Food Service Management Project

Monday, October 13, 2014

MedStar Montgomery Medical Center

Katie Meade and Hilary Smith

We are…

Golden Girls Nutritional Consulting Group, LLC

Providing Long-Term Solutions for Long-Term Care

Image source: http://www.seniorcareinc.org/nutrition-3.html

Golden Girls Nutritional Consulting Group, LLC

Geriatric nutrition experts Specialize in long-term care facilities, nursing

homes, and assisted living centers Develop innovative, budget-friendly menus

for individuals of all dietary requirements and restrictions

Goal: To promote client satisfaction by creating a pleasurable dining experience

Current Project

Hired by Grace Gardens Long-Term and Adult Care Facility to improve: Meal service efficiency Cost-effectiveness Sustainability Resident satisfaction

with mealsImage source:

http://www.foodservicedirector.com/archive/archived-content/articles/changing-face-long-term-care

Deliverables

Create new menus for the residential care, adult day care, and dialysis center

Decrease menu cost per day Develop satellite kitchen for adult day care

and replace main kitchen equipment Re-evaluate RD staffing and scheduling Propose new sustainability practices

Grace Gardens Located in Baltimore/Washington Area Compassionate, comprehensive, individualized care Services offered

High-quality medical services Skilled rehabilitation therapy Nutrition therapy 300-bed residential care Five-chair dialysis center Adult day care program

Image source: http://www.quarryhill.org/lifestyle/photo-gallery

Grace Gardens Amenities

Paved walking paths On-site laundry Salon/barbershop Community library Social and recreational therapy activities

Exercise groups Cooking classes Day trips Game nights

Long-Term Care Residents

Age 65 and over with average age of 85 70% of residents are female 40% of residents have Alzheimer’s disease

or dementia 25% of residents have depression 40% need assistance with at least one ADL 20% need assistance with eating

Adult Day Care Program

7:30 AM to 5:00 PM Monday through Friday Provided with breakfast, lunch, and afternoon

snack Currently 20 participants Care for individuals with neurological deficits

and memory loss Post-stroke disabilities

Dementia

Alzheimer’s Disease

Dining Services

Two community dining areas Residential dining room Adult day care dining area

In-room dining also offered 5% of residents

Conventional main kitchen One straight trayline Four-week non-select menu for breakfast, lunch, dinner Reusable dishware

Dialysis Unit

New five-chair unit Two sessions

7:00-11:00 AM and 1:00-5:00 PM

Mon/Wed/Fri or Tues/Thurs/Sat rotations Image source: http://www.dialyspa.com/Photo_Gallery

Menu Development

Resident and day care complaints about food and lack of variety

Goal – To create a new cost-effective menu that will: Increase satisfaction, intake, and socialization

Provide more variety and color

Be adaptable to accommodate diet modifications

Include seasonal items and plant-based protein

Sample Regular Menu

Breakfast Lunch Dinner

Day 1

 Vanilla yogurt

Banana pancake with syrup and butter

Orange juiceHot tea or coffee

 Butternut squash soup

Saltine crackers Quiche Lorraine

Roasted red potatoes Fruit cup

Milk Hot tea or coffee 

 Pot roast with brown

gravy Sliced carrots Collard greens

Gingerbread cake Iced tea or lemonade

Hot tea or coffee

Day 2

 Toasted English

muffin with peanut butterFruit cup or

stewed prunesCranberry juice

Hot tea or coffee

 Tomato Soup

Saltine crackers Grilled cheese

sandwich Baked zucchini fries Baked apples with

cinnamon Milk

Hot tea or coffee 

 Cilantro lime tilapia

Basmati rice Steamed broccoli &

snow peas Coconut macaroon

Iced tea or lemonade Hot tea or coffee

Sample Adult Day Care MenuBreakfast Lunch Snack

Day 1

 Strawberry yogurt

Scrambled eggApple raisin

muffinOrange juice

Hot tea or coffee

 Creamy broccoli soup

Saltine crackersChicken salad

sandwichSteamed baby carrots

Vanilla wafersLemonade or iced tea 

Sliced peachesShortbread cookie

Milk

Day 2

 Toasted English

muffin with peanut butterSliced apples

Cranberry juiceHot tea or coffee

 Tomato Soup

Saltine crackers Grilled cheese

sandwich Baked zucchini fries Baked apples with

cinnamon Milk

Hot tea or coffee 

 Chocolate pudding

Milk

Special Diets

Create menus for special diets: Liquid (clear & full) Pureed Cardiac Calorie controlled (1600 kcal) Renal

