FOOD SAFETY MANUALhardiagedcare.com.au/management/wp-content/uploads/2018/09/Ha… · Food Safety...

Food Safety Manual – updated September 2018 Copyright - Hardi Nursing Home Management Pty Ltd

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FOOD SAFETY MANUAL APPROVED FOR PUBLICATION SEPTEMBER 2018


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INDEX Section 1 Tracking log for changes to be inserted manually at front of manual. Section 2 Food Safety Program Item 2.1 Scope

2.2 Food Safety Team 2.3 Product Description & Intended Use 2.4 Process Flow Chart 2.5 Hazard Analysis 2.6 Hazard Analysis Table 2.7 Hazard Control Table 2.8 HACCP System–Validation/Justification of Critical Limits 2.9 Verification Table 2.10 Codex Guidelines for the Application of the HACCP System 2.11 Principals of the HACCP system 2.11B Guidelines for the application of the HACCP System 2.12 2.13

Application of the HACCP principles CCP Decision Tree

Section 3 Support Programs Item 3.1 Receipt & Storage of Food Items Labelling & Allergen Management. 3.2 Preparation, Cook, Chill & Service of Food 3.3 Portion Control 3.4 Reheating Guidelines 3.5 Approved Supplier Program 3.6 BBQ, Outings & Other Special Events 3.7 Calibration Program 3.8 Cleaning & Sanitation 3.9 Dishwashing Procedure 3.10 Fresh Produce Cleaning & Sanitising 3.11 Data & Document Control 3.12 Internal Food Recall 3.13 Maintenance Program 3.14 Menu Design 3.15 Pest Control Program 3.16 Pest Reporting Guidelines 3.17 Personal Hygiene Program 3.18 Resident / Family Purchased Meals (Food brought to the Facility by

Relatives & Friends)


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3.19 Staff Training Program 3.20 Verification Procedures 3.21 Internal Auditing 3.22 Waste Management Program (Catering) 3.23 Rules to Avoid Food Poisoning 3.24 Meal Tray Presentation 3.25 Good Handling Practices (GHP) Section 4 Lists forms used to monitor the food safety program Section 5 Diets 5.1 Diets 5.2 Standard/Normal 5.3 Light 5.4 Texture Modified Diets 5.5 Soft 5.6 Minced & Moist 5.7 Puree 5.8 Fluids 5.9 Thickened Fluids 5.10 Full Liquid 5.11 Clear Fluid 5.12 Cholesterol Lowering 5.13 Diabetic and the Glycaemic Index 5.14 High Energy, High Protein 5.15 Low Lactose 5.16 Low Fat 5.17 Restricted Fibre 5.18 High Fibre 5.19 Restricted Oxalate 5.20 Low Potassium 5.21 High Potassium 5.22 Controlled Protein 5.23 High Protein 5.24 Low Purine 5.25 Mono-Amine Oxidase Inhibitors 5.26 No Added Salt 5.27 Vegetarian 5.28 Vegan 5.29 Weight Reduction 5.30 Gluten Free 5.31 Nut Free


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5.32 Portion Control Guide 5.33 Menu Planning 5.34 References Section 6 Supplier Information 6.1 Hardi Suppliers/Providers Contract List Section 7 Reports 7.1 NSW Food Authority Reports 7.2 External Audit Reports 7.3 Internal Audits/Reports (Monthly report filed with monitoring

forms)


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SECTION 2 FOOD SAFETY PROGRAM 2.1 Scope

2.2 Food Safety Team 2.3 Product Description & Intended Use 2.4 Process Flow Chart 2.5 Hazard Analysis 2.6 Hazard Analysis Table 2.7 Hazard Control Table 2.8 HACCP System–Validation/Justification of Critical Limits 2.9 Verification Table 2.10 Codex Guidelines for the Application of the HACCP System 2.11 Principals of the HACCP system 2.11B Guidelines for the application of the HACCP System 2.12 2.13

Application of the HACCP principles CCP Decision Tree


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2.1 Scope The Food Safety Program covers:

• Receipt (from suppliers), storage, thawing, preparation, cooking, post cook processing, hot holding, chilling, reheating, service, delivery of cold and hot foods, assisted feeding and clean up.

• Delivery of food includes food delivered to the residents, staff and community visitors.

• Special attention is given to texture modified foods and liquids, foods brought in by residents and/or their families, foods provided on day trips and donated foods.

2.2 Food Safety Team The food safety team was established in 2007 with the first meeting being held on the 15th February 2007. The team is responsible for:

• developing and maintaining the food safety plan

• updating the HACCP manual

• analysing and improving procedures

• implementing effective controls to manage food safety risks The Food Safety Team membership includes:

NAME POSITION

TEAM LEADER Corporate

Robert Oxford CEO

Compliance Kylie Maddern Compliance Co-Ordinator

TEAM MEMBER Blacktown Facility

Marcella Vasquez Harshaka (Don) Hapuarachchige

Facility Manager Catering Manager

TEAM MEMBER Guildford Facility

Mara Luburic Asif Ahmed


TEAM MEMBER Manly Vale Facility

Janine Holden David De Cruz



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2.3 Product Description and Intended Use Cook Fresh

Product description Fully cooked meals served hot, no chilling step, to be consumed on same day. (Cook Fresh Foods)

Examples Roasts, wet dishes such as casseroles and curries, grills, pies, lasagna / pasta dishes, vegetables, soups, eggs, hot desserts.

Product composition Meat e.g. Poultry, beef, pork, lamb, fish, eggs, cheese, milk, cream, pasta, flour, corn flour, gravy mix, bread crumbs, vegetables, fruit, sugar, oils, condiments, juice, beef booster, pastes.

Method of preservation

Cooking, to a minimum of 75 C. Foods may be baked, roasted, grilled, boiled, steamed, braised, stir fried.

Other food safety characteristics

None, food is high in moisture, low in salt and has neutral pH.

Special preparation characteristics

Food is kept hot in a Bain Marie, oven, hot box or on a stove top prior to portioning and serving. Food is cut and individually portioned prior to serving. Foods are served within 2 hours of final preparation.

Packaging Stored in stainless steel dishes with appropriate lid covers. Fried foods e.g. fish and chips are covered with foil to maintain food quality. Only food grade packaging used.

Storage & Serving Stored in a Bain Marie, oven, hot box or on a stove top.

Food is maintained 60C or greater.

Shelf Life N/A Food is hot, ready to eat and should be consumed within 2 hours of cooking.

Distribution method From kitchen to dining rooms and resident rooms foods are transferred on trolleys.

Consumer Vulnerable populations including elderly residents.

Intended Use Ready to eat.


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Cook Chill – Served Hot

Product description Cooked meals, chilled, reheated and consumed hot. (Cook Chill) Consumed within 48 hours of initial preparation. See figure 2.

Examples Pasta, wet dishes such as casseroles and curries, soups, soufflé and hot desserts.



Cooking, to a minimum of 75 C. Foods may be baked, roasted, grilled, boiled, steamed, braised, stir fried. Chilling. Foods are chilled, using the 2hr/4hr cooling rule. Storage. Foods are stored in the cool room <5.0°C Reheating. Foods are reheated to a minimum of 75 C on the stove top, oven or microwave.


Food may be subject to post cook processing eg. Texture modification, slicing for cold meats to be frozen. Food is reheated quickly to ≥ 75.0°C and then kept hot in Bain Marie, oven, hot box or stove top prior to portioning and serving. Food is cut and individually portioned prior to serving. Foods are served within 1 hour of reheating.

Packaging Stored in stainless steel dishes with appropriate lid covers. Individual portions are stored in microwave safe dishes with lids. Only food grade packaging used.

Storage Stored at 5.0C or less prior to reheating.

Held at 60.0C or more after reheating and prior to serving.

Shelf Life Maximum 48 hours



Intended Use Cook chill


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Cook Chill – Served Cold

Product description Fully cooked meals chilled and consumed cold within 48 hours. (Cook Chill)

Examples Cold meats, cold desserts, eggs.

Product composition Meat e.g. Poultry, beef, pork, lamb, eggs, milk, cream, cereals, flour, corn flour, fruit, sugar, condiments, juice.


Cooking, to a minimum of 75 C. Foods may be baked, roasted, boiled or steamed. Chilling, using the 2hr/4hr cooling rule.

Storage. Foods are stored in the cool room at 5.0C or less. Foods are covered to prevent cross contamination.


Food is chilled prior to portioning. Cold meats are portioned, plated in the kitchen and stored in the cool room. Cold desserts are cut and individually portioned prior to serving. Foods are served within 48 hours of cooking/preparation.

Packaging Stored in stainless steel dishes with appropriate lid covers. Food grade packaging used for all products. Only food grade packaging used.

Storage Stored at 5.0C or less prior to serving

Shelf Life 48 hours

Distribution method Cold meats and desserts are portioned onto individual plates, stored in the cool room prior to meal service and served directly to the intended resident. From kitchen to dining rooms and resident rooms foods are transferred on trolleys.


Intended Use Cook chill


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Texture Modification – Served Hot

Product description Fully cooked meals, portioned, texture modified served hot or chilled and served within 48hrs.

Examples Roasts, wet dishes such as casseroles and curries, pasta dishes, vegetables, soups, stewed fruit.



Cooking, to a minimum of 75 C. Foods may be baked, roasted, grilled, boiled, steamed, braised, stir fried.


Food is kept hot in a Bain Marie, oven, hot box or stove top prior to portioning Food is vitamised in the kitchen prior to serving, ensure above 60 C after processing and before serving. Foods are served within 2 hours of cooking. If using chill step, chill to ≤ 21.0ºC within 2 hours & to ≤ 5.0º C within a further 4 hours. Use shallow covered trays to enable rapid cooling. Maximum storage under refrigeration 48hrs. (If temp <75 ºC after processing for serving hot or to be reheated following cooling process) Reheat rapidly to ≥75ºC

Packaging Stored in stainless steel dishes with appropriate lid covers. Only food grade packaging used.

Storage Held hotter than 60.0ºC and served within 2 hours. Or refrigerated less than 5.0ºC for less than 48 hours.

Shelf Life Ready to eat and should be consumed within 2 hours of cooking.

Distribution method Foods are vitamised in the kitchen, portioned onto individual plates and served directly to the intended resident. From kitchen to dining rooms and resident rooms foods are transferred on trolleys.


Intended Use Ready to eat for residents with dysphagia.


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Texture Modification – Ambient or Cold

Product description Ambient and cold food, served ambient or cold and to be consumed on the same day as preparation.

Examples Fruit, stewed fruit, cake.

Product composition Bread, spreads e.g. Vegemite, peanut butter, cream cheese, beef, pork, lamb, fish, eggs, cheese, milk, cream, pasta, salad vegetables, fruit, sugar, oils, condiments, juice, pastes.


Cooking, to a minimum of 75 C & cooling (2/4 rule). Cold foods are

stored in the cool room at 5.0C or less. Foods are covered to prevent cross contamination.


Food is kept in the store room or, if required, in the refrigerator, prior to portioning. Preparation time for sandwiches is as short as possible and must be less than one hour before being returned to fridge or served. Food is vitamised in the kitchen prior to serving.

Packaging Dishes with appropriate lid covers. Only food grade packaging used.

Storage Stored in refrigerator, if required. Food stored at 5.0C or less prior to serving.

Shelf Life Food is cold or ambient, ready to eat and consume within 2 hours. Sandwiches shelf life when refrigerated is 24 hrs (maintain quality).

Distribution method Foods are vitamised in the kitchen, portioned onto individual plates and served directly to the intended resident. From kitchen to dining rooms and resident rooms foods are transferred on trolleys.


Intended Use Ready to eat for residents.


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Chilled Foods

Product description Chilled foods, prepared and served chilled and consumed on the same day as preparation.

Examples Salads, fruit, cold meats.

Product composition Vegetables, fruit, herbs, meat, condiments.


Approved Supplier Program / Appropriate delivery Chemical sanitation Cool storage


All vegetables and fruit are washed thoroughly. Melons and strawberries are sanitised prior to preparation as well as curly leaf parsley and onions which are not going through a cooking step. Foods are portioned onto plates in the kitchen and stored in the cool room prior to meal service.

Packaging Plates covered with plastic wrap. Only food grade packaging used.

Storage Foods are stored at 5.0C or less Cold meats from vacuum packaging are portioned and stored at

-15.0C or colder if not to be used within 48hrs, (or 7 days from packaging – whichever comes first).

Shelf Life Food is consumed within 48 hours of preparation, (or 7 days from packaging – whichever comes first).





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Ready to Eat Chilled Foods

Product description Foods received, stored and served chilled or frozen without further preparation.

Examples Yoghurt, milk, juice, cream, cheese, cold meats, ice-cream, ice blocks, frozen cakes.

Product composition As per the manufacturers label.


Cold storage (fridge or freezer) Thawing procedure


May be received and served as individual portions or portioned in the kitchen or dining rooms.

Packaging Original manufacturing packaging. Excess external cardboard removed prior to storage. Bulk packs, opened are covered in plastic wrap. Only food grade packaging used.

Storage Chilled foods stored 5.0C or less. Excess cold meats are portioned and stored in the freezer.

Frozen foods stored -15C or colder.

Shelf Life As per expiry date, 7 days from packaging for pre-sliced ready eat meat. Frozen foods, used within 48 hours of thawing – unless food is intended to be served frozen, such as ice cream.

Distribution method Cold foods served at 5.0C or less. Frozen cakes served at room temperature. From kitchen to dining rooms and resident rooms foods are transferred on trolleys.




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Dry Foods

Product description Foods received, stored and served at room temperature.

Examples Cereals, biscuits, bread, fruit e.g. Banana

Product composition As per the manufacturers label


Appropriate storage containers Pest control Use by date Best Before Date

Special preparation Characteristics

Large packs may be decanted to food grade, vermin proof storage containers.

Packaging Storage containers with appropriate fitting lids Only food grade packaging used.

Storage Store in dry cool storage area

Shelf Life As per manufacturers expiry date

Distribution method Check expiry date.




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3. Received

4. Storage (Frozen, Refrigerated, Ambient)

8. Post cook processing, portion, slice, and texture modification

9. Chilling/cooling

10. Storage 12. Hot holding

16. Clean up 10. Storage 10. Storage 16. Clean up

15. Delivery 6. Preparation 6. Preparation

15. Delivery

12. Hot Holding

11. Reheating

7. Cooking

1. Menu design

6. Preparation

13. Hot serve

5. Thawing

6. Preparation

10. Storage

14. Cold Serve 13. Hot Serve 10. Storage 10. Storage

13. Hot Serve

14. Cold Serve

2.4 Process Flow Chart

6a. Sanitize Fruit & Vegetables

2. Ordering & Purchasing

Salads, Sandwich,

Liquids

Cook Fresh Food

Cook Chill / Cooled

Food


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2.5 Hazard analysis is the process of:

• Identifying hazards in a food product (microbial, chemical, physical)

• Assessing the risk of each food safety hazard to determine significant hazards and

• Assigning appropriate control or preventative measures Probability of occurrence (risk) and severity (consequence) classifications have been applied to assess the level of risk of potential hazards as significant or not significant. This method uses the following classifications: Probability (risk): High - Likely to occur Medium - May occur Low - Is not likely to occur Severity (Consequence): Critical - Will automatically result in unsafe food Serious - Will likely result in unsafe food Major - May result in unsafe food Minor - Will not result in unsafe food

Critical Serious Major Minor

High Significant Significant Significant Not significant

Medium Significant Significant Not significant Not significant

Low Significant Not significant Not significant Not significant

The severity of hazard is normally fixed, however the probability of the hazard may vary as it is linked to control measures in place which may change. Microbiological hazards are considered critical, physical or chemical hazards are considered to be serious or major. The decision as to whether a control is a critical control point is supported by the CCP decision tree, modified from Codex (Reference NSW Food Authority Industry Guide)


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2.6 Hazard Analysis Table

Step Possible causes Hazards Significant Hazard?

Justification CCP? Control Measure

Ingredient or process step

Identify potential hazards introduced, controlled, or enhanced at this step.

C= Chemical (e.g. allergens) P= Physical B = Biological (virus, bacteria, toxins)

Is the potential food safety hazard significant? (High severity/ high likelihood)

Is this step a Critical Control Point (CCP?)

What control measure can be applied to prevent the significant hazards?

1-16 All steps

Staff (jewellery, bandaids, hair, gum) Equipment (bolts, grease, glass objects) Building (flaking paint, glass objects)Processing (utensils, plastic packaging)

P = Foreign object contamination

No Unlikely to occur due to good food handling hygiene practices (staff training) and maintenance programs avoid foreign objects

No SPs

Bacteria and viruses that cause food borne illness introduced by poor staff hygiene and work practices

B = contamination by staff

No Unlikely to occur due to good food handling practices, staff training and Illness Policy

No SPs


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Menu Design Foods with high risk of bacterial or viral contamination that cause food borne illness and will not be subjected to further controls e.g. high risk listeria foods

B = microbial contamination

Yes Foods not subjected to further control will be eliminated from the menu

No SPs Eliminate high risk foods not subjected to further controls.

Natural food allergens for those residents with food allergies.

C = natural allergen contamination

Yes Significant risk for residents with food allergy. Nutrition assessment and Procedures will prevent incidents.

