an57 ETmrag 60S. av'ees | feoL Z as[ Trees] aee/se8ueI06 | semuEIO Os amu | 968c'0 aV'6S aoaid | | 20s 2rtts | :e104 He ‘36000 60S Fea] evos[ se t/senop sz Seno Se [se paddous % | oust) 6800 svg oor | ses] __86.¢t/z0y tor dsisz| no anyo-dsix | | ee pue 10 peaug ua peaug g9ezt'o oot agg 86T/ saris OT Seu 0S qeaym ajay | _yeaym ajoym | vos | (zou St) | _ Suisssip 1es9e> a) oor} ors SiPP/20 Be dsquos | _ 994518) dsq1T (70 €¢) | Sse0yp ueseuued szceo z9'ats _oor| _zoers 862/208 ‘ds1 05 parei8 dst T its0) 2800'0 vv 0s sc|__ eeos 51986/ # ST sdng § si2na1a%T| Peles sesoe9 | £0°0S eeT$ inne (20 22) ased 4 svz0°0 ad oot | vets gr t/20ze De mayseds 9 r eysea Osos od'v2$ | HEIL _ iz ~ (2057) ]—— taddad eq | 81200 60 __oot| sorts 51986/2057'7 sty | _punosBdsi xt Appendix D: Nutritional Goal ae Good 4 Sead Wednesday eM LT TS LO MT IM TT ET TAR ‘Brea 272 ‘ 5 ° os ” os aot ° ° 008 ax 0 ow 002 ° ° 005, 904 oa oo 107 aa ase © am on 0a 09, ° ° ° me oz ° ° > ° ° ° oom ° ° ° ° ° ° ° o ° 146 188 ooo 0 907429 0 086 sa a6r 008 ° 0 Bae tra? 138 on 8 ° © 0S ome a7 ae ° ° ° ° ° ° ° ° ° ° ° ° ° o ° ° ° ° 3a oa ° ° 02 ° ose ow ° ° oo as a ° ° ° 033 a68 2 ° o oe 33 ° 009 ora 1st o ° ° ° ° ° 2 6% Hi m% Wednesday ater ay an et aces y PS TE BRET SE EE oe Appendix E: HACCP Flow Chart Appenon ea ea Contamination of bacteria and other unknown diseases. tems should be frozen at proper temperatures to reduce bacterial growth, The quality of product must be inspected for any leakage or tears and excess debris, Any indication of spoilage will be rejected. Find a new supplier. Contamination due to improper handling and storage procedures Always place Poultry on bottom shelves. Keep freezer temps at 40 degrees Fahrenheit. Store freezer temps and logs. If placed on wrong shelf and poultry thawed discard items below it. If Freezer temps rise higher than 40 degrees Fahrenheit freezer must be checked for maintenance. Cross contamination to other ingredients and equipment. Use gloves or minimize amount of hand contact with raw meat. Use clean ‘equipment and sanitize after use. Reject foods that are prepared in un- sanitized equipment. Reject foods prepared by sick employees or did not practice proper hygiene. Remake standard of procedures and educate employees. Bacteria still present due to improper cook temps Raw chicken breast must reach an internal temperature of 165 degree Fahrenheit Adjust thermometer and check oven if working properly. If oven isn’t in working conditions Recook food until optimal temperature is attained in another oven. Contamination by employee who has not washed hands after cooking Place SOP to wash hands before leaving the kitchen area with food and after entering. Manager will observe employee hand washing frequency. All employees will be trained to supervise each other to practice proper hand washing procedures Bacterial growth as a result of incorrect storage. Incorrect labeling of dates. Product must be below 40 degree Fahrenheit and sealed accurately to prevent damage. SOP to label all leftover containers Proper labels on storage containers with dates created correlate to freezer log temps. Do not serve and toss foods past expiration dates or if temperature rise out of storage temoeratures. | Appendix F br? Block Dinner Recipe Menu Item: Com Flake Chicken Nuggets with Garlic Dip Preparation Time: 30 mins Target Market: Seniors, ages 60+ CP- Critical Control Point CCP. Critical Control Points Yield | Yield 100X | Yield Methods at Production HAACP 50X 200% Kitchen Ingredients | Chicken | 20002. | 400 600 oz. | Cut raw chicken breast into | CCP Breast (12.51b) | oz. (251b) | (37.51b) | small pieces ensuring no | cross-contamination. Place into food processor and grind, Transfer to large bowl. | Com Flakes | 500z | 100 150 oz. | Crush comflakes and add to (3.131b) | oz. (6.25Ib) | (9.381b) | ground chicken breast | mixture. Shape the mixture } into small size nuggets. Place in conventional oven for 30 minutes or until internal temps hit 165 degrees Fahrenheit. Roasted 150 /300.cloves | 450 | Cut top ends of bulbs with | CCP Garlic cloves | (30 bulbs) | cloves _| clean knife, Cook in Cloves as (45 conventional oven for 20 bulbs) bulbs) | minutes. Once cooked, mash cloves and mix with mayo, Extra Virgin ] 25 Tbsp. | 50 Tbsp. 75 Thsp. | Drizzle olive oil on garlic | Olive Oil bulbs before cooking, Fat Free 100 200 Tbsp. 300 Add mayo to Garlic Dip and | CP Mayo Thsp. Thsp. | mix. Salt 6 % tsps. | 12 % tsps. 18 4 | Sprinkle on the chicken. ‘tsps. breast/cornflake mixture. Pepper 6 Misps.