SALLY GRACE REED February 14, 2014 Sage Graduate School Dietetic Internship Menu & Theme Meal

Project

Customer Satisfaction Survey

Per request of the dietary manager, a dining services review of patient satisfaction was conducted within the facility. The customer service satisfaction survey used was an existing MFA document and was conducted for the current 4-week cycle menu. Out of 120 long-term care and rehab patients, 30 patients were interviewed. These patients were chosen by the nursing staff as good candidates with no known altered mental status and able to give clear and concise answers. Out of the patients interviewed, 23 were female and 7 were male. The following questions were included on the customer satisfaction survey: - Do you enjoy your meals? - If receiving a therapeutic diet, has anyone explained your diet to you? - DO the meals look appetizing? - When you are served hot food is it hot enough for you? - When you are served cold foo dis it cold enough for you? - Is the meat tender? Are you able to chew your meat easily? - Are your food preferences honored? - Are you offered an alternative if you eat <75% of a food item? - Do you receive enough to eat? - Are your meals delivered promptly? - Are you receiving enough assistance with your tray and with eating your meal? - Are you offered a snack between meals? Patients answers were scored using a point system, if the was answer yes then that received 1 point, no earned 0 points, and a response of sometimes earned .5 points. The total scored was divided by the total number of questions answered and then multiplied by 100 to obtain the final score, with a goal of 90% or greater. The lowest score received was a 27% and the highest was 87%, with the average score being 63%. The most common complaints included food temperature, time spent waiting for food, and never being offered the alternative menu entre. Most patients reported enjoying their meal sometimes, and only a few reported never enjoying their meals. Residents were also dissatisfied with the lack of variety of food choices and having too many starchy food choices. Some residents thought that the existing food pairings or menu combinations were strange and not appetizing. Most residents interviewed communicated the desire for southern and soul food. Additionally, it was noted that there is a lack of gluten free and vegetarian options on the current menu. Although there are only about 5 patients with moderate wheat sensitivities, those residents should be offered the same variety of choices at each mealtime. There are no gluten-free grains kept in stock with the exception of rice. A vegetarian patient would find it hard to have a well-balanced meal with the current menu since every single meal includes an animal protein, with limited non-animal protein choices. In order to reduce waste and protect the environment, Beaufont could cut down on

food wasted at mealtimes, consider ways to use extra food, go trayless, purchase products made with recycled content and ensuring proper storage techniques. Changing the menu to increase customer satisfaction saves money and resources by reducing the amount of food left uneaten. Proper storage techniques are critical to reduce spoilage. As each shipment of food and kitchen supplies comes in, they should be labeled and stored appropriately. Additionally, once food items have been opened, the open date should be noted on the container. My preceptor and I discussed the findings from the customer satisfaction survey, both positive and negatives, and brainstormed ways to improve the menu. A new one-week menu was developed for all three meals served at Beaufont; breakfast, lunch and dinner. This proposed menu was designed to meet the cultural and flavor preferences of the residents as well as their nutritional needs. One meal was chosen as the theme meal, to try out a new recipe during lunchtime. All recipes had to be chosen from an existing recipe bank using the Meal Tracker software that MFA facilities use nationwide.