No SPs Nutrition policies

Ordering & purchasing

Harmful level of compound or contaminant as a result of raw material management (e.g. pesticide use) or contamination during transit

C = chemical contamination

No Unlikely to occur due to Approved Supplier Program.

No SPs

Introduction of foreign objects (metal, glass, wood)

P= Contamination by foreign objects

No SPs

Introduction of food borne bacteria and viruses that cause illness.

B= microbiological contamination

No SPs

Receipt Harmful level of compound or contaminant as a result of raw material management (e.g. pesticide use) or contamination during transit

C = chemical contamination

No Cold foods stored at 5.0C or less to minimise risk, can pose a significant risk if correct delivery temperature and timing not followed.

Yes. Cold food delivery

temp of high risk foods.

SPs Approved supplier program

Introduction of foreign objects (metal, glass, wood)

P= Contamination by foreign objects

No SPs Approved Supplier Program


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Yes SPs Approved supplier program Receipt and storage processes Temperature control (receipt)

Storage Growth of bacteria due to incorrect storage temperatures.


Yes Significant risk for cold or frozen ready to eat foods if correct storage temp not followed. Unlikely to occur due to storage procedures & staff training. Unlikely to occur due to the support programs.

Yes. Correct storage temperature.

Appliance temperature control

Contamination of foods due to cross contamination


No Storage policies and procedures

Contamination of foods due to incorrect stock rotation


No Storage policies and procedures Date labelling (First in first out)

Introduction of foreign objects (metal, glass, wood, pests)

P= Contamination by foreign objects or pests

No SPs Maintenance and pest control

Introduction of chemicals through incorrect chemical use or storage.

C=Chemicals No SPs Chemical storage and staff training


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Thawing Growth of bacteria due to incorrect thawing procedures.

B = microbial contamination

No Potentially hazardous foods requiring thawing will be subjected to further control measures. Foods are only thawed under temperature control.

No Correct thawing procedures under temperature control. Thawing Policy and Procedure

Preparation Contamination by micro-organisms within dirt, fruit and vegetables

B = Survival of bacteria and contaminating microbes when foods not properly sanitised.

Yes High risk foods Melons, Strawberries, curly leaf parsley and onions not subjected to further heat treatment are required to be washed thoroughly, and sanitised prior to preparation Other fruit and vegetables to be washed thoroughly.

Yes Chemical sanitation at 100ppm Time ≥5 minutes Chemical sanitation record.

Contamination by chemicals, oils, cleaners

C = Chemical contamination

No Unlikely to occur. Residual cleaning & sanitising chemicals addressed through cleaning & sanitation program and staff education

No SPs


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Timing of preparation. Growth of bacteria when potentially hazardous foods not maintained at correct temperature for long periods of time during preparation

B = growth of bacteria that causes food borne illness

Yes Need to monitor temperature and times within the temperature danger zone, particularly potentially hazardous foods that are not subjected to further control measures e.g. salads & sandwiches

Yes Limit the amount of preparation time. Appropriate post preparation storage Daily Food Safety Monitoring Record Cold Food Preparation Audit Form

Sanitise fruit and vegetable

Inaccurate sanitiser strength

C = Chemical contamination

No Compliance with policy and procedure will ensure appropriate dilution rates for sanitiser. Food grade sanitiser to be used.

Yes Sanitising policy and procedures Chemical sanitation record

Cooking / Reheating

Cooking/reheating process times and temperatures

B = Survival of bacteria and contaminating microbes when foods not properly heat treated.

Yes Bacteria and contaminating micro-organisms are likely to occur in raw ingredients (especially potentially hazardous foods). The cooking/reheating process must reduce these to safe levels.

Yes Correct heat treatment time and temperature

Post cook processing: texture modification,

Contamination by bacteria during texture modification process


No Severity is high but unlikely to occur due to compliance with texture modification procedures and cleaning & sanitation program

No Texture modification policy and procedure Cleaning and sanitation program


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portioning, slicing.

Timing and temperatures allow growth of surviving heat resistant and any contaminating micro-organisms throughout post cook processing


Yes If product is not portioned or modified quickly after cooking and before cooling or eating, growth of heat resistant or contaminating bacteria is possible

Yes Limit time between the end of the cooking process and refrigeration or consumption. Monitor the service temperature and time out of cook, chill, or serving times.

Hot holding Times and temperature of product allows growth of surviving heat resistant or contaminating micro-organisms

B = microbiological contamination

Yes Food must be held at sufficient hot holding temperatures. Processes ensure food consumed within 2 hours of preparation.

Yes Monitor holding temperatures.

Hot serve

Cold serve



Yes Severity significant but unlikely due to personal hygiene procedures. Food must be held at appropriate temperature.

Yes SPs Encourage resident personal hygiene Correct hot/cold holding temperature and quick serve. Monitor serving temperature

Delivery & assisted feeding

Times and temperature of product allows growth of surviving heat resistant or contaminating micro-organisms


Yes Food must be held at sufficient temperatures for appropriate amount of time

Yes Correct hot / cold holding temperatures and quick service. Monitor serving temperatures.


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Allergens and food consistency cause adverse reactions and choking in residents with allergies or swallowing difficulties

P = Food consistency C = Natural allergens in foods

No Unlikely to occur. Resident’s needs are documented and dietary needs / changes tracked. Catering staff have access to resources to ensure appropriate foods served

No SPs Nutrition policy and procedures Texture modification procedures

Clean up Inadequate dishwasher temperature or chemical concentration allow survival and subsequent growth of any contaminating micro-organisms on utensils and crockery

B = cross contamination by bacteria that cause food borne illness

Yes It is likely that utensils and crockery are contaminated upon return from service.

Yes SPs Dishwasher chemical concentration and rinse temperatures are monitored

Inappropriate clean up where returned food items / crockery / cutlery contaminate food preparation area.

B = cross contamination by bacteria that cause food borne illness

Yes Returned, unfinished meals / foods disposed of in a dedicated area. Kitchen has designated clean / dirty areas. Dirty crockery etc stored in dirty area until clean and sanitised.

No SPs

Inappropriate cleaning procedures, where incorrect chemicals or concentrations are used.

B = growth of bacteria due to inadequate cleaning / sanitising. C = Chemicals contaminate food contact surfaces, plates and utensils

No Unlikely to occur, only approved food grade chemicals are in use. Procedures are documented and staff receive appropriate training

No SPs


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Infestation of pests due to garbage as an available food source.

P = Pests contaminate the food, environment.

No Unlikely to occur. Waste procedures documented. Waste is removed in a timely manner. Pest control program includes regular inspection of pests.

No SPs

Trays, plates, cutlery stored incorrectly.

P = physical contamination

No Unlikely to occur. Trays, plates, utensils stored correctly after cleaning in line with documented procedures.

No SPs

Cross contamination through the use of poorly maintained cleaning equipment

B = Cross contamination

No Unlikely to occur. Colour coding of equipment ensures use of catering cleaning equipment in food areas only. Utensils have no wooden components. Equipment is cleaned in line with cleaning & sanitation program.

No SPs

Potentially contaminated items from residents (e.g. bandages, vomitus, medications, bodily fluids)

B = Cross contamination by micro-organisms P = Physical contamination by foreign object C = Chemical contamination by medication

No Contaminated items to be removed by care staff before returned to kitchen.

No SPs


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Additional Cook Chill Processes

Post cook chilling

Growth of bacteria due to incorrect cooling procedures and times


Yes Foods not chilled within recommended time frames and remain within temperature danger zone for longer periods, risk growth of bacteria.

Yes Correct cooling time and temperatures. Temperature and times are monitored.

Cold storage Growth of bacteria due to incorrect storage times and temperatures


Yes Foods not stored at correct temperature or for extended periods beyond recommended times risk growth of bacteria.

Yes Correct storage temperatures and times. Date labelling.

Reheat Reheating process times and temperatures

B = Survival of bacteria and contaminating microbes when foods not properly heat treated.

Yes Need to monitor reheat temperatures/times as bacteria and contaminating micro-organisms could potentially grow in stored foods (especially potentially hazardous foods). The reheating process will reduce these to safe levels.

Yes Correct heat treatment time and temperature Food only reheated once


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2.7 Hazard Control Table

Process Step

Potential Hazard/s Control

Measures

CCP Critical Limit Monitoring Procedures Corrective Action Records

What How When Who

Menu design

Microbiological – high risk foods not subject to further food safety control

Avoid high risk menu items not subjected to further controls during menu planning Relative / resident education

SP No high risk foods on menu that are not subjected to further food safety controls

Menu review Compare with industry standards and resources identifying high risk foods

Annual Catering manager

Remove menu items and communicate with staff, residents, and relatives.

Menu

Receipt Microbiological (temperature abuse) chilled ready-to-eat (RTE) or potentially hazardous foods

Temperature o f ch i l led RTE or potentially hazardous product on arrival.

CCP Maximum product temperature 5.0oC

Take representative temperatures of chilled RTE food or potentially hazardous foods -every delivery or representative sample.

Sanitised, calibrated thermometer on packets as per manufacturer’s instructions

Every delivery Catering staff

Contact Catering Manager. Reject if temperature is above 5.0oC.

Notify supplier and report.

Delivery Temperature Check in daily monitoring form

Microbiological (temperature abuse) – frozen RTE or potentially hazardous foods

Appearance of frozen product

CCP No evidence of thawing /ice crystal formation. Must be hard frozen.

Feel of each product type per delivery.

Feel frozen packets(not cartons) as per manufacturer’s instructions

Every delivery Catering staff Contact Catering Manager. Reject soft, partially thawed product (-10oC or warmer) and product with ice crystal formation. Notify supplier and report.

Delivery Temperature Check in daily monitoring form


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Microbiological (out of date)

Product to be within use-by

SP Must be within Use by date

V i s u a l inspection of all products.

C h e c k packages and labels


Reject products that are out of date or very close to date if you can’t use i t prior to expiry. Notify Catering Manager. Notify supplier and report. Reject sliced RTE meats if past 7 days from packaging. .

Delivery Temperature Check Form

Contamination Microbiological Chemical Physical

Appearance of a) product b) packaging condition c) delivery vehicle

SP No evidence of problems such as a) dirty, damaged product, b) damaged, dirty boxes, c) poor truck condition

Visua l inspection Check packaging and product Only approved suppliers are used.


Reject products that are damaged or show signs of contamination or tampering. Reject excessively soiled or damaged fruit and vegetables. Notify Catering Manager. Notify supplier and report.

Delivery Temperature Check Form


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Storage Chilled Frozen Ambient

Microbiological (temperature abuse) of foods

Temperature of chilled food Storage temperatures of freezers Storage times

CCP Maximum storage temperature 5.0oC Maximum freezer temperature of -15.0oC or colder 24 hours

Product temperatures Freezer temperature Date label

Sanitised, calibrated, thermometer Freezer thermometer Visual check

Twice a day (morning & afternoon) Daily

Catering staff Chef/cook

For food above 5 C : - food can be used if it complies with the 4hr/2hr preparation rule: - between 0 and 2 hours food can be used or stored in the fridge, between 2 and 4 hours food can be used but must not be returned to the fridge, 4 hours or more, food must be discarded. Discard cold serve foods and cook chill foods which have been stored for 24hrs or more.

Temperature Check Form Day Dot Labels

Contamination Monitor - product packaging - store areas - stock rotation

SP No evidence of: - damaged stock or packaging - poorly maintained store area (eg. rodent activity) - out of date stock - foodstuffs stored uncovered

Examine the storage area and product

Visual inspection Daily Catering staff Correct stock rotation. Discard damaged, exposed, or unlabeled items. Cleaning Procedures.

Daily Food Safety Monitoring Record. Environmental & OHS audits.

Thawing (general)

Microbiological (temperature abuse)

Thaw in cool room only Cool room temperature Thawing time

SP Product to be completely thawed in cool room (maximum 5.0oC)

Product location Visua l inspection

All product daily Cook Continue to thaw until completely defrosted in the cool room, no longer than 48 hours.

Label product for thawing. Corrective action record


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Preparation Growth of bacteria Monitor preparation times

CCP Maximum 60 minutes

Time in preparation room

Visually check that there is no food left out of refrigerator once finished. Preparation time for high risk foods normally under temperature control not undergoing another control step to be less than one hour Recorded on monitoring form

Each prep Catering staff Check times of foods found out of refrigeration. If more than 60 minutes cook immediately or throw away. Notify chef.

Daily Food Safety Monitoring form.

Sanitise fruit & vegetables

Contamination by bacteria

Sanitise Melons and strawberries 100ppm. Use within 24 hours If not going through a cooking step, curly leaf parsley and onion.

CCP 100ppm free chlorine for a minimum of 5 minutes

Wash and Sanitise melons and strawberries, curly leaf parsley and onion not subjected to heat treatment

Prewash and sanitise in food grade sanitiser at 100ppm for 1 minute as stated on product packaging

Prior to use, use within 12 hours of sanitising

Catering staff Check sanitiser strength. Remix sanitiser solution, ensure adequate contact time.

Sanitation Record


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Cooking Survival of bacteria when food is not cooked properly

Check product temperature f o r o v e n cooked, gently h e a t e d o r grilled product f o r e v e r y batch.

CCP 75.0 o C Take at least one final core t e m p e ra tu r e of product

Sanitised calibrated thermometer.

Every potentially hazardous food.

Chef/Cook Keep cooking until core temperature is reached.

Meal Temperature Log

Post Cook processing port ion or texture modification

Growth of bacteria (time and temperature abuse)

Temperature at end of process

CCP Temperature of greater than 60oC at end of process

Processed quickly and reheated to ≥75.0 oC Monitor temp at end of process. Temp of last served ≥60.0

Record reheated temp and last served temp.

Each meal time (breakfast , lunch, dinner)

Catering staff Re-heat food to ≥75.0oC.

Meal Temperature Record in Daily Food Safety Monitoring Record

Microbial contamination Use of clean and sanitised equipment & utensils according to documented procedures

SP Ensure equipment and utensils are clean and sanitised

Check that all equipment and utensils used are clean and sanitised

Visual check Before use Catering staff Re-clean and sanitise equipment and utensils prior to use

Daily Food Safety Monitoring record


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Hot Holding Growth of bacteria due to time / temperature

Product temperature and times

CCP Minimum 60.0oC and limit time to 60 minutes

Take each product temperature and times before it is put into Bain Marie Ensure equipment is not overloaded.

Sanitised, calibrated thermometer

Each meal time (breakfast, lunch and dinner) At start of meal service

Catering staff Adjust Bain Marie set point. Serving when product temperature is ≥60.0 oC. If food falls below 60.0 oC for 30 minutes, discard. Review process to ensure all food is heated to holding temperatures 60.0 oC or higher BEFORE food is transferred to hot holding equipment. If trays are overloaded, remove some of the food , ch i l l immediately and reheat before re-service. Retrain staff.


Delivery & assist feed

Growth of bacteria due to time & temperature

Product temperature

CCP Last meal served is at least 60.0oC Last cold meal served is 5.0°C or below.

Take product temperature of the last meal plated.

Sanitised, calibrated thermometer

Each meal time (breakfast, lunch and dinner)

Person serving meals

Use microwave oven to reheat meals(to 75 C minimum ), i f necessary (Food is only reheated once). Adjust heating process.

Meal Temperature Log & Temperature Check Form


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Adverse resident reactions (choking, allergies)

Staff access to resident information and resources to ensure safe food service

SP Documented allergies and special needs for all residents. Needs/changes are tracked

Resident food needs. Visual inspection that correct meal is given to resident

On handing the meal to the resident

After any significant changes or on admission

Person serving Meal

Manager

Do not give the resident the meal. Provide appropriate alternative.

Diet Analysis List & Diet Alert Card. Incident form.

Clean up Contamination

Clean & sanitise with hot water all Multipurpose crockery and utensils. Clean up done in a dedicated area. Chemical sanitation of all food preparation surfaces.

CCP SP

Dishwasher must achieve wash cycle temp enough to remove fat and so i l and not bake it on. Sanitising rinse cycle must achieve 82°C minimum. Items must air dry

Temperature of dishwasher rinse cycle Chemical concentration

Visual check of dishwasher temperature gauge Chemical test swabs

Rinse cycle (twice a day) Wash cycle (monthly) Monthly

Catering staff Rep from Chemical Company FMT

Service dishwasher Rewash & sanitise utensils using a double sink arrangement with one sink to wash and the other to rinse and sanitise – ensure the second sink has had sanitizer added to a minimum of 100ppm (tested with ppm test paper) Service dishwasher Clean Food Preparation Surface

Temperature Check Form Dishwasher Dishwasher service records Good Handling Practice Form


33

Additional Cook Chill Process

Post cook cooling / chilling

Growth of bacteria due to time & temperature

Product temperature

CCP Products cooled from 60.0oC to maximum core temperature 21.0oC within 2 hours. 21.0oC to 5.0oC within a further 4 hours (total cooling time from 60.0oC to 5.0oC is 6 hours)

Temperature and times of product cooling

Sanitised, calibrated thermometer Timing- clock

Each cook chill food product

Chef/Cook/ Catering Assistant

Discard food that has not been cooled within the 2hr/4hr rule.