| 12% tsps. | 18% | Sprinkle the pepper on the tsps. _| chicken breast/cornflake Dmixture Methods of Preparation: Utilize good hygiene practices; wash hands and sanitize work area prior and after handling of raw foods to prevent cross contamination. Heat chicken to 165°F (CCP) Cut end bulbs of garlic in clean cutting board with clean knife. Preparing and Serving: Employees must wash hands frequently and prior to handling food. Employee must wear gloves and switch out after changing tasks Employees must practice good hygiene and wear clean clothes. Unused Portions and Ingredients: Food left unattended at room temperature for more than 2 hours are not considered safe. (CCP) Evaluating Potential Risk: HACCP regulations and guidelines must be followed to prevent microbial growth and cross contamination, Appendix HT Daily Freezer/ Refrigerator Temperature Log Instructions: This log will be maintained for each refrigerator and freezer (both walk-in and reach-in units) in the facility. A designated food service employee will record the time, air temperature and their initials, in the moming and in the aftemoon, It is not necessary to check temperatures of food products but touch several products to be sure they are cold and frozen items are solid to the touch. The food service supervisor for each facility will verify that food service employees have taken the required temperatures by visually monitoring food service employees and reviewing, initialing, and dating a sample of logs each month. Maintain this log for a minimum of three years and until given permission to discard it. Reftigerators should be | between 36°F and 41°F. Freezers should be between -10°F and 0"F, | Month/Year: _ Location/Unit Description: Date Time Temp Emp Time Temp Emp | (aM Initials (PM) Initials | 10 13 15 14 16 17 18 19 20 27 28 Supervisory Employee's Initials and Date: Lecture Project Contract Nutrition 303 I understand it is my responsibility to contribute to each and every section of this project. Moreover, I understand it is my responsibility to participate individually in each session in which the group convenes (either physical presence or information sent via email to group members). Lastly, it is my responsibility to ascertain that this project has been turned in on the assigned due date specified in the syllabus. Failure to conform to the aforementioned requirements will result in the exclusion of my name from this project by the team members and the assignment of zero (0) points towards my grade in this course by the instructor. Team Member Contact Information 1 Corencarle Qrcesoda (GA) 454-4765 zati W @gmet}.com 2. LOUES Baur sir (WAH Srete. 3 ADPIANNR BAUTISTA (WIDSLG- O08 BZD 4.__Mariso) perez. Gov) 22U-d0le- 5, Aina Poleaste Ayia) SIR - 0073 6. Domina CUeas (S58 )3B5-4872 Group Director/Leader Lakeside Manor Rates ave based upon level of care Level 1 ~ $3650 - Minimum Rate Care and supervision 24-hours per day including awake staff at night. Meals, snacks, activities, health maintenance regarding illnesses and reasons to see a physician, assistance ordering, storing and administering medications, bathing, grooming including hair, teeth brushing & shaving (for men), room cleaning ineluding changing bedding, vacuurning, carpet cleaning & dusting and laundry for clothing and bedding. evel 2_- $3950 - Incontinence When a@ resident becomes incontinent an additional $300 per month is added to the Level 4 rate. A resident is consider incontinent if more than once a week there is need to change and wash clothing or bedding or clean up when incontinence has occurred. Level 3_~ #4300 - Increased Daily Living Activity Care We strive to maintain each resident’s ability to perform daily living activities on their own for as long as possible. Daily living activities include selecting clothing and dressing without assistance, feeding one's sel without assistance, walking without assistance and the ability to transfer on one’s own without assistance. If three or more of these daily living activities can no longer be perforraed by the resident without assistance, a 30-day notice will be given to begin Level 3 yates. Level 4 - #4800 or $160/day ~ End of life and Hospice Care End of Life and/or Hospice Cave is provided when a vesicent needs to be attended more often due to their declining health. This level of cave may include but is not limited to: two-hour bed checks, maintenance of a ‘care log! which tracks intake (food & hydration), output (BM, etc.) diaper changing in bed, ‘turning’ or placement in bed, feeding in bed and bathing in bed. Fee changes require a 30-day notice except when incontinence begins and if a resident is placed on hospice. There is an annual increase of 5% if there has been no increase in fees since adraission. There are no refunds. References: 1) Chang CC, Roberts BL. Feeding difficulty in older adults with dementia. J Clin Nurs. 2008;17: 2266-2274. 2) Woods J, Walker K, Iuliano-Bruns S, Straus B. Malnutrition on the menu: nutritional status of institutionalized elderly Australians in low-level care, J Nutr Health Aging. 2009; 13(8): 693-698, 3) Edahiro A, Hirano H, Yamada R, et al. Factors affecting independence in eating among elderly with Alzheimer’s disease. Geriatrics & Gerontology International. 2012; 12): 481- 490. 