Medical Facilities of America, INC. Dining Services Policies & Procedures Manual MFA facilities use a 4-week cyclic menu, which is developed by a group of dietary managers, cooks and cooperate dietitians. Additionally, menus cycles are matched to the seasons so that food can be purchased at reasonable prices. Menus are be prepared based on DRIs, USDA my food pyramid and dietary guidelines for Americans and are required to have a variety of texture, taste, color and temperature. In general, a 2000-calorie a day menu is recommended, with a 1600-calorie minimum and 2500-calorie maximum, unless otherwise noted by a residents physician. Dessert is included for every lunch and dinner meal, and is included in the total nutrient intake of the meal. When developing a new one-week menu, I considered the patient satisfaction surveys as well as the demographic of the long term care facility. The average age at Beaufont is 82.86 years old, with most patients being female. Most individuals living in long term care desire to eat the food that they are used to eating, and a large majority of patients have liberalized diet orders. Although about 25% of the long-term residents have comfort care orders and eat mostly for oral satisfaction, the rehab patients often need therapeutic diets tailored to recovery and rehabilitation. Every resident stated a desire for warm, comfort food that they are used to consuming at home. It is often hard to get long-term care patients to try new things or branch out from their favorite food items. The Dietary Guidelines for Americans 2010 outlines three major goals for Americans: balance calories with physical activity to manage weight, consume more of certain foods and nutrients such as fruits, vegetables, whole grains, fat-free and low-fat dairy products, and seafood, and consume fewer foods with sodium (salt), saturated fats, trans fats, cholesterol, added sugars, and refined grains. Additionally, weight maintenance was considered a primary factor in menu planning. Weight loss can be very serious for residents in long-term care and rehab, making putting together a pleasing menu very important so that the residents will eat the food they are served. Creating appealing meals that residents will desire to consume can prevent and/or offset sudden weight loss and unintended weight loss. Males: 31-50 y 51-70 y > 70 y Females: 31-50 y CHO 130 g/d Protein 0.66 g/kg/d Cholesterol Total Fat <200 25-35% mg/day Sat Fat <7g Calcium 1000 mg/d Sodium <2300 mg/day Fiber 25 g/d CHO 130 g/d 130 g/d 130 g/d Protein 0.66 g/kg/d 0.66 g/kg/d 0.66 g/kg/d Cholesterol <200 mg/day <200 mg/day <200 mg/day Total Fat 25-35% 25-35% 25-35% Sat Fat <7g <7g <7g Calcium 1000 mg/d 1000 mg/d 1200 mg/d Sodium <2300 mg/day <2300 mg/day <2300 mg/day Fiber 38 g/d 30 g/d 30 g/d

51-70 y > 70 y

130 g/d 130 g/d

0.66 g/kg/d 0.66 g/kg/d

<200 mg/day <200 mg/day

25-35% 25-35%

<7g <7g

1200 mg/d 1200 mg/d

<2300 mg/day <2300 mg/day

21 g/d 21 g/d

New One-Week Menu & Theme Meal When comparing the facilities guidelines and regulations for menu development and the nutrition information of the new one-week menu, the new menu meets the majority of required criteria. The overall goal of the new menu was to allow residents to continue to enjoy the foods that they love, while giving them a variety colors and tastes for each meal. This goal was achieved as each meal includes items that residents indicated they enjoy and would consume. Instead of having three starchy sides at each meal, non-starchy vegetables were incorporated into the meal along with whole grain food items. Each meal was to have at least a serving of dairy, grain (preferably whole), low to medium fat protein, starchy vegetable, non-starchy vegetable, and limited additional fat servings. Although milk is not specifically served during lunch, cheese is often a part of the meal and most residents drink milk with all meals. Residents also have two snacks a day at 10:00 am and bedtime. These snacks often include yogurt, cheese and crackers, milk and/or peanut butter crackers. The nutrient content of snacks was not included in the overall nutrient analysis since each resident receives an individualized snack. (See section 5 for specific nutrient analysis discussion). Residents are allowed to choose 2 additional beverages at meal times including coffee, tea, and fruit juices. These secondary liquids may add additional calories and nutrients depending on the residents choice, but were not included into the nutrient analysis. Dessert for lunch and dinner was also not included on the new menu and thus was not counted into the total caloric or other nutrient analysis. Most grains in the new menu were switched to whole grains, and the overall amount of red meat/beef was reduced to reduce the amount of saturated fat served. If the calorie content from desserts for lunch and dinner is added into the new menu, the overall calorie estimation per day would be adequate to meet the majority of residents needs. Additionally, some margin of error should be considered since the exact foods used at Beaufont could not always be found on the USDAs Supertracker. The production of the new menu is feasible, since the recipes were taken from an existing pool of MFA recipes. All of the required equipment is available in the kitchen and the recipes coordinate with specific food items that can be ordered from the existing food provider. Some of the recipes may require more preparation steps, or may need to be prepared differently than previous recipes. For example, less butter and margarine is used during preparation of the new recipes and more olive oil is used. Aesthetic appeal was taken into consideration when preparing the revised oneweek menu. For each meal, the goal was to have a colorful plate with several different textures. For example, Sundays dinner of lasagna was paired with green beans and garlic bread to give a variety of color (red, brown, yellow, green) and textures. Appropriate pairings were also thought out such as pairing meatloaf with mashed

potatoes instead of French fries. In order for the new menu to be put into place, it would need to be approved by the corporate dietitians and dietary staff.
*WW= Whole wheat **Along with drink served, residents are allowed to choose their own beverage