Cooling Cooked Foods Form

Cold Storage Growth of bacteria due to time & temperature

Product temperature and length of storage time

CCP Maximum product storage temperature 5.0oC. 48 hours

Product temperatures Date labels

Sanitised, calibrated thermometer Visual check

Daily – random Chef/Cook Chef/Cook

Discard if above 5 C 48 hours for fruit and vegetables.

Temperature Check Form

Reheat Survival of bacteria when food is not cooked properly

Product temperature

CCP Reheat temperatures must reach 75.0oC (instant)

Product temperature Sanitised, calibrated thermometer

All cook chill products reheated

Chef/Cook/ Catering assistant

Continue reheating until core temperature of 75.0oC reached.



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2.8 HACCP SYSTEM – VALIDATION/JUSTIFICATION OF CRITICAL LIMITS

Control Measure

Critical Limit

Justification / Validation

Receipt

Receipt of Chilled & Frozen product: Checking temperature

Chilled 5.0C or colder Frozen: ‘Hard Frozen’

Australia & New Zealand Food Safety Standards (Food Safety Code) Standard 3.2.2, Division 3, Number 5 - Food Receipt, Clause (1) & (3)

Storage

Maintaining temperature of chilled & frozen products during storage

Cool rooms, fridges 5.0C or

colder

Freezer: -15.0C or colder

Australia & New Zealand Food Safety Standards (Food Safety Code) Standard 3.2.2, Division 3, Number 5 - Food Receipt, Clause (1) & (3). Australia & New Zealand Food Safety Standards (Food Safety Code) Standard 3.2.2, Division 3, Number 6 - Food Storage. NSW Standard for Construction & Hygienic Operation of Retail Meat Premises, Section 8, point 8.1.3. See NOTE 1

NSW Food Authority (2015) Guidelines for food service to vulnerable persons

Thawing Bring frozen food to chilled temperature state, using appropriate thawing procedures.

Cool rooms, fridges 5.0C or colder

NSW Food Authority (2015) Guidelines for food service to vulnerable persons Vulnerable Persons

Prep /

Cooking

Ready To Eat (R.T.E). Food: Plating food & Bain Marie service of food.

Chilled food 5.0C or colder

Hot food 75.0C or hotter

Australia & New Zealand Food Safety Standards (Food Safety Code) Standard 3.2.2, Division 3, Number 5 - Clause (3), see NOTE 2, and Division 3, Number 7 - Food processing Clause 1 (b) (ii)

NSW Food Authority (2015) Guidelines for food service to vulnerable persons Cooling

Appropriate cooling temperatures -v- time to be maintained

From 60 - 21.0C (or less) within 2

hours,

then from 21 - 5.0C or colder within a further 4 hours

Australia & New Zealand Food Safety Standards (Food Safety Code) Standard 3.2.2, Division 3, Number 7 - Food processing Clause (3)

Reheating

Appropriate temperature to be reached when re-heating food

Reheat food to 75.0C or

equivalent

Codex Alimentarius: General Requirements (food hygiene), Volume 1 Guidelines for food service to vulnerable persons (appendix 2) cooking temperature for cook serve food – last entry on table (reheat) states to reheat to 70 C for 2 minutes – note for alternative compliance at bottom of table states 75 C.

Australia & New Zealand Food Safety Standards (Food Safety Code) Standard


35

3.2.2, Division 3, Number 7 - Food processing Clause 4 (states 60 C or above) Service

Temperature maintained for service of the non-cooked food

Temperature maintained for the service of the cooked food intended to be served hot

Chilled or Frozen food to be:

5.0C or colder

Hot food to be:

600 C or hotter

Australia & New Zealand Food Safety Standards (Food Safety Code) Standard 3.2.2, Division 3, Number 6 - Food Storage, Clause (2a). See NOTE 3.

Australia & New Zealand Food Safety Standards (Food Standards Code) Standard 3.2.2, Division 3, number 7 – Food processing

Recall

Loss of traceability to received goods

No non-traceable products

Australia & New Zealand Food Safety Standards (Food Safety Code) Standard 3.2.2, Division 3, Number 12 - Food Recall.

NOTE 1: This Australian standard was used as the reference as the Hardi Group Aged Care Facilities are storing meat and other potentially hazardous foods at chilled and frozen temperatures in the same manner as a retail premise does. Storage of the food does not differ from one ‘industry type’ to another as the food remains the same. The Australian standard states that ‘if it is food that is intended to be stored frozen, ensure the food remains

frozen during storage’ this is quantified in NSW Standard for Construction & Hygienic Operation of Retail Meat Premises, Section 8, point 8.1.3 as -15C so as to be able to be monitored easily by Hardi Group personnel. NOTE 2: This Number particularly mentions Food Receipt & references these temperatures as it is looking at the receipt of the food by the consumer (resident) therefore it must be used as the reference for the service/plating/Bain Marie temperatures for food. NOTE 3: Food handling & service should be at the same safe temperatures as those used for storage.


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2.9 HACCP Verification Table

CCP / Support Program Verification Activity Frequency Person Responsible Records

Menu Design Review of menu to ensure all high risk

foods are controlled or eliminated.

Annual Catering Managers / Dietitian/

Group Manager Compliance

Menu

Recipes

Approved Supplier Program Review of Approved Supplier

performance

Annual Manager for contracts/Catering

Manager / HACCP team

Approved Supplier List

Delivery checks in Daily Food Safety

Monitoring Form

Approved suppliers have current HACCP

certification

Annual Group Manager responsible for

contracts

Approved Supplier List

Supplier files (HACCP certificates)

Receipt of potentially

hazardous foods under

temperature control

Monitor records

Monthly report

Monthly

Catering Manager /FMT Delivery checks in Daily Food Safety

Monitoring form Catering Report

Appliance temperatures Monitor records

Monthly report

Monthly

Catering Manager /FMT Temperature checks in Daily Food

Safety Monitoring form Audit Report

Preparation time and

temperatures

Monitor records

Monthly report

Monthly

Catering Manager/FMT Meal Temperature records in Daily

Food Safety Monitoring form

Catering Report

Cleaning & Sanitise fresh

produce

Monitor records

Monthly report

Monthly

Catering Manager/FMT Chemical Sanitation Records in Daily


Chemical contractor service sheet

Catering Report

Cooking process times and

temperatures

Monitor records

Monthly report

Monthly

Catering Manager/FMT Meal Temperature records in Daily


Catering Report


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Hot Holding & Service

Monitor records

Audit

Monthly

Catering Manager /FMT Meal Temperature records in Daily


Catering Report

Cleaning & Sanitation Dishwasher Sanitation Records Monitor

Catering Report

Monthly

Catering Manager/FMT Dishwasher Temperature records in

Daily Food Safety Monitoring form

Catering Report

Good Food Handling Form

Catering Report

Monthly

Monthly

Catering Manager/FMT Good Food Handling Form

Catering Report

Legionella water sample Annual External Service Provider Pathology report

Calibration

Hand held probe Calibration checks

monthly

Equipment thermometer calibration

checks 6 monthly

Catering Audit

Monthly

6 Monthly

Catering Manager /FMT Calibration records

Service reports

Catering Report

Good Food Handling

Practices & Personal

Hygiene


Catering Report

Monthly

Monthly

Catering Manager/FMT


Catering Report

Maintenance Program Monitor preventative maintenance

program compliance

6 Monthly Catering Manager/ Maintenance

personnel

PM Planner / Maintenance Service

Records

Environmental Audits At least

Annual

As per audit

program

Maintenance Personnel/ FMT Environmental Report

Pest Control Monitor pest control program

compliance

Monthly Catering Manager / Maintenance

personnel

Service Records

Hazard Forms

Environmental Audits Annual Maintenance Personnel/ FMT Environmental Report

Resident / Family Purchased Staff feedback re concerns Monthly Catering Manager/ FMT Incident Forms


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Meals Monitor incidents Complaints

Resident Food Allergies Monitor Incidents Monthly Catering Manager/ FMT Incident forms

Complaints

Staff training Monitor attendance to training Annual Catering Manager/ FMT Staff training records

Staff appraisal forms

All processes Monitor incidents and complaints Monthly Catering Manager/ FMT Incident forms

Complaints

HACCP system review audit

Annual

HACCP Team

Review results

NSW Food Authority Audit Annual HACCP Team/ MAAS/Group

Manager Compliance

Audit results


39

2.10 CODEX GUIDELINES FOR THE APPLICATION OF THE HACCP SYSTEM

(The Hazard Analysis and Critical Control Point [HACCP] System) THE HACCP SYSTEM Excerpt from Preamble: “The HACCP system, which is science based and systematic, identifies specific hazards and measures for their control to ensure the safety of food. HACCP is a tool to assess hazards and establish control systems that focus on prevention rather than relying mainly on end-product testing and inspection. Any HACCP system is capable of accommodating change, such as advances in equipment design, processing procedures or technological developments.” DEFINITIONS Control (verb): to take all necessary actions to ensure and maintain compliance with criteria established in the HACCP plan. Control (noun): to state wherein correct procedures are being followed and criteria are being met. Control measure: any action and activity that can be used to prevent or eliminate a food safety hazard or reduce it to an acceptable level. Corrective action: any action to be taken when the results of monitoring at the CCP indicate a loss of control. Critical Control Point (CCP): a step at which control can be applied and is essential to prevent or eliminate a food safety hazard or reduce it to an acceptable level. Critical limit: a criterion which separates acceptability from unacceptability. Deviation: failure to meet a critical limit. Flow Diagram: a systematic representation of the sequence of steps or operations used in the production or manufacture of a particular food item. HACCP: a system which identifies evaluates and control hazards which are significant for food safety. HACCP plan: a document prepared in accordance with the principles of HACCP to ensure control of hazards which are significant for food safety in the segment of the food chain under consideration.


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Hazard: a biological, chemical or physical agent in, or condition of, food with the potential to cause an adverse health effect. Hazard analysis: the process of collecting and evaluating information on hazards and conditions leading to their presence to decide which are significant for food safety and therefore should be addressed in the HACCP plan. Monitor: the act of conducting a planned sequence of observations or measurements of control parameters to assess whether a CCP is under control.

Step: a point, procedure, operation or stage in the food chain including raw materials, from primary production to final consumption. Validation: obtaining evidence that the elements of the HACCP plan are effective. Verification: the application of methods, procedures, tests and other evaluations, in addition to monitoring to determine compliance with the HACCP Plan. 2.11 PRINCIPLES OF THE HACCP SYSTEM The HACCP system consists of the following seven principles: Principle 1 - Conduct a hazard analysis. Identify the potential hazard(s) associated with food production at all stages, from primary production, processing, manufacture and distribution until the point of consumption. Assess the likelihood of occurrence of the hazard(s) and identify the measures for their control. Principle 2 – Determine the Critical Control Points (CCPs) Determine the points, procedures or operational steps that can be controlled to eliminate the hazard(s) or minimize its (their) likelihood of occurrence. A “step” means any stage in food production and / or manufacture including the receipt and / or production of raw materials, harvesting, transport, formulation, processing, storage, etc. Principle 3 – Establish critical limit(s) Establish critical limit(s) which must be met to ensure the CCP is under control. Principle 4 - Establish a system to monitor control of the CCP. Establish a system to monitor control of the CCP by scheduled testing or observations.


41

Principle 5 - Establish the corrective action to be taken when monitoring indicates that a particular CCP is not under control. Principle 6 – Establish procedures for verification to confirm that the HACCP system is working effectively. Principle 7 – Establish documentation concerning all procedures and records appropriate to these principles and their application.


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2.11B GUIDELINES FOR THE APPLICATION OF THE HACCP SYSTEM Prior to application of HACCP to any sector of the food chain, that sector should be operating according to the Codex General Principles of Food Hygiene, the appropriate Codex Codes of Practice, and appropriate food safety legislation. Management commitment is necessary for implementation of an effective HACCP system. During hazard identification, evaluation and subsequent operations in designing and applying HACCP systems, consideration must be given to the impact of raw materials, ingredients, food manufacturing practices, role of manufacturing processes to control hazards, likely end-use of the product, categories of consumers of concern and epidemiological evidence relative to food safety.

The intent of the HACCP system is to focus control at CCPs. Redesign of the operation should be considered if a hazard which must be controlled is identified but no CCPs are found. HACCP should be applied to each specific operation separately. CCPS identified in any given example in any Codex Code of Hygienic Practice might not be the only ones identified for a specific application or might be of a different nature. The HACCP application should be reviewed and necessary changes made when any modification is made in the product process or any step. It is important when applying HACCP to be flexible where appropriate, given the context of the application, taking into account the nature and the size of the operation.


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2.12 Application of the HACCP Principals consists of the

following tasks as identified in below:

Logic Sequence for Application of HACCP

1. Assemble HACCP Team

2. Describe Product

3. Identify Intended Use

4. Construct Flow Diagram

5. On-Site Confirmation of Flow Diagram

6. List all Potential Hazards,

Conduct a Hazard Analysis,

Consider Control Measures

7. Determine CCP’s

8. Establish Critical Limits for Each CCP

9. Establish a Monitoring System for Each CCP

10. Establish Corrective Actions

11. Establish Verification Procedures

12. Establish Documentation and Record Keeping


44

• Assemble HACCP Team The food operation should assure that the appropriate product specific knowledge and expertise is available for the development of an effective HACCP plan. Optimally, this may be accomplished by assembling a multidisciplinary team. Where such expertise is not available on site, expert advice should be obtained from other sources. The scope of the HACCP plan should be identified. The scope should describe which segment of the food chain is involved and the general classes of hazards to be addressed (e.g. does it cover all classes of hazards or only selected classes).

• Describe Product A full description of the product should be drawn up, including relevant safety information such as composition, physical / chemical structure (including A pH etc.), packaging, durability and storage conditions and method of distribution.

• Identify Intended Use The intended use should be based on the expected uses of the product by the end user or consumer. In specific cases, vulnerable groups of the population, e.g. institutional feeding, may have to be considered.

• Construct Flow Diagram The flow diagram should be constructed by the HACCP team. The flow diagram should cover all steps in the operation. When applying HACCP to a given operation consideration should be given to steps preceding and following the specified operation.

• On-site Verification of Flow Diagram The HACCP team should confirm the processing operation against the flow diagram during all stages and hours of operation and amend the flow diagram where appropriate.

• List all potential hazards associated with each step, conduct a hazard analysis, and consider any measures to control identified hazards (see Principle 1) The HACCP team should list all hazards that may be reasonably expected to occur at each step from primary production, processing, manufacture, and distribution until the point of consumption. The HACCP team should next conduct a hazard analysis to identify for the HACCP plan which hazards are of such a nature that their elimination or reduction to acceptable levels is essential to the production of a safe food. In conducting the hazard analysis, wherever possible the following should be included:

• the likely occurrence of hazards and severity of their adverse health effects;

• the qualitative and / or quantitative evaluation of the presence of hazards;


45

• survival or multiplication of microorganisms of concern;

• production or persistence in foods of toxins, chemicals or physical agent; and conditions leading to the above.

The HACCP team must then consider what control measures, if any; exist which can be applied for each hazard. More than one control measure may be required to control a specific hazard(s) and more than one hazard may be controlled by a specified control measure.


46

Example of decision tree to identify critical control points

Q1 YES NO YES NO Not a CCP Stop* Q2 YES NO Q3 YES NO Not a CCP Stop* Q4 YES NO Not a CCP Stop* * Proceed to the next identified hazard in the described process ** Acceptable and unacceptable levels need to be defined within the overall objectives in identifying the CCPs of the HACCP plan. The decision tree should be used in conjunction with professional judgement, and modified in some cases.

Do control preventive measure(s) exist?

Modify step, process, or product

Is control at this step necessary for safety?

Is the step specifically designed to eliminate or reduce the likely occurrence of a hazard to an acceptable level? **

Could contamination with identified hazard(s) occur in excess of acceptable levels(s) or could these increase to

unacceptable levels?**

Will subsequent step eliminate identified hazard(s) or reduce likely occurrence to an acceptable level?

CRITICAL CONTROL POINT


47

• Determine Critical Control Points (see Principle 2) There may be more than one CCP at which control is applied to address the same hazard. The determination of a CCP in the HACCP system can be facilitated by the application of a decision tree [see Figure] which indicates a logic reasoning approach. Application of a decision tree should be flexible, given whether the operation is for production, slaughter, processing, storage, distribution or other. It should be used for guidance when determining CCPs. This example of a decision tree may not be applicable to all situations. Other approaches may be used. Training in the application of the decision tree is recommended. If a hazard has been identified at a step where control is necessary for safety and no control measure exists at that step, or any other, then the product or process should be modified at that step, or at any earlier or later stage, to include a control measure.

• Establish Critical Limits for each CCP (see Principle 3) Critical limits must be specified and validated if possible for each Critical Control Point. In some cases more than one critical limit will be elaborated at a particular step. Criteria often used include measurements of temperature, time, moisture level, pH, A, available chlorine, and sensory parameters such as visual appearance and texture.