4) Polzer K. Assisted Living State Regulatory Review 2013. American Health Care Association Website. svww ahcancal.org/ncal/resources: cessed Nov. 25, 2013, jocuments/2013_reg_review.pdf, Published Mar 1, 5) Bernstein M, Munoz N. Position of the academy of nutrition and dietetics: Food and nutrition for older adults: Promoting health and wellness, Journal of the Academy of Nutrition and Dietetics. 2012; 112(8): 1255-1277. 6) Gregoire BM, Food Service Organizations. 7th Ed. Upper Saddle River NJ: Prentice Hall; 2010. 7) Iuliano S, Olden A, Woods J. Meeting the Nutritional Needs of Elderly Residents in Aged-Care: Are we doing enough? The Journal of nutrition, health, & aging. 2013.17: 503- 508. 8) Pasinetii GM, Jun W, Shanee P, Lap H. Calorie Intake, Dietary Lifestyles, Macronutrient Composition, and Alzheimer’ Disease Dementia. Jniernational Journal of Alzheimer's Disease, 2011. (2011): 806293 9) Duncan K. House Plan Room Sizes - Ideal Dimensions for Kitchens. Ezinearticles. N.p. 11 Aug 2011, Web. 10 Dec 2013. . 11) Zeratsky K. Is it possible to take too much vitamin C2, Mayo Clinic. Nip. 13 Jl 2013. ‘http://www mayoclinic.com/health/vitamin-c/ANOL801>, 12 Aging and immunity - Impact of behavioral intervention, Brain, Behavior, and Immunity. (2013): 1-15. Print 13) Silva F, Gibbs P. Non-proteolytic clostridium botulinum spores in low-acid cold- distributed foods and design of pasteurization processes. Trends in Food Science & Technology. 2010; 21(2): 14) Doets EL, Cavelaars A, Dhonukshe-Rutten R, Veer P, Explaining the Variability in Recommended Intakes of Folate, Vitamin B12, Iron and Zine for Adults and Elderly People. Public Health Nutrition. 2012; 15.5: 906-915. } t woo ue Lecture Project Grading Criteria Part. DESCRIPTION a, establishment & services offered Purpose of operation is clearly stated, Establishment is described by how food is procured (any key purchasing, receiving and inventory methods) produced (type of system, number of labor, production hours) and/or served (hours of service, method of service or distribution). The patron should also be described by their dietary needs and preferences. Relevant and current citations are used in the description. ', menu type & output volume Menu type, meal pattems/periods and output volume (atleast $0 served per meal period) ate clearly stated and are appropriate for the syle of service andior type of establishment. ABP A: Sample Menu contains 5-6 meals that have at least 2reeipeitems each. Choices are appropriate end feasible forthe description of establishment and services offered in terms of volume and facility resources. Menu is word-processed and demonstrates some level of creativity to express the,style of the establishment, For food tracks and farmer's markets, refer to jour notes as per directions given in class. Bech Prereda f «facility space & equipment ‘Space required and equipment summary is stated and is appropriate for the establishment and menu. APP B: Equipment is listed in @ table that includes its function in menu execution. Each menu item/recipe is represented in the table. Part If, GOALS budgetary goat Budgetary goal is stated in a measureable terms (% food cost, cost of food, sales per meal/day/week, etc), corresponds to the ‘menu pattern, and is expressed appropriatcly for the type of establishment according to current and relevant citations. The strategies (foods used, pricing factors) used to meet budgetary goals are clearly discussed in the text of the project. APP C: Raw AP cost, yield percentage and AS (EP) cost for each ingredient used in all meals (yield atleast 50) for ONE day is clearly displayed in one table/page per meal and is subtotaled for every recipe. Meal average is totaled and highlighted. Best efforts to determine wholesale costs are made (source of prices are cited). Cost per ingredient is expressed in appropriate purchasing units. Determination of menu price is shown if applicable. Specification details are provided for each ingredient. In the heading of each table, the budget goal, and the actual cost are shown. ¢. nutritional goal ‘Nutritional goal is stated in a meusureable terms (% keals from specific macronutrients, limited to, or at least X gig of any macro/micronutrient, % of DRI, food groupsiservings, or any other claim per meal/day/week), corresponds to menu pattern, and is expressed appropriately for the type of establishment according to current and relevant citations. The strategies used to ‘meet nutritional goals are clearly discussed. APP D: Pertinent nutrition content for one serving is obtained from a computritional database (data base used is cited, and you ‘need to include the printout of the analysis inthe appendix) for each meal for ONE day. It is clearly displayed in one table/page per meal and is subtotaled for every recipe. Meal average is totaled and highlighted. Heading of each table contains the nutritional goal, the actual performance, % DRI etc. For food trucks and farmer's markets, refer to your notes as per

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