BREAKFAST Orange Juice- 4 oz. Milk- 8 oz. Oatmeal- c. Sausage Links- 2 ea. WW pancakes- 2 ea. Margarine- 1 T Syrup- 2 T

LUNCH Water- 8 oz. Baked tilapia w/ lemon butter sauce- 3 oz. Brown rice- c. Stewed tomato-1/2 c. WW role- 1 sm. Margarine- 1 T Sliced peaches- c. Water- 8 oz. Herbed pork chop- 3 oz. Hash brown potatoes c. Seasoned yellow squash- c. WW role- 1 sm. Margarine- 1 T THEME MEAL TASTE TEST TUESDAY Water- 8 oz. Lemon Tarragon Salmon- 4 oz. Roasted purple potatoes- c. Sauted Asparagus- c. WW roll- 1 ea Margarine- 1 T Water- 8 oz. Roast Turkey- 2oz. Gravy- 2 oz. Cornbread stuffing- c. Peas- c. Copper Carrots- c. Water- 8 oz. Hot dog w/bun- 1 ea. Baked beans- c.

DINNER Milk- 8 oz. Lasagna- 1 square Green beans- c. Garlic bread- 1 ea. Fruit salad- c.

SUNDAY

MONDAY

Orange Juice- 4 oz. Milk- 8 oz. Scrambled Egg- 2oz. Bacon- 2 sl. WW Toast- 1 sl. Margarine- 1 Jelly- 1

Milk- 8 oz. Toasted sesame chicken- 4 oz. Creamed Corn- c. Seasoned broccoli- c. Au gratin potatoes- c.

TUESDAY

Orange Juice- 4 oz. Milk- 8 oz. Boiled Egg- 1 ea. Breakfast ham- 2 oz. Corn Flakes Cereal- 1 c.

Milk- 8 oz. Meatloaf- 3 oz. Tomato Sauce c. Turnip greens c. Mashed potatoes- c. WW role- 1 sm. Margarine- 1 T

WEDNESDAY

Orange Juice- 4 oz. Milk- 8 oz. Scrambled egg- 2 oz. Sausage patty- 1 ea. Biscuit- 1 ea.

Milk- 8 oz. Cheese Ravioli w/ marinara sauce- 9 oz. Green beans- c. Tossed garden salad- 1 c. Dinner roll- 1 ea. Milk- 8 oz. Salisbury steak- 2 oz. Gravy- 2 oz.

THURSDAY

Orange Juice- 4 oz. Milk- 8 oz. Oatmeal- 1 c.

Sausage Links- 2 ea. Boiled egg- 1 ea.

Potato salad- c. Chili- c.

Pinto beans- c. Asparagus- c. WW roll- 1 ea. Milk- 8 oz. Beef burgundy- 4 oz. Cauliflower/broccoli blend- c. Bowtie pasta- c. Breadstick- 1 ea. Pears- c.

FRIDAY

Orange Juice- 4 oz. Milk- 8 oz. Scrambled Egg- 2oz. Bacon- 2 sl. WW Toast- 1 sl. Margarine- 1 Jelly- 1

Water- 8 oz. Tomato soup- 6 oz. Ham & cheese sandwich with lettuce1 ea. Tossed salad w/tomato and carrots1 C. Dressing- 1 T. Water- 8 oz. BBQ Pork on bun- 2 oz. Coleslaw- c. Baked sweet potato wedges- c. Fresh Fruit- 1 ea.

SATURDAY

Orange Juice- 4 oz. Milk- 8 oz. Cheese egg omelet- 3 oz. Sausage patty- 1 ea. Biscuit- 1 ea.