• Establish a Monitoring System for each CCP (see Principle 4) Monitoring is the schedules measurement or observation of a CCP relative to its critical limits. The monitoring procedures must be able to detect loss of control at the CCP. Further, monitoring should ideally provide this information in time to make adjustments to ensure control of the process to prevent violating the critical limits. Where possible, process adjustment should be made when monitoring results indicate a trend towards loss of control at a CP. The adjustments should be taken before a deviation occurs. Data derived from monitoring must be evaluated by a designated person with knowledge and authority to carry out corrective actions when indicated. If monitoring is not continuous, then the amount or frequency of monitoring must be sufficient to guarantee the CCP is in control. Most monitoring procedures for CCPs will need to be done rapidly because they relate to on-line processes and there will not be time for lengthy analytical testing. Physical and chemical measurements are often preferred to microbiological testing because they may be done rapidly and can often indicate the microbiological control of the product. All records and documents associated with monitoring CCPs must be signed by the person(s) doing the monitoring and by a responsible reviewing official(s) of the company.

• Establish Corrective Actions (see Principle 5) Specific corrective actions must be developed for each CCP in the HACCP system in order to deal with deviations when they occur. The actions must ensure that the CCP has been brought under control. Actions taken must also include proper disposition of the affected product. Deviation and product disposition procedures must be documented in the HACCP record keeping.


48

• Establish Verification Procedures (see Principle 6) Establish procedures for verification. Verification and auditing methods, procedures and tests, including random sampling and analysis, can be used to determine if the HACCP system is working correctly. The frequency of verification should be sufficient to confirm that the HACCP system is working effectively. Examples of verification activities include:

a. Review of the HACCP system and its records; b. Review of deviations and product dispositions; c. Confirmation that CCPs are kept under control.

Where possible, validation activities should include actions to confirm the efficacy of all elements of the HACCP plan.

• Establish Documentation and Record Keeping (see Principle 7) Efficient and accurate record keeping is essential to the application of an HACCP system. HACCP procedures should be documented. Documentation and record keeping should be appropriate to the nature and size of the operation. Documentation examples are:

⎯ Hazard analysis;

⎯ CCP determination;

⎯ Critical limit determination. Record examples are:

⎯ CCP monitoring activities;

⎯ Deviations and associated corrective actions;

⎯ Modifications to the HACCP system.


49

TRAINING Training of personnel in industry, government and academia in HACCP principles and applications, and increasing awareness of consumers are essential elements for the effective implementation of HACCP. As an aid in developing specific training to support a HACCP plan, working instructions and procedures should be developed which define the tasks of the operating personnel to be stationed at each Critical Control Point. Cooperation between primary producer, industry, trade groups, consumer organisations and responsible authorities is of vital importance. Opportunities should be provided for the joint training of industry and control authorities to encourage and maintain a continuous dialogue and create a climate of understanding in the practical application of HACCP. The International Commission on Microbiological Specifications for Foods (ICMSF) monograph HACCP in microbiological safety and quality, which describes the type of training required for various target groups, is an example of a general approach to training. Its section on training (Chapter 8) is equally applicable for training regarding other hazards besides those of a microbiological nature.


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2.13 CCP (Critical Control Point) DECISION TREE

Q1. Is there a hazard at this

process? What is it?

YES

Q2. Do control measures exist for the identified

hazard?

YES

Q3. Is the step specifically designed to

eliminate or reduce the hazard to an

acceptable level? Does this step exist

solely to control the hazard?

NO

Q4. Could the hazard occur at or

increase the unacceptable levels?

YES

Q5. Will a subsequent step in the food

chain including consumer action

eliminate or reduce the hazard to an

acceptable level?

YES

Not a CCP or CQP. Must be CP

(Safety) or QP (Quality)

NO

Not a CCP, CP, CQP or QP

Modify Step, Process or Product

YES

Is control necessary at this

step for safety or quality?

NO

NO

NO

Not a CCP or CQP

Not a CCP or CQP.

Must be a CP (Safety)

or QP (Quality)

Is it a food safety hazard?

YES

NO

NO

CRITICAL

CONTROL

POINT

CRITICAL

QUALITY

POINT

YES

NO

YES

Is it a Food Safety Hazard?

Food Safety Manual – September 2018 Copyright - Hardi Nursing Home Management Pty Ltd

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Section 3 SUPPORT PROGRAMS Item 3.1 Receipt & Storage of Food Items 3.1 (a) Control Measures for High Risk Foods served to Vulnerable persons 3.2 Preparation, Cook, Chill & Service of Food 3.3 Portion Control 3.4 Reheating Guidelines 3.5 Approved Supplier Program 3.6 BBQ, Outings & Other Special Events 3.7 Calibration Program 3.8 Cleaning & Sanitation 3.9 Dishwashing Procedure 3.10 Fresh Produce Cleaning & Sanitising 3.11 Data & Document Control 3.12 Internal Food Recall 3.13 Maintenance Program 3.14 Menu Design 3.15 Pest Control Program 3.16 Pest Reporting Guidelines 3.17 Personal Hygiene Program 3.18 Resident / Family Purchased Meals (Food brought to the Facility by Relatives & Friends) 3.19 Staff Training Program 3.20 Verification Procedures 3.21 Internal Auditing 3.22 Waste Management Program (Catering) 3.23 Rules to Avoid Food Poisoning 3.24 Meal Tray Presentation 3.25 Good Handling Practices (GHP)


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3.1 Receipt & Storage of Food Items Note: ‘RTE’ = Ready To Eat RECEIPT OF FOOD ITEMS: All goods received:

1. When packaged: items must be marked or labelled with supplier or manufacturer name & contact details, the ‘name’ of the product, storage conditions and expiry date (unless fresh fruit & vegetables).

2. Goods must have accompanying documentation so that the items can be checked off before being taken into stock.

3. Goods in packs to be receipt dated where necessary by the person receiving the load as they are being put away (date only required if there is no expiry date on the item).

4. Goods to be stored immediately if chilled or frozen. Items are put away “ASAP” when dry or shelf stable foods or other goods. Stock is rotated on each delivery.

5. Visual inspection, as may be seen around the outside of the delivery/cartons/packs for damage, to be completed. Any damage is to be checked by the Catering Manager to see if there has been any contamination of the product. If items are OK, the Catering Manager may choose to receive the goods. If contamination of food product has occurred, the Catering Manager is to reject contaminated packs and in form Facility Manager and MAAS.

Frozen Goods: • All above checks (points 1 - 5) to be carried out. • Packs to be pressed to ensure hard frozen. • If cartons can be opened, personnel to check inside for signs of thawing – e.g. icing, soft

areas, wet cardboard at base of pack, etc. If food product is partially (or fully) thawed or there are signs that product had thawed & been re-frozen, goods to be rejected.

• If OK & accepted - receipt date where needed & store immediately. • Delivery Temperature Check form to be completed (tick if hard frozen). • The Catering Manager is to be informed of any problems.

Chilled Goods: • All above checks (points 1 - 5) to be carried out. • Packs to be temperature checked: probe thermometer to be placed between packs & left to

acclimatize. Once display is stable and temperature is at or below critical limit on the HACCP Chart goods may be received. If goods are found to be over temperature, load to be rejected – inform the Facility Manager and the manager responsible for contracts.

• If accepted - receipt date where needed & store immediately.

• Delivery Temperature Check to be completed with actual temperature recorded.

• The Catering Manager is to be informed of any problems.

Fruit & Vegetables: • All above checks (points 1 - 5) to be carried out. • Fruit to be visually inspected for acceptable quality. Damage, contamination (e.g. by

residues, insects, dirt, etc), deterioration (e.g. wet, soft, brown areas not normally associated with the item) - should any be found, these items (or whole delivery) to be rejected. All contaminated RTE (ready to eat) fruit & vegetables to be rejected.

• If accepted - store appropriately immediately. All processed fruit & vegetables & other RTE items to be stored in chilled conditions to minimise growth of any pathogens.

• Supervisor to be informed of any problems.


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STORAGE OF FOOD ITEMS: POLICY All foods, non-food items and supplies related to and used in food preparation shall be correctly stored as to prevent bacteriological, chemical and physical contamination, thus making the food safe for human consumption. PROCEDURE STORAGE OF PERISHABLE FOOD ITEMS: Refrigeration

• The refrigerator has adequate space to provide cold storage for all perishable foods, both in the raw and cooked state. Foods in the refrigerator should not be over-crowded, or stacked to prevent the free circulation of cooled air. A thermometer is fitted to the refrigerator and is checked twice daily to ensure foods are maintained within the correct temperature range (0.0°C – 5.0°C).

• Prepared foods are stored above raw foods in the refrigerator to prevent accidental drippage and possible contamination of prepared foods by raw foods.

• Clean containers to hold fruit and vegetables are to be used. Daily sorting is done and damaged or spoiled pieces are discarded. Fruit and vegetables are washed and sanitised before use to remove contaminants from the surface.

• Food items stored in the refrigerator are covered and dated. Food items that have been cooked and cooled are kept for a maximum of 48 hours.

• Fruit, vegetables and juices are not stored in open can. The food is transferred to containers of non-corrosive materials that are easily cleaned. Containers are to be labelled and dated with opened date and expiry date and identify the type of food.

• Leftover foods are not mixed with fresh foods. • Cooked food stored in the cool room / refrigerator, is only reheated once.

Labelling Policy

• All food items coming into the facility are to have either a use by (best before) or be labelled with a received on date to comply with stock rotation system. Received on date label must be able to be clearly identified as different to the opened date.

• Stock is to be rotated on each delivery

• Food items are to be stored with dates (either 'use by' or 'received on') visible, if possible

• Food items are to be rotated according to 'use by' date or 'received on' date

• Dry store items, (such as powdered product and dry herbs), that do not have an expiry on the packet are to be discarded twelve months after they were opened and labelled with the opened date.

• Food items owned by resident only permitted as per policy and labelled with the residents name and have allergens listed on the product. Follow food safety labelling.

• Open bottles and jars are to be labelled with the date that they were opened. Expiry is as per original packaging or in the absence of instructions refer to refrigerated food storage chart to identify expiry date.

• All food items once decanted must be placed in a clean container with a tight fitting lid. To be labelled with product name, date opened and expiry date if different to chart.


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Check that allergens for that product are on the allergen list in the kitchen, update the list if needed. If item clearly identifiable, opened date is sufficient. Expiry in 48 hrs

• Prepared food is to be placed in appropriate containers and dated with the date prepared. The food will be discarded within 48 hrs. If it is likely that staff could be unsure of the identity of the product it is to have the name of the product.

• If the prepared food is to be frozen it is to have a label stating the product identity, date prepared and original use-by and be labelled “frozen on” with the date. Expiry is within three months of the frozen on date. Check that the allergens are able to be identified through recipe, or allergen list, otherwise label with ingredients.

• When removed from freezer for use, the food is to be labelled with the date and to be used within two days of commencing thawing If the product had less than two days on it’s pre frozen expiry, then only the remainder of that time is allowed after commencing thawing.

• All staff, working in the food preparation area, are responsible for stock rotation and the correct use of labels.

• Chef/Cook is to monitor the quality of all food

• Chef/Cook is to ensure that the stock and all containers are labelled as per policy and that the rotation system is adhered to and allergen list is current.

• Food that is unfit for consumption, out of date or to be returned to supplier but cannot be disposed of immediately is to be clearly labelled to indicate it is not for use.

Allergen Management

• Residents with allergies are identified at entry to facility.

• Allergens are communicated to all kitchen staff.

• Staff receive training and prompting tools e.g allergen matrix.

• Allergen matrix is updated when new items are received and a second check of the matrix occurs when the product is decanted.

• Any resident allergens are identified during receival.

• Storage is designed and operated to prevent cross contamination.

• Processing and serving practices developed to prevent cross contamination. Staff read ingredient labels on products to help ensure resident allergen management is adhered to.

Foods are from approved suppliers to achieve consistency in food labeling.

Supplied foods containing allergens are identified on a list and displayed.

When there is a product change that introduces tree nuts, shellfish/mollusks, fish, milk, eggs, sesame, gluten, lupin or soy the allergen list is updated.

When decanting food, staff check the product label for allergens and correlation with allergen list. Update the list when an omission is identified.

If a resident has an allergy to an ingredient other than the standard group of allergens then that item must be listed on the supplementary allergen matrix.

RNs notify the kitchen of allergies on admission and whenever a new food allergy is identified.

Dietician provides advice as necessary for residents with allergies.

Foods are stored in a manner to avoid risk of cross contamination.


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All foods are prepared in a manner so as not to contaminate other foods. Preparation areas and equipment are cleaned thoroughly before any other food is prepared on that surface.

When a product contains an allergen, that food is not to be served to a resident with allergy to that product.

When cross contamination of an allergen occurs of stored product it is to be labeled to indicate this, or discarded. After opening expiry dates for refrigerated foods:

Use before expiry or best before date on label AND

Within the after opening expiry date.

Anything cut, prepared at facility or defrosted

48 hours refrigerated.

(Follow cooling procedures & records. Thaw in refrigerator.)

Opened canned or jar foods

As per manufacturer’s instruction

or in absence of instruction

48 hours after opening (in sealed container)

Acidified foods and preserved food e.g jam

As per manufacturer’s instruction

or in absence of instruction

7 days. (in sealed container)

Soft Cheese or cheese removed from original packaging

7 days from packaging. (Once opened store in a sealed container)

Commercial sauces e.g. soy, pickles and hard cheese and margarines.

Provided in original bottle/ container expiry date as per manufacturers label. If decanted 7 days.

(Only open date required on facility label as manufacturers label contains all other required information for these products.)

Raw Meat As per manufacturer label or 3 -5 days, whichever is sooner, Refrigerated

Raw fish or minced meat As per manufacturer label or 3 days, whichever is sooner, Refrigerated

Raw poultry or shellfish As per manufacturer label or 2 days, whichever is sooner, Refrigerated

Freezer • The freezer maintains its temperature from -15.0°C, or below, to ensure proper freezing of

foods occur. • All food items stored in the freezer are labelled and dated. • All frozen products are thawed in the refrigerator / cool room, not at room temperature. • Thawed foods must not be refrozen. • Expiry is as per manufacturer’s use by date on package (Items bought frozen).

• In the absence of manufacturer’s instructions 3 months will be used as the storage life.


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Monitoring of catering refrigerator and freezer temperatures

• Temperatures to be monitored twice daily to ensure within critical limits stated on the HACCP Chart.

• When temperature is over that stated as being safe action is to be taken immediately. This action should include: For Chilled food: checking temperature of food in storage - if still safe temperature, re-check each hour to ensure that this does not change. If food is approaching critical limit - move food to alternate safe storage to ensure that it is not made unsafe by rising temperature. If food is over temperature it is to be dumped in waste bin. Record corrective action. For Frozen food: check food in storage to ensure not thawing - if still hard frozen, re-check each hour to ensure that this does not change. If personnel are unsure - check temperature of the food by placing probe from thermometer between packs of product & wait for it to stabilise (keep electronic part of the thermometer out of the freezer). Ensure that the temperature is at or below the critical limit for ‘Freezer storage” in the HACCP Chart. If food is approaching critical limit - move food to alternate safe storage to ensure that it is not made unsafe. If food is able to be thawed for use, has thawed and is under the critical limit for chilled food, use food immediately or store in cool room until use. If food is over temperature (for chilled food), thawing or thawed & can’t be used thawed - to be dumped in waste bin. Record corrective action. The Catering Manager is to make all decisions.

• All stored goods to be date coded by the manufacturer / supplier & if no date code, with the date of receipt or date of cooking by Hardi Group personnel.

• Store goods off the floor & ensure all lights are covered, all areas to be kept clean. • All goods to be used in FIFO system (first in first out) to ensure correct stock rotation.

STORAGE OF DRY FOOD ITEMS A supply of non-perishable foods is kept on the premises to meet the requirements of the planned menu. PROCEDURE

• The storeroom is cleaned weekly and items are moved forward on shelves to allow room for new items to be stored behind.

• All lights to be covered & light covers clean. • All spills to be cleaned immediately so as not to attract pests. • All dry store items are dated on delivery according to the Food Labelling Policy. • All goods are date coded, sealed in a container/pack and stored off the floor. All containers

to be checked to ensure they are clean & suitable before use. Any found not clean, to be washed & dried before use, any found not suitable to be thrown away.

• "Use By" or “best before” date should be checked to allow reasonable shelf life.

• Any damaged or unsuitable stock is noted on the C. Unacceptable Food Items Form and

returned for credit

• All products to be removed from excess corrugated cardboard cartons on day of delivery.

• All goods to be used in FIFO system (first in first out) to ensure correct stock rotation. • Visual inspections of storage areas are to be carried out for pests or evidence of pests. If

evidence is found, it is to be reported to a Supervisor or Facility Management Team immediately (before forgotten). Pest control is to be arranged. Personnel to make sure that all food used is free from any contamination as used. No pellet baits to be used.


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• Containers of a non-corrosive material, that can be easily cleaned, and that have well-fitting lids are used for storage of bulk items (once opened) such as flour, sugar, rice etc.

• New packets of cereal, pasta etc. are not opened until current stock is used. • Packets once opened must be placed in a clean, labelled and dated container with a tight

fitting lid. The manufacturers packaging or if removed from the manufacturers packaging - all details such as the product name, expiry date, batch number and allergens are to be transferred to a sticker & the sticker adhered to the new container.

• Cleaning materials are not stored in the food storeroom to ensure chemicals cannot contaminate food.