Sample Liquid and Pureed Diets

Clear Liquid Diet Full Liquid Diet PureedBreakfast Breakfast Breakfast

Vegetable broth Orange gelatin

Grape juice Hot tea or coffee

Cream of wheat Milk

Cranberry juice Hot tea or coffee

Vanilla Greek yogurtScrambled egg puree

Cream of wheatCinnamon sugar

Orange juiceHot tea or coffee

Lunch Lunch Lunch

Beef broth Cherry Italian ice

Apple juiceHot tea or coffee

Creamy broccoli soup Grape juice

Chocolate pudding Hot tea or coffee

Creamy broccoli soup pureeChicken salad sandwich puree

Green peas pureeBanana pudding

Milk Hot tea or coffee

Dinner Dinner Dinner

Chicken brothPopsicle

Cranberry juiceHerbal tea

Chicken broth V8 juice

Vanilla milkshake Herbal tea

Roasted turkey breast pureePoultry gravy

Whipped potatoesGlazed carrots puree

Pears pureeIced tea or lemonade

Hot tea or coffee

Sample Cardiac Diet

Breakfast Lunch Dinner

Turkey sausage pattyScrambled egg

substituteFrench toast

SyrupMargarine

Orange juiceHot tea or coffee

Nondairy creamer

Chicken noodle soup (LS)Low sodium crackers

Herbed chicken breast on bun

Summer squash and carrotsFruit cupSkim milk

Hot tea or coffeeNondairy creamer

PepperSalt-free seasoning

Meatloaf Brown gravy (LS)

Mashed sweet potatoesSliced green beans

Vanilla wafers Iced tea

Hot tea or coffee Nondairy creamer

PepperSalt-free seasoning

Sample Calorie Controlled Diet

Breakfast Lunch Dinner

Turkey sausage pattyScrambled egg

French toastSyrupButter

Orange juiceHot tea or coffeeNondairy creamerSalt and pepper

Chicken noodle soup Saltine crackers

Herbed chicken breast on bun

Summer squash and carrotsFruit cup

MilkHot tea or coffee

Nondairy creamerSalt and pepper

Meatloaf Brown gravy

Mashed sweet potatoesSliced green beans

Vanilla wafers Iced tea

Hot tea or coffee Nondairy creamerSalt and pepper

Sample Renal Diet

Breakfast Lunch Dinner

Turkey sausage pattyScrambled eggs

French toast Syrup

Margarine Whole milk (4oz)

Chicken noodle soup (LS)Herbed chicken breast on bun

Garden saladItalian dressing

Sliced green beansHerb seasoning and pepper

Meatloaf Brown gravy (LS)

Dinner roll White rice

Green peas Pumpkin pie

Herb seasoning and pepper

Dialysis Snack Rotation

New five-chair dialysis center needs a snack menu

Goal – To create an appropriate and palatable snack menu for dialysis patients with snacks low in Potassium Phosphorus Sodium Calcium

Sample Dialysis Snack Menu

  Monday Tuesday Wednesday

AM Snack1 pk Graham crackers 4oz Apple slices

1 Rice cake with Tofutti spread and Strawberry Jam or Grape Jelly

1 Nut-free cranberry apple muffin

PM Snack

4 oz Carrot sticks 1 bag Unsalted pretzels

1 bag Unsalted baked pita chips 4 oz Red bell pepper slices

4 oz Cucumber Slices 2 oz Non-dairy veggie dip

Menu Cost Reductions

Grace Gardens current average cost: $7.50/resident/day for meals

Goal – To decrease food cost from $7.50/day to $5.85/day

New menus cost less than $5.85/resident/day 22% savings for Grace Gardens

Day 1 Day 2 Day 3

$5.29 $5.65 $5.81

Staffing and Scheduling

Create new RD schedule Goal: To meet budget requirements

Annual RD budget: $275,000 CNM Salary of $75,000 (+25% for benefits) Consultant RD wage of $40.00/hour Need four hours coverage on Saturdays

Budget Breakdown

Total Salary Budget $275,000

CNM Base Salary $75,000

CNM Benefits (25%) $18,750

Total CNM Salary Cost $93,750

Consultant RD Budget $181,250

Consultant Hourly Wage $40.00

Payable Consultant Hours Per Week 87

New ScheduleWeek 1 Monday Tuesday Wednesday Thursday Friday Saturday Total

HoursCNM 9:00-5:00 9:00-5:00 9:00-5:00 9:00-5:00 9:00-5:00 40

RD #1 7:00-3:00East Wing

7:00-3:00East Wing

7:00-3:00East Wing

7:00-3:00East Wing

7:00-3:00East Wing

37.5

RD #2 11:00- 7:00West Wing

11:00- 7:00West Wing

11:00- 7:00West Wing

11:00- 7:00West Wing

11:00- 7:00West Wing

37.5

RD #3 10:00-2:00 Floater

10:00-2:00 Dialysis

Coverage

9:00-1:00

Floater

12

Kitchen Design and Remodel

Develop satellite kitchen for adult day care and replace old equipment in conventional main kitchen