Milk- 8 oz. Chicken Parmesan- 6 oz. WW Penne Pasta- c. Pacific blend veggies- c. Dinner roll- 1 ea. Sliced pineapple- c.

4
5

Supervise the design of theme meal, work with head cook, prepare and quality test two entre items, present results to preceptor. Nutrient Analysis

In order to determine if the new menu fit into the required criteria, the USDAs Meal Tracker was used to calculate calories, protein, carbohydrate, cholesterol, total fat, saturated fat, sodium and fiber. As mention previously, some margin of error should be taken into consideration when estimating nutrient content since the Supertracker does not import specific recipes and ingredients from the MFA facilities recipe book or ordering log. When comparing the theme meal to the meal that it is replacing, the theme meal had an overall butter nutrient profile. The regular lunch that was served included 6 oz. of sweet & sour pork, cup blended vegetables, cup of sticky rice, 1 dinner roll and 1 tablespoon of margarine. The theme meal consistent of 4 oz. of lemon tarragon salmon, cup roasted purple potatoes, cup sauted asparagus and 1 whole wheat bread roll. The regular meal/meal being replaced has 537 calories, 17 grams of protein, 65 grams of carbohydrate, 40 mg of cholesterol, %40 total fat, 7 grams of saturated fat and 1675 mg of sodium, 6 grams of fiber. The theme meal has 493 calories, 34 grams of protein, 36 grams of carbohydrate, 72 mg of cholesterol, 45% total fat, 4 grams of saturated fat, 988 mg sodium and 6 grams of fiber. The fat in the theme meal is from the salmon, which is a good fat rich in omega-3 fatty acids. The theme meal also has more protein, less saturated fat, and less sodium.

An overall analysis of the revised menu indicates that most RDA/DRIs for the selected age group as well as facility guidelines/regulations were met. When looking at the nutrient analysis charts below, the average daily calorie intake is below the facilities recommended minimum of 1600 calories. However, dessert is served with both lunch and dinner and this food item was not included on the new menu. Adding a dessert into two meals out of the day would not only increase calories, but also it would also increase the total fat percentage, which is not always desired. Increasing the portion sizes of any fruit and/or vegetable serving from cup to 1 cup could increase total daily calorie intake. This would increase the nutrient and caloric density of the meal without adding fat or saturated fat. Menu entrees that include could also be increased in portion size to increase calorie and protein content, without drastically increasing the saturated fat content. For both males and females ages greater than 31 years old, 0.66 g of protein/kg/day is recommended. This estimation is for patients with a regular diet only. With weights ranging anywhere from 45 kg to 90 kg, protein needs for individual patients ranges from 30 grams to 60 grams a day. The amount of daily total protein for the new menu from Sunday to Saturday sequentially is 59 grams, 66 grams, 91 grams, 70 grams, 78 grams, 81 grams, and 115 grams. This indicates that protein needs for most patients is most likely being met every day, especially since only one day provides less than 60 grams of protein and individuals with greater needs often get nutritional supplements. The revised menu exceeds the recommended 130 grams of carbohydrate a day for each day of the week, which is consistent with the regular menu currently in place. The highest amount of carbohydrate would be served on Sundays, with a total of 226 grams. Individuals on diabetic diets would be controlled to not exceed the recommended 3 to 5 servings, or 30 to 75 grams, depending on their gender and disease status. The main sources of carbohydrate from each meal include the 1- cup serving of grain, dinner roll, milk, and any fruit served. Although the new cholesterol guidelines have changed to recommend several options based on an individual's risk of a heart attack or stroke and not just a single number, the recommendation to keep daily cholesterol intake less than 200 mg/day is used in this facility. This was achieved on every day except Tuesday, Wednesday and Thursday. Tuesday and Thursday both had the highest amount of cholesterol served at breakfast, where both eggs and either sausage or breakfast ham were on the menu. Wednesdays dinner had the highest amount of cholesterol due to the cheese ravioli. The recommendation for total fat is to be between 25-35% of the daily intake of calories. This was exceeded with almost every meal on the revised menu. The highest total fat content on the new menu was Mondays lunch at 56% total fat and the lowest was Friday and Saturdays dinners at 20% total fat. Most of the breakfast meals include sausage and/or bacon, both of which are sources of fat. Although turkey bacon and turkey sausage would be good alternatives, the population at Beaufont would not accept these items. Instead of using margarine for dinner rolls and preparation, the facility should consider switching to olive oil and plant based butters if possible. This would reduce the total fat concentration of every meal. Saturated fat No more than 2300 mg is the daily goal for sodium consumption. Out of every day on the revised menu, only Monday came close to this goal at 2501 total mg of sodium. In order to decrease the amount of sodium in the individual meals and daily totals, all