STOCK CONTROL – DRY STORES POLICY The Nursing Home operates a stock control system that aims to maintain adequate supplies, prevent pilfering and makes ordering and stocktaking simple and efficient. PROCEDURE

• A stock level is established concurrently when doing the dry stores order. • A minimum stock level for every item has been established and is renewed as necessary.

Constant review of amounts ordered in conjunction with menu requirements maintains adequate stock and exposes any excess usage.

• It is the responsibility of the Catering Manager to set the store level and nominate the purchase unit, so purchasing in the most efficient and economical way.

ONCE OPENED

• Dry food the expiry remains unchanged, however where no expiry is recorded they must be discarded 1 year after opening the date opened on the product.

• All storage units must be emptied and cleaned prior to re filling with new stock • Refer Hardi food labeling policy Refer to table below which is to be displayed in the kitchen for easy reference to identify

product expiry. 3.1(a) Control Measures for High Risk Foods served to Vulnerable persons

Food Type Control measures – options for controlling hazards

Meat and Poultry 1. All meat and pultry are cooked in accordance with minimum recommended cooking temperatures. 2. Purchase packaged, whole portions of unsliced ready-to-eat meat and poultry and slice in central processing unit, kitchen or service departments and limit shelf life to 7 days after slicing and re-packing. 3. Purchase meats pre-sliced from a licensed manufacturer with a Listeria Management program. Apply a limited shelf life of no more than 7 days from date of packaging. It is not recommended to purchase sliced meats from delicatessans or retail shops etc. 4. Use canned or shelf stable meats. 5. Purchase frozen cooked meats.

Dairy 1. Serve products made from pastuerised milk 2. May serve soft cheeses with a shelf life of no more than 7 days from date of packaging

Seafood 1. All seafood is cooked. 2. May serve cold smoked seafood, with limited shelf life of 7 days from date of packaging


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3. Used canned seafood or shelf stable seafood 4. Purchase frozen seafood.

Eggs 1. Do not use cracked or dirty eggs 2. Serve eggs that are cooked until the white is firm and yolk begins to thicken 3. Use pastuerised egg in dishes which will not be cooked.

Fruits, vegetables and salads

1. Inspect all fresh produce prior to use and remove dirty, cut, mouldy and bruised stock. Wash all fruit and vegetables under running potable water. 2. May serve packaged pre-cut vegetables, fruit and salads with a shelf life limted to no more than 7 days from date of packaging 3. Wash and santise melons (e.g. rockmelons/cantaloupe, honeydew) in sanitisers appropriate for fresh produce. 4. Serve seed sprouts only if they are cooked.

Juices 1. Serve pastuerised juices. 2. Inspect all fresh produce prior to use and remove dirty, cut, mouldy and bruised stock. 3. Wash all fruit and vegetables under running, potable water prior to juicing. Serve freshly squeezed juice immediately after preparation.

Pate and Dips 1. Serve shelf stable pate, pastes and dips (e.g. Canned) 5. May serve pate, pastes and dips that have been fully cooked with a shelf life limited to no more than 7 days from date of packaging

3.2 Preparation, Cook, Chill & Service of Food PROCESSING FOOD Defrost:

• All frozen items requiring thawing or defrosting prior to use to be thawed in fridge or cool room (so as to ensure that the temperature of the product when thawed does not exceed the safe chilled temperature for food).

• Products thawing will be labelled with the product description and date of thawing. • Thawing raw food is stored on the bottom shelves of the cool room to make sure it does not

contaminate other food. • Products will be completely thawed prior to food preparation and/or serving. • No thawing to be completed in hot water or hot area. • No food to be re-frozen following thawing.

Preparation: • All bench areas, containers, knives & other utensils, tubs, bowls, pans, pots, etc to be used,

to be clean & fit for use prior to being used. If not clean - to be cleaned prior to use, if not suitable - to be thrown away & replaced if required.

• As food is prepared, to be checked for possible signs of contamination - e.g. foreign matter or deterioration. All food contaminated with foreign matter to be made safe to eat prior to use or thrown away. Food to be checked to ensure that expiry date has not been exceeded. If expired - item to be disposed of in waste bin. Food items being prepared are to be protected against contamination from dust, insects and other vermin, unclean utensils and work surfaces, unnecessary handling, coughs, sneezes, flooding, drainage and overhead leakage, and any other source of contamination.

• The colour coding used for the cutting boards to be adhered to. Sign with the colour coding legend to be displayed near the storage area for boards.


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• Personal hygiene is essential – please see “Personal Hygiene Program” and “Good Handling Practice” both detailed in this Section (3.)

• All visitors to adhere to the same safe Good Handling Practices (GHP) as Hardi personnel. Cook:

• All cooking to be carried out to the temperatures as specified in the HACCP Charts to ensure the maximum number of pathogens are killed thereby making the safest possible food.

• Monitoring of a sample of the items cooked is carried out and recorded on the Meal Temperature Log form.

• Whole eggs are cooked till the whites are firm and yolk is beginning to thicken, eggs cooked for cold service in sandwiches or salads are cooked to 75 C minimum.

Chill / Cool Cooked Foods: • Chilling or cooling of cooked food to be done in line with guidelines set out in the Australian

Food Standards Code. These guidelines are specified in the HACCP Chart. Food not cooled within these guidelines to be discarded.

• Monitoring the cooling to ensure that the guidelines are being met is to be completed and recorded on the Cooling Cooked Food Checks form.

Reheating Cooked and Chilled Food: • Reheating of previously cooked and chilled food is to be done to the temperatures as set out

in the HACCP Chart. Monitoring and recording of the temperature of re-heated food is to be completed for every batch re-heated. Record on the Meal Temperature Log form.

• Personnel are to be made aware that re-heating food can only be completed once i.e.: fresh food which is cooked and then chilled for later use, may only be reheated once. If food is left over from this re-heated batch, it is to be discarded. Where food is cooked by a manufacturer /supplier (prior to supply to Hardi Group) is heated for service to residents, all left over food from this batch is not to be stored or re-heated again.

• Reheating left over food is at the discretion of the Facility Management Team, as a guide, food must only be reheated once. Sign to re-enforce this may be found in kitchen.

Food Placed in Bain Marie for Plating and / or Service: • All bays, covers, surrounds, etc. to be visually inspected prior to use to ensure clean.

Anything that is not clean must be cleaned before use. • Bain Marie to be switched on and heated so that it is up to temperature when the food is

placed in the bays - to maintain the temperature of the food. Bays are to be covered until food is required to be served.

• Food to be served / plated as soon as possible to ensure that the top surfaces do not become cold. Where food is in the Bain Marie for an extended time - the food in each bay to be ‘turned over’ so that the colder surfaces are mixed with hot & the entire bay is kept at correct safe temperature. If there is a delay in serving the food, it may be necessary to return the food to pots and place back on hotplates or in ovens to ensure temperatures. Temperatures are to be checked before plating.

Plating & Serving Meals: • Plates are to be visually inspected to ensure clean prior to use (as being passed to have food

placed on) - any seen to be unclean to be put aside and left for washing later. All other items used to be visually inspected in the same manner.

• Should there be any foreign matter seen in a meal being plated, the meal to be put aside for later - Supervisor to later check what the foreign matter is & determine where it may have come from & take preventative action to ensure no recurrence if this is appropriate.


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• Plated meals to be served as soon as practicable. Texture Modification:

• Texture modified foods, including puree and minced foods, are provided for residents that have difficulty swallowing. Texture modified foods pose a greater risk of post cooking microbial contamination.

• Procedures for texture modification of foods such as puree and minced foods are in place to minimise the risk of food contamination.

• Personal hygiene standards are maintained and staff responsible for modifying foods wash and dry hands thoroughly before commencing.

• Foods are modified in separate areas to where raw food is handled to prevent cross contamination.

• Only clean and sanitized equipment used for cooked foods, is used to texture modify foods. • Texture modified foods are modified whilst hot and reheated to ≥75.0C then maintained and

served at a temperature 60.0ºC or above. • Texture modified foods that are modified and stored for later consumption are subject to

the requirements of cook chill: - Foods are texture modified whilst hot. - Cooled from 60 to 21.0ºC in 2 hours and then from 21.0 to 5.0ºC in a further 4 hours,

(2/4 hour rule). - If not used within 48 hours, discard. - Frozen texture modified foods are thawed in the cool room. - Reheated >75.0ºC within 1 hour.

• Texture modified foods are stirred throughout the reheating process to ensure even heating. • Texture modification equipment is cleaned thoroughly and sanitized at the end of use.

Equipment is checked for cleanliness prior to use. • Corrective actions are taken and documented when temperatures or cleanliness is not

complied with. • Foods are modified in accordance with Speech Pathology or resident Practitioner advice. • Manufacturer’s directions for food thickeners, are followed to ensure appropriate thickness

of thickened fluids. Monitoring and Recording Temperatures of Cooked Food:

• Temperature of a sample of the food is to be checked & recorded on the monitoring form.

• Samples are to be checked for: Breakfast, Lunch and Dinner of a hot meal, a cold meal, a beverage & a dessert.

• Temperature is to be as listed in the HACCP Chart. • Temperature to be checked at the start of plating to ensure temperatures are correct before

they are delivered to residents - this need not be recorded (the temperature at the end of plating is to be recorded as this is the temperature of the coolest food which would have been served to residents (in the case of hot food service) or the warmest (in the case of cold food being served). If hot temperatures are not high enough at the start the food is to be returned to cooking facilities to raise temperature appropriately before starting service. Cold food to be served is not to be removed from cold storage until immediately before use/service.

• Food to be checked either in Bain Marie when plating is finished or of a plated sample meal. • Food which is found to be outside the safe temperatures listed in the HACCP Chart is to be

either re-heated (or discarded) if it is a hot meal, or fast chilled down if it is a cold meal - as long as the meal is no more than 1 hour old, (2hr/4hr preparation rule is adheared to). This is at the discretion of the Catering Manager. If the food has been served, eaten & the sample


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is out of temperature, the Facility Management Team is to be informed & a better way of keeping food hot or cold for service is to be found immediately.

Non-Cooked Food: • Non-cooked food to be subject to the same checks when being plated as cooked food. Check

plates as they are being used to ensure that they are clean & free of any visible foreign matter. Food is not to be removed from storage until required to be served - to avoid possible contamination, etc. Food from cool rooms / fridges / freezers should be at the correct temperature for storage of the item, when being served.

• Temperature checks to be completed as described above. • Sandwiches, salads or uncooked desserts prepared containing high risk foods to have their

prep time recorded per batch. High risk foods used in this step for prep time record are meat, fish, pre-cooked egg, dairy. Preparation does not include when the component is only added to the plate during meal service.

• Fruit & vegetables which are ready to eat - to be washed thoroughly.

• Melons, strawberries, curly leaf parsley and onions not going through a cooking step to be sanitised prior to being served.

• Fruit & vegetables which are already prepared (by approved supplier) to be stored in cool room or fridge & to be served at chilled temperatures.

• Fruit & vegetables which are to be peeled either by the resident or by staff are to be washed & sanitized prior to peeling.

• Staff to observe appropriate hygiene standards when peeling fruit or vegetables ready for residents.

• Fruit & vegetables which are served at ambient temperature need not be temperature checked during service.

• Frozen food is to be served while still frozen. No frozen food to be served over ‘safe frozen storage temperature’ (unless cooked to manufacturers specifications). Should uncooked frozen food rise over the safe frozen storage temperature - to be discarded.

Food Disposal • Food may need to be disposed of because: The product has exceeded its shelf life; the

product does not comply with the Food Safety program; or the product has been recalled. • If food is to be disposed of but cannot be discarded immediately it is marked clearly with

“HOLD FOR DISPOSAL” and stored separately from other food. • Food waste is disposed of in garbage disposal units. All waste is enclosed in garbage bags

and tied. • Fats, oils and bulk food wastes are not to be disposed of down drains. These are stored in

leak proof containers prior to disposal in garbage disposal units. Equipment

• Unsealed wood and timber are not used in food preparation areas. • Chipped or cracked crockery is not used – it is disposed of appropriately and the Catering

Supervisor is informed for replacement. • Equipment is used for its intended purpose only and is kept clean and well maintained. • Cool rooms and freezers are serviced and temperature gauges are calibrated regularly. • Food transport vehicles are maintained in a clean and sound condition so that food does not

become contaminated. Any food safety or quality issues are to be addressed to the Facility Management Team.


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3.3 Portion Control

Attention All Kitchen Personnel


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3.4 Reheating Guidelines To make sure that the food we serve is safe to eat, please make sure that food is only reheated once. If food is cooked here, from fresh product and cooled down, it must be labelled with the date or a day dot when put in the fridge, so that others will know the date it was cooked and cooled. If this food is then reheated as a meal for a resident and some of the reheated food is again left over (not served) – this left over must be disposed of – it cannot be cooled again and reheated again. If a ready to eat meal (pre-cooked by a supplier) is heated and served, any left-over must be disposed of – it cannot be re-cooled and reheated again. If there are any questions, or if you are not sure, please ask catering manager.

3.5 Approved Supplier Program (Catering) POLICY Suppliers of food, chemicals and food services, provide a safe and quality product or service in line with The Hardi Group’s Food Safety Program requirements. PROCEDURE

• The Hardi Group has identified suppliers for all goods and services which are considered to have high standards of product and services in line with the facility’s food safety program.

• Potential suppliers are sent a Supplier Approval Letter and are required to complete a Supplier Approval Application prior to being nominated as an approved supplier.

• Food suppliers for high risk items are required to submit evidence of current HACCP certification. In the case where food suppliers do not have HACCP certification, the facility will implement internal critical controls to ensure safe food production.

• A list of current approved suppliers and the foods they supply is maintained by the Catering Manager. Refer to Supplier Approval Applications and evidence of HACCP certification or other quality assurance programs are maintained in a central file.

• The facility only purchases items of potentially hazardous foods from approved suppliers. • Receipt of unsatisfactory or poor quality goods are recorded on the C. Unacceptable Food

Items Form and invoice. These records are used to evaluate supplier performance on an ongoing basis and at least annually.

• In the case that suppliers do not meet the required standards, alternative suppliers will be accessed.

Refer to Flow Chart 8, Purchasing and Inward Goods.

3.6 BBQ, Outings and Other Special Events POLICY Food safety standards will be maintained during special events such as BBQs, outings, resident involvement and sharing of foods. PROCEDURE

• The Hardi group promotes resident lifestyle through organizing BBQs, resident outings to restaurants and other eateries, day outings with packed picnics, resident involvement with preparing and sharing of foods.


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• Food safety standards are maintained by following basic food safety principles to prevent cross contamination, poor temperature control and contamination through poor personal hygiene standards.

• BBQs: - Meats and salads are purchased from approved suppliers. - Meats are delivered to the BBQ prior to cooking. - Meats are cooked to a core temperature of 75.0°C. - Salads, sauces etc are kept refrigerated prior to service. - Good Personal hygiene standards are maintained. - The BBQ is cleaned thoroughly before and after use, and preheated prior to cooking.

• Outings:

- Residents are taken on outings to reputable restaurants / eateries only e.g. major clubs. - Only chain takeaway venues that have provided evidence that they are HACCP certified

are to be used. Contact Group Compliance Officer for verification. - The only exception is for fried fish and chips where council certificates are available and

the venue is observed to be clean. Venues are to be inspected prior to the outing. • Picnics:

- Potentially hazardous foods are avoided on picnics. - Perishable foods for picnics are stored in insulated containers. - Foods are stored outside of refrigeration no longer than 2 hours.

3.7 Calibration Program POLICY All equipment used to conduct food safety system checks must be calibrated to ensure their accuracy. PROCEDURE

• A list of all equipment to be calibrated is maintained and includes equipment, equipment identification code and frequency of calibration.

• It is the Catering Managers’ responsibility to ensure all temperature measuring devices are calibrated.

• All equipment calibrated will be recorded on the Calibration record. • The maximum error allowed before corrective action is +/- 1.0°C for all temperature

measuring devices. • Hand held thermometers have calibration check internally monthly. Using ice & boiling

method or control test as per manufacturer’s instructions. Calibration control machine to be calibrated annually by contractor. Fixed thermometers have calibration checked at least 6 monthly.

Ice Point Check:

• Make sure that the thermometer has been at ambient room temperature for at least 10 minutes.

• Fill a small insulated container with crushed ice that has been made from potable water. • Add water to the container, no more than one third the quantity of ice, to start the ice

melting. There should be water between the ice pieces but the ice should not be floating. Pour off the excess water.

• Place the thermometer probe in the centre of the container so that the point of the probe is in contact with the ice and water and stir. The point of the probe should not touch the base


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of the container. (If using an IR gun then check the temperature of the ice slurry as per manufacturer’s instructions)

• Leave until a steady reading is obtained. • Read the temperature on the thermometer. If:

- The thermometer is accurate it should read 0.0°C. - The temperature is not at 0.0°C note the difference in the temperature reading. - The temperature is greater than 1.0°C from 0.0°C, change the battery and re-test, if still

outside parameters, replace the thermometer or return to the manufacturer for servicing.

Boiling Point Check:

• Make sure that the thermometer has been at ambient room temperature for at least 10 minutes.