Goal – To provide equipment that will: Enhance quality of menu items

Meet budget requirement of $35,000

Replace old equipment in main kitchen to rely less heavily on ready-to-eat foods and ultimately drive food cost down

Foodservice System

The planned satellite kitchen will receive food from the main conventional kitchen before breakfast and lunch

Food received at the satellite kitchen is served in an adjacent community dining area for the adult day care participants

Work Table

For sanitary meal and snack preparation in the satellite kitchen

Versatile

Cost: $448.02

Two-Door Refrigerator

To replace an old refrigerator in the main kitchen

Energy Star rated

Cost: $6,560.01

Wire Shelving Unit

For storage of dry goods in the satellite kitchen

Wire shelving promotes air circulation and decreases dust build-up

Cost: $143.43

Commercial Microwave

For heating and reheating in the satellite kitchen

Cost: $224.99

Mobile Enclosed Cabinet

To transport prepared foods from the main kitchen to the satellite kitchen before breakfast and lunch Mon-Friday

Non-electric

Hot and cold holding for up to four hours

Cost: $2817.36

Commercial Food Processor

To replace an old food processor in the main kitchen

To prepare fresh pureed foods instead of relying on ready-made

Promotes better intake and food quality

Cost: $915.36

Commercial Toaster

For the adult day care dining area near the satellite kitchen

For participants to enjoy hot toast with breakfast or lunch

Cost: $95.00

Chest Freezer

For the satellite kitchen to store frozen goods and desserts

Cost: $736.25

Three Compartment Sink

Will be used in the satellite kitchen to wash dishes, pans, plates, and utensils.

Will prevent having to send dirty dishes to the main kitchen

Cost: $1,024.25

Countertop Boilerless Convection Steamer

To reheat items from the main kitchen to temperature if necessary

Energy Star rated

Cost: $4,425.00

Ice Dispenser

For the adult day care dining area adjacent to the satellite kitchen

Nugget ice shape is easier for participants to manipulate

Energy Star rated

Cost: $2,959.00

Panini Grill

For participants in the adult day care to enjoy panini sandwiches as requested

Cost: $468.00

Countertop Warming and Baking Oven

For baking and warming goods in the satellite kitchen

Cost: $1,295.80

20-Gallon Steam-Jacket Kettle

To replace an old steam kettle in the main kitchen

Will be used to make soups, stews, gravies, and breakfast cereals

Cost: $6,619.71

Gas Restaurant Range

Will replace an old range in the main kitchen

Versatile functioning

Cost: $4,365.00

Coffee Brewer

For adult day care participants to enjoy hot coffee or tea right in the dining area instead of being transported from the main kitchen

Cost: $313.50

Total Cost

Shipping: $872.62 Total cost all items + shipping: $34,283.30

Sustainability

Current practices Reusable dishes and tablecloths in dining areas

Paper napkins

Basic recycling in nursing and administrative areas: glass, paper, and plastic

Recycling bins not available in resident rooms or community spaces

Sustainability

Goal – To identify three possible areas of improvement in sustainability practices Sourcing local, seasonal, and sustainable produce

Reducing organic and inorganic waste

Reducing carbon intensity

Recommend implementation strategies

Sourcing Local Produce

Switch to a produce vendor who can provide wide variety of locally grown products Keany Produce in Mid-Atlantic region

Support local farmers from Maryland, Virginia, and Pennsylvania

Minimize impact of food travel

Increase availability of fresh, seasonal produce

Garden Project

Utilize available space at facility to start a garden

Vegetables and herbs grown in the garden can be featured on the menu

Residents feel more connected to their food

Benefits of Gardening

Residents can assist with planting and tending to garden

Raised bed and container design for accessibility

Research suggests gardening may

Improve physical function

Enhance social interaction

Lead to more self confidence

Improve mood

Image source: http://latimesblogs.latimes.com/home_blog/2011/09/oxnard-senior-vegetable-garden.html

Potential Drawbacks

Costs Lack of dedicated staff

RD and recreation director to share responsibility for pilot garden

Seeking volunteer assistance

Procedures and documentation required to use vegetables in commercial food service

Reduce Organic Waste

Begin composting program Addresses plate waste by repurposing food scraps

Compost can be used in on-site garden

Contract with outside company for transport

Requires supplies and education for food service staff

Consider expanding current recycling program

Reduce Carbon Intensity

Purchase Energy Star equipment Ice dispenser Reach-in fridge Countertop steamer Freezer chest

Inspect oven and refrigerator gaskets Install plastic curtain across door of walk-in

cooler Switch to compact fluorescent lights

Questions?