vegetables used, both canned and frozen, should be low sodium. Canned beans and corn should be drained and rinsed prior to use. Any broth or soup should also be purchased as a low sodium product. Additional salt used during preparation should be kept to a minimum. Adults greater than 30 years old have a range of fiber needs from 21-38 grams per day. For older adults who require less fiber in their diet, a special diet order would be authorized to keep their intake within the desired amount. The average amount of daily fiber in the new menu is 16 grams per day. In order to increase the amount of fiber consumed, residents could choose bran and whole grain cereals and increase the portion sizes of fruits and vegetables. SUNDAY BREAKFAST LUNCH DINNER TOTAL MONDAY BREAKFAST LUNCH DINNER TOTAL TUESDAY BREAKFAST THEME MEAL ALT. LUNCH DINNER TOTAL (w/theme) KCAL 705 449 520 1674 KCAL 501 524 466 1491 KCAL 456 493 537 620 1569 PROTEIN 23 g 15 g 21 g 59 g CHO 94 g 59 g 73 g 226g Cholesterol TOTAL FAT 74 mg 36 % 19 mg 36% 30 mg 29% 123 mg --Cholesterol TOTAL FAT 30 mg 39% 21 mg 56% 56 mg 33% 107 mg --Cholesterol TOTAL FAT 252 mg 30% 72 mg 45% 40 mg 40% 81 mg 39 % 405 mg --SAT. FAT 17 g 4g 8g 29 g SAT. FAT 6g 8g 7g 21 g SAT. FAT 5g 4g 7g 8g 17 g SODIUM 927 mg 674 mg 1138 mg 2739 mg SODIUM 880 mg 773 mg 848 mg 2501 mg SODIUM 1124 mg 988 mg 1675 mg 1466 mg 3578 FIBER 5g 4g 6g 15 g FIBER 2g 6g 6g 14 g FIBER 1g 6g 6g 9g 16

PROTEIN CHO 24 g 14 g 28 g 66 g 54 g 47 g 54 g 155 g

PROTEIN CHO 28 g 34 g 17 g 29 g 91 g 53 g 36 g 65 g 67 g 156 g

Meal Theme Meal is Replacing (Regular Lunch): Sweet & Sour Pork- 6oz, Kyoto Blend Vegetables C., Sticky Rice C, Dinner Roll- 1ea, 1 T margarine WEDNESDAY BREAKFAST LUNCH DINNER TOTAL KCAL 402 393 562 1357 PROTEIN CHO 20 g 23 g 27 g 70 g 42 g 43 g 72 g 157 g Cholesterol TOTAL FAT 33 mg 38% 65 mg 34% 170 mg 29% 268 mg --SAT. FAT 6g 4g 8g 18 g SODIUM 643 mg 902 mg 2053 mg 3598 mg FIBER 1g 7g 6g 14 g

THURSDAY BREAKFAST LUNCH DINNER TOTAL FRIDAY BREAKFAST LUNCH DINNER TOTAL SATURDAY BREAKFAST LUNCH DINNER TOTAL

KCAL 485 619 419 1523

PROTEIN 24 g 25 g 29 g 78 g

CHO

Cholestero l 54 g 242 mg 67 g 91 mg 56 g 43 mg 177 g 376 mg

TOTAL FAT 36 % 41 % 22 % ---

SAT. FAT 7g 10 g 4g 21 g SAT. FAT 6g 8g 4g 18 g SAT. FAT 8g 6g 5g 19 g

SODIUM 454 mg 2126 mg 974 mg 3554 SODIUM 880 mg 1733 mg 325 mg 2938 mg SODIUM 1322 mg 942 mg 1044 mg 3308