• Boil an amount of water in a saucepan/pot. • Place the thermometer probe in the centre of the pot so that the point of the probe does

not touch the base of the saucepan/pot. (If using an IR gun then check the temperature of the boiling water as per manufacturer’s instructions)

• Leave until a steady reading is obtained. • Read the temperature on the thermometer. If:

- The thermometer is accurate it should read 100.0C. - The temperature is not at 100.0°C note the difference in the temperature reading. For

example, if the thermometer is 100.5C, then the difference is -0.5C. - The temperature difference is greater than 1.0°C from 100°C, change the battery and re-

test, if still outside parameters, replace the thermometer or returned to the manufacturer for servicing.

Cool-room and Freezer temperature calibration:

• After hand held probes have been calibrated the cool-room and fridge temperatures are to be checked by leaving a beaker of water in the fridge overnight and placing the probe in this beaker within the fridge. The probe temperature result is then compared to the cool-room thermometer. This test is to be the first activity in the morning. The temperatures are recorded in the calibration log. Discrepancy over 1.0°C is reported to the Catering and Maintenance Managers.

• Freezer temp can be measured by leaving the hand held probe in the freezer for 10 minutes and checking the reading against the freezer thermometer.

• Alternatively 6 monthly service and calibration checks by contractor. 3.8 Cleaning and Sanitation POLICY To ensure correct cleaning and sanitising procedures are in place, utilising approved techniques and appropriate equipment to achieve safe food and minimise food contamination. PROCEDURE

• All Staff receive instructions in correct cleaning methods prior to working in the kitchen. • Colour coded cleaning equipment is in use. Green is the designated colour for food

production areas and blue is the designated colour for general areas such as dining rooms. • All cleaning equipment is in good condition and is cleaned regularly. Wooden handled

equipment is not used. Specific areas are designated for the cleaning of cutlery, crockery and equipment to prevent cross contamination.


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• Meat slicer, can openers and food processor blades to be washed after each use to ensure no organic material is present after use.

During cleaning, the main things to complete are:

• Scrape off & dispose of as much foreign matter as possible from plates, benches, cutting boards, etc.

• Unless the dishwasher is to be used, wash the item with detergent & HOT water - this may be the bench, preparation equipment, cutting boards, etc. The job of a detergent is to dissolve grease and remove dirt. Rinse to remove the dissolved dirt, grease, detergent and foreign matter.

• Sanitize: benches, cutting boards, all food contact surfaces (surfaces that food will touch) and hand contact surfaces (surfaces that hands will touch before handling food – e.g. fridge / cool room handles, handles on utensils, etc) are to be sanitised as required, this may be after use or at least once per day. The job of a sanitizer is to reduce the number of bacteria to a safe level. If the sanitizer is not a ‘no-rinse’ one, then after the contact time, rinse again.

If a dishwasher is to be used, see procedure following. The dishwasher goes to a high enough temperature to sanitise, but benches or areas that are food contact or hand contact surfaces need to be sanitised using a sanitizing chemical.

NOTE: Some bacteria may survive the dishwasher temperature or the chemical sanitizer by becoming a spore, so make sure the job you do kills as many of the bacteria on the surface as possible by adhering to the dilution rates or making sure that all items go through the dishwasher. Clean-as-you-go philosophy to be used - as items which are in regular or constant use become dirty or are used, they are to be cleaned prior to next use. Personnel to ensure that correct colour coded cutting boards are used and that no items or utensils used for raw items are subsequently used for ready to eat items. No items to be put away or stored wet. As the dry items are stored, they are to be put away up-side down to ensure no contamination drops in from above where safe to do so & the items will not slip apart (e.g. plastic plate lids/covers, cups, plastic/metal containers, pots, pans, etc).

• Areas, equipment and utensils in daily use to be cleaned daily, or after use if required. • Areas, equipment and utensils in occasional use to be cleaned weekly. • All manufacturers’ instructions on cleaning to be adhered to. • When using cleaning chemicals, wear rubber gloves to protect skin. Special care must be

taken not to splash chemicals near face and eyes. Appropriate protective clothing is to be worn when necessary and always if specified by the chemical manufacturer.

• Cleaning monitoring forms to be completed as required.

Chemical Safety • All staff are trained in chemical safety. • Chemicals will be stored separately to food products. Chemicals used in the kitchen are food

grade. Cleaning chemicals must never be stored in food containers. All chemical containers are clearly labelled. Material Safety Data Sheets are located within the chemical storage area for each chemical in use.

• Chemicals are used in accordance with the manufacturer’s directions. • Personal protective equipment is made available and used when using chemicals.


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3.9 Dishwashing Procedure POLICY Dishwashing is undertaken to ensure all crockery and utensils are clean and free of any possible contamination. PROCEDURE

• After meals, trays are collected from the residents and placed on a trolley to be returned to the kitchen.

• The trays are stripped and crockery is sorted. Cutlery and crockery is sprayed to remove excess food.

• All crockery, cutlery, lids, bases, and trays are washed in the dishwasher. The dishwasher must rinse at a minimum of 82°C to ensure all bacteria are destroyed. The Catering Manager is responsible for checking dishwasher rinsing temperatures.

• One member of staff handles all dirty crockery and cutlery etc and another person unloads the clean crockery and cutlery etc.

• Clean crockery must be removed from the dishwasher racks, stacked and put away with minimum handling ensuring there is no contact with dirty surfaces.

• When stacking cups ensure they are dry to eliminate any condensate being formed. • Cutlery after cleaning is inverted into a clean container so that handles are pointing

upwards. 3.10 Fresh Produce Cleaning and Sanitising POLICY Raw fruits and vegetables may be contaminated with micro-organisms. Washing raw produce thoroughly before preparation. Sanitizing is required in addition to this for melons and strawberries and if not undergoing a cooking step, curly leaf parsley and onions PROCEDURE

• Commercially available fruit and vegetables sanitizer is used. The chemical supplier will provide evidence of the food grade chemical and validated chemical preparation requirements.

• Only clean, undamaged, fresh produce will be purchased. The fruit and vegetables are stored in the cool room.

• A single sink /container is designated for the washing and sanitizing of fresh produce. The sink /container is labelled as such.

• Fruit and vegetables are washed thoroughly in clean water, to remove all excess dirt, prior to sanitation. Ideally the water is slightly warmer than the produce.

• Work Health & Safety requirements for handling chemicals are followed when handling the chemical sanitiser.

• Where an automated dispensing system is installed to ensure appropriate chemical concentration of 100ppm chlorine. The chemical contractor conducts monthly checks of the chemical concentration.

• Alternatively the chlorine and water volume will be measured manually to gain concentration of 100ppm chlorine.

• Test strips are used at each sanitising process to ensure accurate chemical concentration is achieved. This is recorded on the Daily Food Safety Monitoring form.


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• The washed produce is added to the chlorine solution and agitated to ensure all surfaces are wet and there are no bubbles. The produce is soaked for 5 minutes.

• Rinse the produce as per manufacturer’s guidelines. The produce is used within 48 hours of sanitizing.

3.11 Data and Document Control POLICY Effective document and data control is implemented to ensure staff uses the current version of a document and information contained within documents has been approved by management. PROCEDURE

• All documents are identified by document name, revision status and implementation date.

• All documents are approved by the Management Team prior to issue.

• A master current copy of the Food Safety Program is maintained by the Catering Manager. However, copies of the program and records may be displayed in other relevant food service areas.

• All data entry records are signed/initialled and dated.

• All records are retrievable, stored securely and protected from damage.

• Delivery dockets are to be kept for 7 years and monitoring forms for 5 years.

3.12 Internal Food Recall POLICY The Hardi Group catering services have procedures in place to ensure recalled products are tracked from receipt through to delivery to resident / consumer. The food service does not provide meals externally from the facility and hence is not required to have an external food recall procedure. PROCEDURE Internal recall

• All packaged stock received by the service will have a batch and or expiry date. • Small stock levels are maintained such that weekly deliveries are consistent with weekly

food production. • In the event that a product is recalled, the Catering manager identifies any applicable food

or foods prepared / cooked and isolates immediately. • Food is returned or disposed of immediately. • If food has already been served the Catering Supervisor informs the Facility Manager who

contacts the supplier and the local health authorities. • Food recall actions are recorded. • All catering managers are subscribers to the FSANZ recall emails.


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3.13 Maintenance Program POLICY A maintenance program is implemented to provide a safe environment for residents, staff and visitors. The maintenance program provides a systematic approach to ensure the maintenance of all environment and grounds, buildings, plant equipment, fixtures and fittings and vehicles to reduce the risk of injury and provide quality and safe care and service to our residents. PROCEDURE

• All items of the environment, equipment and structure are maintained in good repair and condition.

• All staff are trained in reporting any defects in relation to the environment, structure and equipment to ensure timely repair.

• A preventative maintenance program is in place and includes: ovens, cool rooms, freezers and dishwasher (refer to external contractors program).

• Any defect noted, in the kitchen, by staff will be reported to the Catering Manager, who in turn inspects the defect and completes a Maintenance Log. The form is submitted to the maintenance personnel for action (log at the reception). Defect equipment is removed from operation until repairs are completed.

• All maintenance will be dealt with in priority. Where maintenance staff do not have the skills to undertake the work, licensed and qualified contractors will be used.

• Once the defect is rectified, it will be recorded on the log form. • Maintenance repairs and compliance with the preventative maintenance program are

reported through meetings. • Environmental inspections occur as per the audit schedule. • WHS ‘walk rounds’ are conducted every three months to ensure a safe and clean

environment is maintained. Issues identified through the WHS ‘walk rounds’ are actioned and reported through the WHS committee.

• Monthly C. Good Handling Practices Form is used to document any maintenance issues in the kitchen area. Forms such as Maintenance and Housekeeping Logs can also be used to identify any maintenance issues.

3.14 Menu Design POLICY To ensure that the menu provides for the Resident’s nutrition and hydration needs, contributes to resident quality of life and supports the food safety program. The menu will be designed to provide quality foods that meet resident preference and responds to resident feedback whilst avoiding foods that are potentially high food safety risk for a vulnerable population. PROCEDURE

• A four week cyclic menu will be planned using a variety of resources including: - Resident feedback - Staff feedback - NSW Food Authority Fact Sheets - Knowledge of seasonal foods - All changes to be reported and approved by GMC

• Potentially high risk foods for vulnerable population that are included on the menu are

subjected to control measures to decrease the risk of food contamination. Control measures include:


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• Chemical sanitation

• Purchase from approved suppliers

• Delivery and Storage procedures

• Other

• Foods considered high risk for vulnerable populations that will not be subjected to further control measures are eliminated from the menu. These include:

- - Uncooked high risk fruits and vegetables which are unable to be adequately

washed and sanitized such as mushroom, sprouts. - Uncooked seafood such as oysters. - Unpasteurized dairy products. - Raw eggs.

• Allergens are considered as part of the menu design process. New products or recipes that introduce allergens will be documented.

• Residents are informed of changes to the menu and high risk foods through the resident meetings.


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3.15 Pest Control Program POLICY To ensure the facility prevents and controls all pests and vermin. PROCEDURE

• Visual inspections of storage areas to be carried out for pests or evidence of pests. Checks to be recorded on the Good Handling Practices (GHP) form. Regular cleaning will be maintained to prevent attraction of pests and vermin.

• All excess outer corrugated cardboard and packaging will be removed on receipt of goods and disposed of to prevent pest entry.

• Waste will be disposed of and stored appropriately to prevent attraction of pests and vermin.

• Appropriate pest control measures are used to prevent entry of pests into food service areas including door stops and fly screens. Doors are closed to prevent entry of pests.

• If evidence found e.g. cockroaches – either dead or alive, mouse poo, ant trails, corners of cartons damaged etc – this is to be reported to a Supervisor, the Catering Manager or Facility Management Team immediately (before it is forgotten).

• Pest control is to be arranged through a professional pest control company. • The Pest Control Contractor will provide pest prevention through the installation of pest and

rodent baits and chemicals. • Provide monthly inspections and treatment of pests and rodents. • Provide an emergency call out service if required. • Provide A map of the location of pest control bait stations. • Provide A list of chemicals in use. • Provide Material safety data sheets for all chemicals in use and evidence the chemicals are

safe for use in food areas. • Provide Service records which includes type, location and size of pest activity, actions taken

to control activity, preventative actions to control any identified activity. • No pellet baits to be used - only solid blocks. • In the event of staff observing pests or signs of pest activity, the staff member is required to

inform the Catering manager who in turn informs the Facility Manager to organise pest control contractor emergency visit. The Catering manager will be responsible for assessing the risk of food contamination by the pest and implementing appropriate action. Action may include, cleaning and sanitising of work or storage areas and/ or food disposal. Details of all actions taken are to be made either on GHP (C. Good Handling Practices) Form or on the back of the form or on a sheet and attach it to the form.

• Personnel to make sure that all food used is free from any contamination as the foods are used or prepared. Including visual inspections of packs for pest damage before use & watching ingredients as they are added to mixtures to ensure no contamination is evident.

• Not only are many common pests capable of carrying infections, but the sight of insects and pests within the Nursing Home environment can be disturbing to residents, staff and visitors. It is a basic requirement of any cleaning program that attention be paid to protective measures designed to minimise pest infestation.

The major pest problems are:

• House Fly Flies breed in waste such as decaying vegetable matter, meat, human and animal excrement. Major breeding areas are heavily contaminated with bacteria associated with the human


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and animal gut. (E.g. garbage areas, toilet areas). Flies carry bacteria into the Nursing Home environment.

• Food, amenity and toilet areas are to be kept clean.

• Garbage receptacles are lined and fitted with tight lids when not in use.

• Garbage receptacles are always kept clean.

• External Aged Care Facility windows are covered by screens which are maintained in good

working order.

• Mosquitoes The presence of mosquitoes in the Nursing Home can cause resident distress. A number of diseases can be transmitted by the mosquito. Precautions recommended for excluding flies will generally be effective with the mosquito.

• Cockroaches Cockroaches breed in warm, dark places where they have ready access to human food. They can carry many infections into the Nursing Home including gastrointestinal infections, cholera and hepatitis. They do this with their feet and within their intestinal tract. Cockroach droppings are therefore a definite source of infection.

The following control measures are essential: • All food must be stored properly in containers with fitted lids. • Food processing and assembly areas must be kept clean. • Food processing machinery must be cleaned after each use. • All storage areas must be properly maintained. • Waste receptacles must be kept clean. • All excess packaging cardboard and litter must be disposed of. • All areas subject to cockroaches must be sprayed on a regular basis. • Rodents

The three main species found in Nursing Homes are the brown rat, the black rat and the house mouse. A number of diseases are associated with rodents and they can cause considerable damage.

Methods to control rodents are: • Thorough, constant clearing of all potential areas of infestation. • Regular, careful inspections for evidence of pests. • Storage of waste and garbage in watertight containers. • Thorough cleaning of all garbage containers after use. • Daily removal of all stray litter not placed in correct receptacles. • Proper storage of all food and supplies likely to serve as food for pests.

3.16 PEST REPORTING GUIDELINES Each time staff come to work, they look to make sure that there is no sign of pests, e.g. mouse droppings, dead (or live) cockroaches, ants, nibbled areas on packs, etc. If staff find anything they inform their Supervisor or the Manager immediately (before it is forgotten) so that they can organise a pest controller to visit and log your findings onto a Maintenance alert for documentation purposes.


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3.17 Personal Hygiene Program POLICY Personal hygiene helps promote the health of the individual, prevent the spread of disease from one person to another and prevent food contamination. The Hardi Group promotes a high standard of personal hygiene through the implementation of the personal hygiene program. PROCEDURE Personal Hygiene

• Wash your hands immediately before commencing work, after cleaning, after meals, tea breaks and after visiting the toilet, smoking, handling a rubbish container, using a handkerchief or tissue. (Refer to Standard 4.7 (06) - Hand Washing).

• Personnel to ensure that hands (and wrists) are washed on each entry into the kitchen where food is going to be handled or prepared. If personnel are not to prepare food, & hands have not been washed on entry - personnel to ensure that no food or food contact surfaces are touched.

• Wash hands after handling raw or uncooked food and before touching cooked or ready to eat food.

• Hands are to be wiped on a paper hand towel only - not on an apron or a tea-towel. • No eating, chewing, spitting or drinking by personnel or visitors in the kitchen, food

preparation or service areas. • Smoking near food or in the kitchen is prohibited. • No personal items to be stored in the kitchen or on benches. • Clean clothes will be worn at the start of each day & shoes will be non-slip, closed and clean. • Wear clean protective clothing to prevent food contamination. This includes aprons; gloves;

hair protection. Staff personal clothing must be clean each day. (Refer to Standard 4.7 (16) – Protective Clothing and Equipment).

• All personnel are to wear protective clothing as appropriate to the tasks being completed. All protective clothing is to be clean. Protective clothing is to be changed on re-entry to the kitchen where the person has visited toilets, lunch areas, outside areas, or other areas where contamination may have occurred. Where disposable gloves are worn, they are to be changed on each re-entry to the kitchen, after touching raw product, prior to handling RTE product and any other time considered reasonably necessary. Hands are to be washed before putting on disposable gloves.

• Keep hands and fingers away from your mouth, nose, hair, ears and eyes. If this is unavoidable wash your hands afterwards.

• Keep fingernails clean and trimmed at all times; food handlers are not to wear false nails or nail polish.