FIBER 4g 8g 9g 21 g FIBER 2g 5g 7g 14 g FIBER 1g 9g 8g 18 g

KCAL 501 525 555 1581 KCAL 518 507 633 1658

PROTEIN CHO 24 g 22 g 35 g 81 g 54 g 53 g 72 g 179 g

Cholesterol TOTAL FAT 30 mg 39% 56 mg 44% 55 mg 20 % 141 mg --Cholesterol TOTAL FAT 41 mg 34% 46 mg 23% 108 mg 20% 195 mg ---

PROTEIN CHO 37 g 23 g 55 g 115 g 49 g 77 g 72 g 198 g

Reducing Waste/Protecting the Environment

For the theme meal, no trays were used in the dining room for food service. This cut down on the amount of water by half needed for dishwashing and time spent washing dishes. This was a challenge because the facility always uses trays, however since the lunch meal was served from a hot line in the dining room, trays were not necessary. Some of the staff was worried that not having trays would increase the amount of time spent serving lunch, but this did not end up being a problem. The West wing uses trays more frequently due to most of their residents eating in their own rooms. CNA staff was able to help residents get their plates, serve everyone drinks and side salads if desired and then serve the plated entre. Clean up was done easily by bringing a bussing cart by each table with bins for silverware, food waste, bowls, plates and linens. The bussing cart was then pushed to the dining room and dishes sent through the dishwasher.

Theme Meal Marketing & Advertisement

Due to the nature of long-term care, minimal marketing is usually done for special events. A calendar is made at the beginning of each month and posted on both the West and East wings of the building. The activities director is in charge of putting together the calendar and making the residents aware of events during the month. The theme for the day was placed on the calendar and a flyer was created and posted in each of the halls. On

the day of the taste test, the receptionist announced over the loud speaker that a new menu item could be tasted during lunchtime. Flyer for East & West hallways:

Come try a new menu entre for lunch!

I was able to make the February Calendar with the help of the activities director and posted both in small (8x11) and large format (bulletin board):

Budget, Equipment Order and Recipe Cost Market Unite Cost Quantity needed for recipe Total cost (price
per amount to be used, not cost of total order)

Food/ingredients Specifications Market needed for Unit Size Theme Meal

Lemon juice Tarragon Reduced Fat sour Cream Salmon

Asparagus New potatoes Whole Wheat dinner roll

Individual plastic containers Spice tarragon leaves, whole Cultured, grade A Skinless, boneless, vac pac loins, no napes, no tails Whole, fresh Potato red exterior color Dough roll, wheat

12 containers/ 32 oz. each 3.5 oz. 10 lb (160 oz.) 10 lb

$22.44/case $9.28/each $12.78/case $53.09 /cases $25.02 /case $24.95 / case $30.49 /case

5 cups/ 40 oz. 1.25 cups/ 10 oz. 120 oz. 480 oz./ 30 lb 480 oz./ 30 lb 480 oz./ 30 lb 120

In stock $26.51 $9.59 $159.27

24 lb 50 lb 240 rolls/ 1.25 oz. each

$31.28 $14.97 $15.25

Total Cost of meal: $256.87 Cost/Person: $2.14 Food/ingredients Specifications Market needed for Meal Unit Size Being Replaced Market Unite Cost Quantity needed Total cost
(price per amount to be used, not cost of total order)

Pork

Sweet & Sour Sauce Kyoto Blend

Butcher block brand pork chop, center cut Plastic container Edamame

160 oz.

$27.10/case 720 oz.

$121.95

4 gallons 15 lbs

$46.59/case 1 gallon $26.00/case 30 lbs

$11.65 $52.00

Vegetables

Sticky rice Dinner roll

soybeans, broccoli florets, julienne carrots, cut corn, diced red peppers Bags 25 lbs Pre-portioned 300 rolls/ 1.12 oz each

$13.39 30 lbs /case $20.75/case 120 rolls

$16.07 $8.30

Total Cost of meal: $209.97 Cost/Person: $1.75 The total cost of the theme meal is $0.39 more expensive than the meal being replaced, however, the theme meal has more nutritional value. The most expensive item of the theme meal is the salmon, at $53.09 for 10 lbs. In order to maintain nutritional value, but decrease cost, the facility could consider using a cheaper fish such as tilapia. The wholewheat rolls are also more expensive, at $0.13 per rolls. The regular, white bread dinner rolls are only $0.07 per roll. The whole, fresh asparagus was less expensive per pound than the frozen blended vegetable mixed used for the regular menu item. The total department budget of $26, 712.840 per month based on a department PPD of 8.673 is divided into multiple categories including dairy, meat/fish/poultry, bakery, frozen/grocery/produce, coffee/tea, pre-thickened liquids, china/small wares, cleaning, disposable, other supplies, supplements and purchased services. The dietary manager often saves money within the monthly budget in order to splurge and buy a few higher qualities food products, such as salmon for a special meal. Also, not every month new disposable items and purchased services are needed, which can save around $2500 per month. Equipment Order Equipment Needed Oven Sautee pan Whisk Dinnerware/Utensils In Stock/Standard Kitchen Supply? Yes Yes Yes Yes

No new equipment was needed to make the theme meal since all recipes were derived from the standardized recipe book specifically for the facility.

Recipe Cost for Theme Meal- Lemon Tarragon Salmon (serves 120 people) Ingredient Amount Purchase Case Cost Unit Cost= Total Cost= Case Amount x Unit Needed Size
Cost/Amt in case Cost

Salmon Tarragon Sour Cream

3.5 oz. 10 lbs/160 oz. Lemon juice In stock Salt In stock Pepper In stock Olive Oil In stock Total recipe cost for Lemon Tarragon Salmon: $194.99 Total cost/person: $1.62

480 oz./ 30 lb 10 oz. 120 oz./ 15 cups 5 cups To taste To taste

10 lbs

$53.09 /cases $9.28/each $12.78/case

$5.30 per lb $2.64 per oz $0.08 per oz

$159.00 $26.40 $9.59

Although the cost of salmon is higher than other meats used, this menu entre would only be served once every 4 weeks and therefore would fit into the total budget of $5,636.00 (PPD 1.830) per month for meat, fish and poultry

Planning schedule:

Food Prep & Cooking for theme meal Task Preheat oven for salmon & potatoes Whisk together lemon juice, tarragon and sour cream. Time Allotted 1 minute 5 minutes Responsible Individual Sally Sally Sally

Season salmon with salt and 5 minutes pepper and then spread sour cream mixture over salmon Wash and chop potatoes into 10 minutes quarters Season potatoes with olive oil, salt and pepper Spread potatoes on cookie sheet and roast in oven Place dinner rolls on cookie sheet & bake 5 minutes 30-40 minutes minutes 15-20 minutes

Dot Dot Dot Sally

Bake fish Wash and chop ends from asparagus Heat olive oil on stove top & saut asparagus until tender Meal Service (Lunch) Task Build trays for west wing, package items for east dining room Deliver tray cart to west wing Deliver trays to residents on west wing Deliver hot line items to east wing dining room Take drink orders & serve salad/soup if desired Dish food & Serve from hot line in east wing dining room Clean Up Task Clear tables in east dining room onto bussing cart Pull bussing cart to kitchen Place linens in laundry cart Collect trays from west residents rooms, place in tray cart Bring tray cart from west wing to kitchen Put all dirty dishes through

20-22 minutes until opaque throughout 5 minutes 5-10 minutes

Sally Dot Dot

Start time/Time Allotted 11:10am/30 minutes

Responsible Individual Antoine, Sally, Jean

11:40am/5 minutes 11:45am/15 minutes 11:40am/5 minutes 11:45am/15 minutes 12:00/1 hour

Charles CNA Shocka CNA, Sally, MOD for mealtime Shocka, CNA, Sally, MOD for mealtime

Time Allotted 20 minutes 5 minutes 5 minutes 10 minutes

Responsible Individual CNA, Sally, MOD for mealtime Shocka CNA CAN

5 minutes 30 minutes

Charles Antoine

dishwasher Put away clean dishes Roll silverware for dinner meal 20 minutes 20 minutes Antoine Sally

10 11

Supervise theme meal from ordering to preparation and serving.