• Hair must not be able to contaminate food. Long hair must be tied back. Hair is to be covered with a hair net whilst in food preparation areas. Beards are to be kept tidy.

• Tasting food during preparation is to be avoided. If food requires tasting, the spoon(s) used must be washed between tastes and not reused.

• Carry tableware and utensils away from clothing. • Sitting or lying on food preparation tables or benches is prohibited. • No jewelry is to be worn where there is a possibility of contamination of food. If the jewelry

is of special sentimental (e.g. wedding ring) or religious significance, the decision of ‘wearing an item or not’ to be made by the Facility Management Team. The only acceptable earrings are plain sleepers. No studs in ears, face or any uncovered part of body.


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• All visitors entering the kitchen areas to wear hair covering. If person is to be touching food or food contact surface - person to wash hands and if required by the Supervisor, to also wear gloves. An apron may also be required - this is at the discretion of the Supervisor.

• Contract workers in the kitchen are to comply with the above Good Handling Practices (GHP) and to ensure that all tools are taken out of the kitchen at the end of the day or end of the job. Fixing of plant and equipment is to be completed with care so as not to contaminate food or food contact surfaces that are in use. This is to be monitored by the Supervisor. All areas/equipment used or fixed are to be re-cleaned and sanitised prior to further use in food preparation or service.

Coughs, Sneezes:

• Personnel to ensure that they do not cough or sneeze over food. If a cough or sneeze is blocked, personnel are to wash hands and change disposable gloves (when worn) prior to further work. Notify your Supervisor if you are sick with a cold or flu, where, if dealing with food, bacteria may be passed to the food item which may then be passed on to a resident. If personnel report as sick, it is the Supervisors responsibility to transfer to another area or to complete tasks which would preclude the risk of transferring these harmful bacteria.

Wounds: • Personnel with sores which are weeping or open (including cuts, abrasions, boils) are to

ensure that the wound is covered with a blue (or brightly coloured) Band-Aid. If the wound is on the hand a disposable glove must also be worn over the hand. These personnel are to be transferred to an area or tasks which will preclude the risk of transferring any bacteria to food. This is the Law. Personnel involved in food preparation or service are made aware that they must advise their Supervisor if they are sick.

Personal Health

Staff are required to report to the Catering Manager if they have any gastrointestinal illness, food poisoning (including diarrhoea and vomiting), colds or localized skin infections before starting work. Staff suffering a transmittable condition or symptoms of food borne disease shall not engage in food handling if there is any possibility of them contaminating the product. Incidents of staff not attending work due to food borne illness will be recorded as per the outbreak management policy and procedures. (Refer to Standard 4.7 (21) – Staff Health); Staff can only return to work in the kitchen if the medical practitioner authorizes fitness to return to work, or they have been free of symptoms for 48 hours. Symptoms are Diarrhoea (last loose stool), or last vomit. Staff are informed of their responsibilities for personal health and hygiene through the induction program, staff handbook and annual Food Handlers training.


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3.18 Resident / Family Purchased Meals (Food brought to facility by relatives & friends) POLICY Residents and families often bring in meals and food for residents. This is encouraged to support the resident’s social and emotional health. However, the facility maintains duty of care to minimize the risk of food contamination. PROCEDURE

• Information is made available to residents, family and friends regarding food safety and

strategies to minimize food contamination.

• Residents / Resident family/visitors are responsible for the safety of the food brought into

the facility. Fresh fruit or commercially manufactured food that requires storage is to be

transported to the facility in a food grade container. These foods will then be labelled, dated

and stored in the facility as described below.

• No food that is prepared at home is to enter the kitchen.

• Food to be labelled with the resident’s name.

• If food is of a type which should be under temperature control - receiving personnel to make

sure that the temperature is appropriate or frozen goods are hard frozen, write the date of

receipt on the packaging or attach a sticker & date it, then have the item stored immediately

by kitchen staff.

• If there are any concerns about the type of food, the temperature of the food, or any other

concerns, the concerns to be addressed to the person leaving the food & also to the Facility

Management Team.

• Fruit and vegetables which can be eaten raw are to be washed thoroughly prior to eating.

Sanitise as per food safety program.

• Food which is pre-packaged (e.g. chips & biscuits) must be within the manufacturers expiry

date. If the food is not fully consumed, to be appropriately labelled, dated & stored for later

use.

• Prepared food (e.g. take away or home cooking) to be eaten immediately and not to be

heated or served by Hardi staff and may not enter the kitchen.

• No food to be accepted or given to a resident where there is the likelihood or reasonable

suspicion that the food may cause sickness. In this case, either reject the food, or if already

accepted, dump the food in waste bin.

• No food received for one resident to be shared with other residents unless discussed prior

with the resident &/or their representative.

• Food in fridges is to be disposed of as soon as it is outside its best before or use-by date.


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• Resident fridge and cupboards are regularly checked by staff for out of date items. Staff are

to communicate with residents / family if there are any out of date items and recommend

disposal.

• Staff are to document in the resident file any refusal to dispose of out of date items.

3.19 Staff Training Program POLICY All staff must be trained to enable them to perform their job safely and competently. PROCEDURE

• All new staff attend an orientation program prior to commencement of work. Orientation will include introduction to the food safety program and instructions on how to perform their duties to ensure good food handling procedures are followed.

• All catering staff are required to attend annual Food Safety training for Food Handlers which includes:

- Good personal Hygiene - Safe food handling procedures - Cleaning and sanitation

• The Catering Manager is required to attend HACCP training. • Attendance forms are maintained for all training. All staff training is recorded in individual

staff training files and a central register. • Staff attendance and future needs for training is reviewed annually during the performance

appraisal process. 3.20 Verification Procedures POLICY A verification program is in place to verify that the Critical Control Points and support programs are effective and the facility complies with the Food Safety Program. PROCEDURE

• To ensure the Food Safety Program meets its objective to control food safety each product flow chart is verified by the HACCP Team by confirming all processes are identified and all critical control points are captured, and validated critical control points are used.

• The entire Food Safety Program is reviewed at least annually and whenever there are changes to the product or process. This includes:

• Ensuring all product is covered by the food safety program; • Reconfirming the flow chart; • Reviewing the hazard analysis; • Reviewing the monitoring and recording; • Reviewing corrective actions and recording • Reviewing advice from FSANZ, NSW Food Authority and Third Party Auditor – frequency to

be determined depending on audit reports • If the verification activities reveal that the system is not working correctly then the system is

revised. This may include: • Redesign of forms • Staff training • Revise flow charts as a result of changed process or menu design


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• Review of hazard analysis and CCPs.

3.21 Internal Auditing POLICY To ensure that procedures and practices used are being controlled adequately according to the documented food safety program. PROCEDURE

• The Facility Management Team shall establish an annual internal audit schedule of the complete HACCP documented system (all procedures must be included).

• Where possible, a person independent of the task/procedure to be audited shall perform each audit.

• Checklists shall be completed (including examples or instances of the items checked) and filed with audit reports as confirmation that audit was completed.

• Hardi Group has a standard or usual checklist; this may be used as a guide to prepare other checklists for internal audit if the ‘standard checklist’ is inappropriate for the area in the facility to be checked.

• If the ‘standard / usual checklist’ is appropriate to the areas in the facility to be checked, then this is the one to be completed during the internal audit.

• Following completion of an internal audit, the checklists are to be reviewed to ensure: a) all aspects of Company HACCP System were audited; b) details of compliance or non-compliance were noted; c) decisions regarding any changes required to the HACCP system may be made.

• The Internal Audit reports must show either all areas were OK - or as per the manual, or, not OK - not as per the manual.

The frequency of the audits shall be determined by the Facility Management Team. This shall be based on results of past audits, but as a minimum the complete HACCP system shall be audited annually. This constant review of the System and procedures shall provide a solid basis for the steady improvement of the Company and thereby the provision of improving service to customers of The Hardi Group. 3.22 Waste Management Program (Catering) POLICY To ensure all food waste are disposed of and stored in the correct manner and to not encourage pest activity. PROCEDURE

• All waste to be disposed of in a timely manner. Plate waste from the residents’ meals, and from food preparation area, is to be disposed of in a lined bin.

• No rubbish to be allowed to accumulate in kitchen or storage areas - e.g. old boxes or containers accumulating in a corner, etc. Waste bins to be emptied when the bag is two-thirds full.

• As waste is disposed of, personnel to ensure that there is no contamination of food preparation areas or surfaces or of food. If waste is to be carried through a food preparation area or storage area - to be in a bag tied at the top.

• Personnel disposing of waste to wear protective clothing. Following disposal of waste all protective clothing (apron, gloves, etc) to be changed. Hands and wrists are to be washed before putting on new protective clothing.

• Waste bin to be cleaned in line with the Cleaning Program / Job Routines.


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• Any broken glass or crockery to be disposed of separately - so as not to break the waste bag. • Used fat to be stored in a separate special container and removed as required.

3.23 Rules to Avoid Food Poisoning 1. Keep hot foods hot and cold foods cold:

• Keep food at a temperature higher than 60.0ºC or lower than 5.0ºC. Between 5.0ºC and 60.0ºC food poisoning bacteria thrive.

2. Make sure food is cooked or reheated thoroughly: • All reheated food should reach 75.0ºC before it is served. • Poultry, in particular, must be well cooked without any pink meat around the bones.

3. Do not thaw foods at room temperature: • At room temperature the surface of thawing meats will be wet and warm allowing bacteria

to grow. • Thaw food in the refrigerator or cool room.

4. Avoid transferring bacteria from raw to cooked food: • To prevent contamination cooked foods should not come into contact with raw foods. • Keep in separate areas of the fridge so that raw foods cannot drip onto other foods. • Use colour coded chopping boards. • Wash hands and utensils between preparing raw and cooked foods.

5. Do not obtain foods from unsafe sources: • Buy only from reputable vendors. • Wash all fruit and vegetables before use to remove any contaminants.

3.24 Meal and Tray Presentation POLICY The actual presentation of the finished meal deserves special attention, as it is the final process of a system that strives to provide the best meal possible to residents. PROCEDURE 1. Tray presentation should be attractive and items well placed for ease of eating. 2. Clean tray covers may be used if required and all china, cutlery etc. must be spotlessly clean. 3. Care is needed as trays are set. Items should be carefully placed onto the tray. 4. The placement of the food on the plate is also important. The meal can be spoilt by carelessly

placing the food on the plate. Attention to detail can improve the meal considerably without slowing the speed of production. The following points will assist in the attractive presentation of meals: a) Ensure that gravy or sauces are not spilled over the plate; use another dish as a drip tray

when serving. b) Place a coloured vegetable between white vegetables i.e. Place carrots, between

cauliflower and potatoes. c) Drain all vegetables thoroughly. d) Do not cover the whole dessert or meat with sauce or gravy; make sure it can be

recognised. e) Salads should be high and not squashed down with plastic wrap where possible. f) Do not place beetroot onto a food item, which will accept the colour from the beetroot e.g.

potato-salad or cucumber. g) Do not pile small pieces of meat on top of each other; spread them out attractively. h) Give regard to resident’s personal tastes, do not serve anything without first checking with

the Chef /Cook. If the food does not look nice enough for you, do not serve it. i) Do not hesitate to bring to ask the Chef/Cook anything issue of which you are unsure.


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j) Add garnish if required, after plating is completed.

3.25 Good Handling Practices (GHP) 1. All areas used for storage or preparation of food as well as all items used in preparation of food

to be appropriate for the use they are intended. No items to cause any contamination of the food. No personnel to cause contamination of food. These are FSANZ Food Safety requirements - it is the law

2. Soap & single use hand towel to be in toilets which are used by kitchen personnel. There must also be a waste bin for disposal of paper hand towel close to the toilet.

3. There must be no eating, drinking or smoking in the kitchen. Areas are provided for personnel to eat/drink and smoke - separate to food preparation and storage areas.

4. All personnel to be dressed appropriately at the start of the day. No clothing or jewelry to be worn which may cause contamination of food being prepared or handled.

5. Protective clothing to be worn by all personnel in the kitchen - appropriate to the task. 6. Sinks and hand basins are to be kept clean. No personnel to wash hands in sinks or wash food

or food preparation items in hand basins. Soap and single use hand towel to be provided at hand basins with a waste bin available to throw paper towel away.

7. All lights to be covered in the kitchen and all storage areas. Light covers to be clean. 8. All stored food is to be labelled. Cooked food to be labelled - so that it is only reheated once -

see other food handling procedures. 9. Plates + other items to be stored appropriately. Where possible and safe to do so, items to be

stored up-side down - including plastic plate-covers, cups, pots, pans, etc. 10. No rubbish is to build up in kitchen or storage areas - e.g.: in corners. Storage areas and the

kitchen is not to be used for storage of disused items from other departments. 11. No steel wool is to be used as it can (and does) leave pieces in pots, pans, bowls, etc which are

then transferred to a food product being prepared & cooked. They can cause cutting of the mouth or throat if eaten in the food by a resident.

12. No chemicals are to be stored over or placed on food preparation benches as they may drip on food or leave residues.

13. All implements used are to be appropriate for their use. All areas used for food preparation or storage are to be appropriate for use. Cracked or chipped crockery to be disposed of (the cracks & chips can harbor bacteria).

Record of all GHP (Good Handling Practices) checks completed are to be made on the C. Good Handling Practices Form.


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Section 4

Forms used to monitor the food safety program include:

c. CALIBRATION RECORD c. DAILY FOOD SAFETY MONITORING c. GOOD HANDLING PRACTICES FORM c. UNACCEPTABLE FOOD ITEMS FORM CATERING REPORT INTERNAL MAINTENANCE FORM STOCK CONTROL FORM Cleaning program is displayed. Maintenance and hazard requests and log are located in the Manad computer system. Full maintenance schedule is kept by maintenance officer. Copy of contracts can be obtained from Head Office. Contracts include detail of what is to be provided and requirements of provision of certificates.


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AUDIT PLANNER - Catering

AUDIT JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC

HACCP Systems Review X

Good Handling Practice Form monthly. X X X X X X X X X X X X

Daily Food Safety Monitoring X X X X X X X X X X X X

Audit- Catering Report X X X X X X X X X X X X

Calibration Record X X X X X X X X X X X X

Servicing of equipment checked X X X X X X X X X X X X

Kitchen High Cleaning, Coolroom & Freezer (at least twice a year)

X X X


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SECTION 5 DIETS Item 5.1 Diets 5.2 Standard/Normal 5.3 Light 5.4 Texture Modified Diets 5.5 Soft 5.6 Minced & Moist 5.7 Puree 5.8 Fluids 5.9 Thickened Fluids 5.10 Full Liquid 5.11 Clear Fluid 5.12 Cholesterol Lowering 5.13 Diabetic and the Glycaemic Index 5.14 High Energy, High Protein 5.15 Low Lactose 5.16 Low Fat 5.17 Restricted Fibre 5.18 High Fibre 5.19 Restricted Oxalate 5.20 Low Potassium 5.21 High Potassium 5.22 Controlled Protein 5.23 High Protein 5.24 Low Purine 5.25 Mono-Amine Oxidase Inhibitors 5.26 No Added Salt 5.27 Vegetarian 5.28 Vegan 5.29 Weight Reduction 5.30 Gluten Free 5.31 Nut Free 5.32 Portion Control Guide 5.33 Menu Planning 5.34 References


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5.1 DIETS The existing Nursing Home menu is modified when necessary to accommodate the nutritional requirements of all residents. Therapeutic diets are recommended for residents with medical or dietary needs and / or monitored by the Dieticians and doctor. Some residents may be on a combination of therapeutic diets (e.g. soft and high energy/high protein diet). Staff and residents can get the information about suitability of a dish or information about how to modify a dish by referring to the corresponding diets in this section. Moreover, residents or staff can contact the Dietitian with any queries about the suitability of a dish or to ask how a diet can be modified to meet the requirements of a special menu. Note: If in doubt regarding a special diet, the dieticians should be contacted. 5.2 STANDARD/NORMAL DIET This diet aims to provide a balanced diet with a variety of foods for patients able to eat normally. It is suitable for all residents who are nutritionally well and nutritionally not at risk, but not those with special or high nutritional needs. The Nursing Home menu, plus care in preparation, cooking and service should ensure that the resident’s nutritional needs are met. The menu is prepared in consultation with an Accredited Practising Dietician. At all times the menu will aim to provide meals that are flavoursome and balanced in its nutritional content. When a person has a preference for their culturally specific foods, families are able to bring these into the facility as long as the foods are safe and suitable for the resident. Please refer to the document “Food Brought into this Aged Care Centre by Visitors which are in line with the current regulations as set by “Food Safety Australia & New Zealand” for further information. There is no modification to the texture in this Standard/Normal diet. However, this diet may be combined with thickened fluids to replace thin fluids if needed. People on this diet are able to eat nuts, tough meats, toast, bread; with crusts, apple and muesli, to name a few. Many aged care facilities avoid these foods as many elderly people are unable to chew them. This is usually due to age rather than a physical disorder. 5.3 LIGHT DIET A light diet aims to provide a diet which contains foods lower in fat, fibre and spices. Indications:

• Post-surgery/medical procedures

• As a transition from a liquid to a normal diet

• Nausea General kitchen recipes and menu choices will be used when possible. If adequate choice is not available the following will be offered at lunch and dinner:


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• Hot choices – at least two choices (grilled fish, steamed chicken, omelettes will be available if necessary, although they should not become repetitious

• Sandwiches – at least one choice

• Desserts – at least one option other than ice cream, jelly and custard Foods that are NOT allowed:

• Strongly spiced dishes (e.g. strong curry, satay)

• High-fat dishes >15g fat per serve (e.g. fried foods and pastries)

• Dishes containing nuts or legumes

• Fried potato chips or wedges

• Corn, broccoli, brussel sprouts, cauliflower, cabbage, capsicum

• Minestrone

• Lentils, broccoli, potato and leek soups

• Pickles, chutney, gherkin

• Bran-based breakfast cereals

• Bacon, sausages, baked beans

• Rhubarb, prunes, dates, pineapple

• Any desserts >10g fat per serve (e.g. pastries, pies, cheesecake)

• Cream All other dishes on the general menu are allowed.