Post Theme Meal Customer Satisfaction Survey

In order to conduct and evaluate a post theme meal customer satisfaction survey, a brief survey was designed. The post theme meal survey included questions such as: Did you like the baked salmon? Would you eat the salmon again? Did you like the roasted new potatoes? Would you eat the new potatoes again? Did you like the asparagus? Would you eat the asparagus again? Did the meal look appetizing? Was the meal hot enough?

Out of 23 people surveyed, 18 people liked the salmon, 15 would have it again and 4 disliked it, 22 liked the new potatoes and would have them again, with only 1 person disliking the dish, 20 liked the asparagus, 12 would have it again and only 3 disliked the side dish, 15 people both liked and would have the whole wheat roll again and 8 did not like the roll. Most people commented that they would enjoy more fish on the menu and were appreciative of a change. Everyone who ate in the dining room was pleased with the temperature of their food and felt that the lunch service was on time. Based on the survey results, I would consider serving both whole and white wheat dinner rolls and switched to tilapia as the main protein. The roasted new potatoes could also be added as a more frequent side dish, since so many residents enjoyed them.

25 20 15 10 5 0 Salmon Potatoes Asparagus Whole Wheat Roll Liked it Would Have Again Disliked it

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Summary/Individual Reflection

The first step of this project was to discuss possible themes with my preceptor. The only major holiday during my food service rotation was Valentines Day and there were already several activities planned for that day. My preceptor suggested doing a taste test of a new recipe since the menu planning committee was meeting to create the new 2014 menus. After deciding to call my theme meal lunch, taste test Tuesday, I thoroughly browsed the approved recipe list on Meal Tracker to choose items that I felt would be tasty and healthy. I ended up choosing two recipes to test, lemon tarragon salmon and oven-fried tilapia. My preceptor and I tested out both recipes and did a small taste test during activities. We allowed nurses and members from the management team to also taste the two different fish entrees. The results from the first, smaller taste test were used to pick the main dish for actual theme meal and the side items were then chosen. On the day of the theme meal lunch, several announcements were made over the intercom that residents could choose to eat the new menu item or eat the regular lunch and sample a small portion of the lemon tarragon salmon. The food preparation for the lunch meal went smoothly since the preparation schedule was set ahead of time (see section 9 for specific schedule) and since the recipe was tested out several days prior on a smaller scale. In the future, the head cook might be resistant to trying new recipes if she was asked to complete the task on her own, but since I was helping she was more willing to cook new items. My preceptor commented that usually when there is a change in the menu or a change in the type of foods prepared in the kitchen there is a lot of push back from her staff. Learning new cooking techniques and using new food items often requires more effort and more production time initially. The nutritive value of the theme meal was moderate to high. The theme meal has 493 calories, 34 grams of protein, 36 grams of carbohydrate, 72 mg of cholesterol, 45% total fat, 4 grams of saturated fat, 988 mg sodium and 6 grams of fiber. Salmon is a protein item that is not commonly served at Beaufont but contains healthy omega-3 fatty acids. Asparagus is a good source of dietary fiber, protein, vitamin A and vitamin C. Overall, the theme meal was a success and had many positive outcomes. Residents were excited to try new foods and glad for a change of pace. Staff members were also excited to see healthier food options served, since they are able to eat meals at the facility if desired. Several people who seemed hesitant to try salmon were surprised by the flavor and appeal. Serving the meal out of the dining room ran smoothly, although CNAs and some dietary staff would benefit from an in-service discussing what the diet orders mean. In the future, I would give all residents a sample of the new menu item on their tray so that more people might try the new item. Changing the menu in a long-term care facility is a long process that involves many groups to work together. Since the entre options at meal times is limited to the regular entre and one alternative entre, making appealing menu choices is vital for customer satisfaction. As a full time RD working in long term care, I think it would be easier to make an impact on the menu versus just working as an intern. The goal of medical nutrition therapy is different in long-term care than acute or critical care; patients are allowed to consume a more liberalized diet instead of strict diet instructions. This means that there is

more flexibility when planning menus and evaluating them for nutritional content.