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5.4 TEXTURE MODIFIED DIETS A texture modified diet may be needed if the consistency of the normal diet cannot be tolerated because of the following:

• Difficulty chewing

• Dysphagia (difficulty swallowing assessed by a Speech Pathologist)

• Poor dentition or no dentures

• Inadequate saliva flow

• Medical or surgical conditions affecting the mouth or oesophagus

• A progression from liquid diet to normal diet for post some gastrointestinal surgery The food or fluids are modified in texture and consistency only. Nutritional value or integrity needs to be ensured when creating the modified texture and consistencies. These diets may be permanent or temporary depending on the resident’s chewing or swallowing function. There are four levels of texture modification:

Unmodified Most modified

Unmodified – Regular

Every day foods

Texture A – Soft (1.5 cm)

Food may be naturally soft (eg ripe banana), or may be cooked or cut to alter its texture

Texture B – Minced and Moist (0.5 cm)

Food is soft, moist and easily mashed with a fork; lumps are smooth and rounded

Texture C – Smooth Pureed

Food is smooth, moist and lump free; may have a grainy quality


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Modified Meals Guide

Puree Lump free and moist

Minced Moist, soft, and finely diced with lumps up to 0.5cm

Soft Soft foods, without hard, crunchy, tough or chewy foods

Meats & Fish

✓ All meats and fish should be

moist and pureed

✓ Meats should be minced and moist

✓ Fish should be flaked off the bone

✓ Soft foods (that could be easily mashed with a fork)

✓ Casseroles with small pieces of tender meats

Crunchy battered fish

Dry, tough or chewy/crispy meats eg. Chicken schnitzel

Vegetables & Salad ✓ All vegetables should be

moist and pureed

✓ Minced (slightly textured)

✓ Soft cooked/diced vegetables that are easily mashed with a

fork

No peas, no corn

✓ Well-cooked vegetables served in small pieces, or soft enough to

be mashed or broken up with fork

No crunchy salad (eg lettuce, cucumber, celery)

No hard fibrous or stringy veg (eg. broccoli stalks)

Bread No bread

Only allowed bread if specified by SP and must be crustless,

white bread with spreads only

✓ Soft sandwiches with moist fillings, not hard or crunchy

No grains, seeds, or crunchy fillings

Toast No toast, muffins, crumpets No toast, muffins, crumpets No toast, muffins, crumpets

Biscuits & Danishes No biscuits No biscuits

No hard biscuits

No hard foods, popcorn, chips

Fruit ✓ Pureed fruit

✓ Mashed or finely diced soft fruits (eg. nectarines, peaches,

banana, tinned fruit)

✓ Soft, skinless fruits in bite-sized pieces

No apples, whole grapes/cherries or pineapple

Cheese ✓ Pureed cottage cheese

✓ Minced cottage cheese

No hard cheeses

✓ Soft cheeses (eg. Camembert)

No hard cheeses

Eggs ✓ Pureed eggs (Scrambled

eggs must be pureed)

✓ Scrambled

✓ Poached, boiled – cut up

✓ Scrambled, Poached or boiled

Fried eggs

Cereals ✓ Porridge/Weet Bix -pureed

No other cereals

✓ Porridge, Weet Bix

✓ Rice Bubbles soaked in milk

✓ Rice bubbles, Special K or Cornflakes, soaked in milk,

No Sultana bran, nuts, seeds or dried fruit

Rice &

Pasta ✓ Pureed pasta and rice ✓ Minced, mashed/ finely cut-up pasta and rice

✓ Soft past and rice

No Pizza

Cake

No cake

✓ Soft, moist mashed sponge cake/desserts with lots of custard,

cream or ice-cream

No crunchy base on cheesecakes, hard crumbles

✓ Moist cakes

✓ Soft pastry

No dry cakes or pastry

No crumbly or flaky pastry or coconut eg. apple crumble

NB: If someone is having thick fluids, they cannot have ice-cream, jelly, syrup in tin fruit, milk on cereal, thin soup, watermelon etc.

Ref: Lisa Forbes (2015) Speech Pathologist


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5.5 SOFT DIET Food in this category may be naturally soft (e.g. ripe banana), or may be cooked to alter its texture. The food pieces should be no greater than 1.5cm x 1.5cm. Characteristics:

• Soft foods can be chewed but not necessarily bitten

• Minimal cutting required, easily broken up with a fork

• Food should be moist or served with a sauce or gravy to increase moisture content (NB: sauces or gravies should be served at the required thickness level).

Recommended foods and those to avoid (examples only)

Recommended foods Avoid

Bread, cereals, rice, pasta, noodles

• Soft sandwiches(a) with very moist fillings, e.g. egg and mayonnaise, hummus (remove crusts and avoid breads with seeds and grains)

• Breakfast cereals well moistened with milk(b)

• Soft pasta(a) and noodles

• Rice (well cooked)

• Soft pastry, e.g. quiche with a pastry base

• Other, soft, cooked grains

• Dry or crusty breads, breads with hard seeds or grains, hard pastry, pizza

• Sandwiches that are not thoroughly moist

• Course or hard breakfast cereals that do not moisten easily, e.g. toasted muesli, bran cereals

• Cereals with nuts, seeds and dried fruit

Vegetables, legumes

• Well-cooked vegetables(a) served in small pieces or soft enough to be mashed or broken up with a fork

• Soft canned vegetables, e.g. peas

• Well-cooked legumes (the outer skin must be soft), e.g. baked beans

• Salads identified in menu by speech pathologist for soft diet

• All raw vegetables (including chopped and shredded)

• Hard, fibrous or stringy vegetables and legumes, e.g. sweet corn, broccoli stalks


Fruit

• Fruit pieces that are naturally soft, e.g. banana, well-ripened pawpaw, Kiwi, soft peach/per without skin

• Stewed and canned fruits in small pieces

• Pureed fruit

• Fruit juice(b)

• Large/round fruit pieces that post a choking risk, e.g. whole grapes, cherries

• Dried fruit, seeds and fruit peel

• Fibrous fruits, e.g. pineapple

• Raw apple

• Minced grape


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Milk, yoghurt, cheese

• Milk, milkshakes, smoothies(b)

• Yoghurt (may contain soft fruit) (b)

• Soft cheese(a), e.g. Camembert, ricotta

• Yoghurt with seeds, nuts, muesli or hard pieces of fruit

• Hard cheeses, e.g. cheddar and hardened/crispy cooked cheese

Meat, fish, poultry, eggs, nuts, legumes

• Casseroles with small pieces of tender meat(a)

• Moist fish (easily broken up with the edge of a fork)

• Eggs(a) (all types except fried)

• Well-cooked legumes (the outer skin must be soft), e.g. baked beans

• Soft tofu, e.g. small pieces, crumbled

• Dry, tough, chewy, or crispy meats

• Meat with gristle

• Fried eggs

• Hard or fibrous legumes

• Pizza

Desserts

• Puddings, dairy desserts(b), custards(b), yoghurt(b) and ice-cream(b) (may have pieces of soft fruit)

• Moist cakes (extra moisture, e.g. custard may be required)

• Soft fruit-based desserts without hard bases, crumbly or flaky pastry or coconut, e.g. apple crumble

• Creamed rice, moist bread and butter pudding

• Dry cakes, pastry, nuts, seeds, coconut, dried fruit, pineapple


Miscellaneous

• Soup(b) (may contain small soft lumps, e.g. pasta)

• Soft juice jellies or non-chewy lollies(a)

• Soft, smooth chocolate

• Jams and condiments without seeds or dried fruit

• Soups with large pieces of meats or vegetables, corn, or rice

• Sticky or chewy foods, e.g. toffee

• Popcorn, chips, biscuits, crackers, nuts, edible seeds

(a) These foods require case-by-case considerations. (b) These foods need modification for individuals requiring thickened fluids.


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5.6 MINCED AND MOIST DIET

A Minced and Moist Diet consists of foods which require very little chewing. Food needs to be minced, mashed or soft and cut into very small pieces no larger than 0.5 cm. Food in this category is soft and moist and should easily form into a ball. Characteristics:

• Individual uses their tongue rather than teeth to break the small lumps in this texture

• Food is soft and moist and should easily form into a ball

• Food should be easily mashed with a fork

• May be presented as a thick puree with obvious lumps in it

• Lumps are soft and rounded (no hard or sharp lumps)

Recommended foods and those to avoid (examples only)

Recommended foods Avoid (In addition to the Foods to Avoid

listed for Texture A - Soft)

Bread, cereals, rice, pasta, noodles

• Breakfast cereal with small moist lumps, e.g. porridge or wheat flake biscuits socked in milk

• Gelled bread

• Small, moist pieces of soft peas, e.g. moist macaroni cheese (some pasta dishes may require blending or mashing)

• All breads, sandwiches, pastries, crackers, and dry biscuits

• Gelled breads that are not socked through the entire food portion

• Rice that does not hold together, e.g. parboiled, long-grain, basmati

• Crisp or dry pasta, e.g. edges of a pasta bake or lasagne

Vegetables, legumes

• Tender cooked vegetables that are easily mashed with a fork

• Well-cooked legumes (partially mashed or blended)

• Vegetable pieces bigger than 0.5cm or too hard to be mashed with a fork

• Fibrous vegetables that require chewing, e.g. peas

Fruit

• Mashed soft fresh fruits, e.g. banana, mango

• Finely diced soft pieces of canned or stewed fruit

• Pureed fruit

• Fruit juice (a)

• Fruit pieces larger than 0.5cm

• Fruit that is too hard to be mashed with a fork

Recommended foods Avoid (In addition to the Foods to Avoid

listed for Texture A - Soft)

Milk/dairy products

• Milk, milkshakes, smoothies(a)

• Yoghurt(a) (may have small soft fruit pieces)

• Very soft cheeses with small lumps, e.g. cottage cheese

• Soft cheese that is sticky or chewy, e.g. Camembert


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Desserts

• Smooth puddings, dairy desserts(a), custards(a), yoghurt(a) and ice-cream(a) (may have small pieces of soft fruit)

• Soft moist sponge cake desserts with lots of custard, cream or ice-cream, e.g. trifle and tiramisu

• Soft fruit-based desserts without hard bases, crumbly or flaky pastry or coconut, e.g. apple crumble with custard

• Creamed rice

• Desserts with large, hard or fibrous fruit particles (e.g. sultanas), seeds or coconut

• Pastry and hard crumble

• Bread-based puddings

Miscellaneous

• Soup(a) – (may contain small soft lumps, e.g. pasta)

• Plain biscuits dunked in hot tea or coffee and completely saturated

• Salsa’s, sauces and dips with small soft lumps

• Very soft, smooth chocolate

• Jams and condiments without seeds or dried fruit

• Soups with large pieces of meats or vegetables, corn or rice

• Lollies including fruit jellies and marshmallow

(a)These foods may require modifications for individuals requiring thickened fluids.


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5.7 PUREE DIET Food in this consistency is smooth and lump free. It is similar to the consistency of commercial pudding. At times, smooth pureed food may have a grainy quality, but should never contain lumps. Characteristics:

• Smooth and lump free but may have a grainy quality

• Moist and cohesive enough to hold its shape on a spoon (i.e. when placed side by side on a plate these consistencies would maintain their position without ‘bleeding’ into another)

• Food could be moulded, layered or piped It is important to ensure that the nutritional value of the meal is maintained despite the blending of the foods. In order to obtain the correct smoothness, fluids are usually added which would dilute the nutritional content. This must be taken into consideration when preparing a meal and/or menu. Small, frequent meals should be offered. Puree meals can consist of nearly all foods: it is the blending process that is critical. Pureed foods should be presented as separate food items NOT blended together. Foods that do NOT blend well and should be avoided include:

• Corn, peas, celery

• Undercooked or stringy vegetables which are not able to be pureed strained and made smooth.

• Stringy or segmented fruits e.g. pineapple, oranges

• Whole grain breads

• Cereals with dried fruit or nuts, toasted or raw muesli

• Cereals which do not soften completely with hot milk

• Most rice (especially long grain) as this does not puree into a smooth consistency

• Tough, gristly, dry or undercooked-meats or chicken or fish

• Dry or overcooked egg dishes e.g. fried egg, scrambled egg

• Filo pastries.


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5.8 FLUIDS Usually the minimum is between 1500ml and 2000ml (6-8 cups) per day. More will be required if there are extra losses, fever or hot weather. Sufficient fluids are essential to help prevent constipation and dehydration. The consequences from excessive fluid intake or dehydration can be serious. Fluid requirements for the elderly can be calculated as: 100ml fluids per kg body weight for the first 10kg

50ml fluids per kg for the next 10kg, and 15ml fluids for each remaining kg body weight.

For example:

65kg resident = 100 x 10 = 1000 50 x 10 = 500 15 x 45 = 675 = 2175

Thus 65kg resident requires 2175ml fluid/day.

Tips to increase fluid intake in residents who are poor drinkers:

• Give small drinks frequently

• Provide an increased variety of drinks

• Provide ice blocks or ice chips to suck

• Use suitable cups

• Serve drinks at each meal and mid-meal and with medications

• Provide straws for residents who can’t get to the bottom of their drinks

• Add cordial to the bedside water

• Fill cups twice at mid-meals

• Have a staff member who is assigned to make regular rounds with a beverage trolley

• Consider putting a symbol (e.g. a water drop) above the beds of residents at risk dehydration

• Residents needing thickened fluids require extra monitoring.

5.8 FLUIDS continued Remember fluids come in many shapes, tastes and forms. Below are listed some fluids that may be especially helpful for residents who are prone to dehydration or required to have fluid restriction:

½ cup custard = 100ml fluid A juice glass = 120ml fluid

½ cup sago/tapioca pudding = 80ml fluid ¾ cup thick soup = 150ml fluid

A plastic feeder glass = 200ml fluid 2 scoops ice cream = 70ml fluid

A coffee cup = 150ml fluid 200g carton yoghurt = 180ml fluid

A fruit juice Tetra Pak = 250ml fluid ½ cup jelly = 100ml fluid


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5.9 THICKENED FLUIDS Thickened fluids are recommended for residents with swallowing disorders. When the flow of liquid is not well controlled due to uncoordinated oral muscles, liquid can enter the airway, then the lungs, which can lead to chest infections and pneumonia. Replacing unmodified liquid drinks with thickened drinks may help prevent these complications. Care must be taken to ensure adequate fluid intake when thickened liquids replace normal consistency fluids. Thickened fluids should be offered regularly (every 1-2 hours) to ensure adequate hydration. There are four levels of fluids modifications:

Unmodified Most modified

Level Flow rate Description

Unmodified Very fast – fast flow

• Regular fluids; Various thickness

Level 150 – Mildly Thick (Nectar)

Steady, fast flow

• Pours quickly from a cup but slower than regular, unmodified fluids

• May leave a coating of residue in the cup after being poured

• Drink this fluid thickness from a cup

• Effort required to take this thickness via a standard bore straw

Level 400 – Moderately Thick (Honey)

Slow flow

• Cohesive and pours slowly

• Possible to drink directly from a cup although fluid flows very slowly

• Difficult to drink using a straw, even if using a wide bore straw

• Spooning this fluid into the mouth may be best way of taking this fluid

Level Flow rate Description

Level 900 – Extremely Thick (Pudding)

No flow

• Cohesive and holds its shape on a spoon

• It is NOT possible to pour this type of fluid from a cup into the mouth

• It is NOT possible to drink this thickness using a straw

• Spoon is the optimal method for taking this type of fluid

• This fluid is too thick if the spoon is able to stand upright in it unsupported


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Fluids that need to be thickened:

• Water

• Tea, coffee

• Milk, flavoured milk, drinking yoghurt

• Fruit juice, cordial, soft drinks

• Soups

• Commercial supplements e.g. Sustagen, Ensure, Resource Fruit Beverage, TwoCal HN

• Movicol dissolved in thin fluids Fluids that do not require thickening:

• Thick custard

• Thick vanilla or plain yoghurt

• Fruché

• Mousse

• Pureed fruit

• Thick gravies Fluids to AVOID as they become thin in the mouth: (IMPORTANT: At NO time should the following food items be given to a person on thickened fluids, unless it is thickened and recommended by the Speech Pathologist)

• Jelly

• Gelatin desserts (unless thickened with commercial thickener during production)

• Ice, ice blocks

• Ice cream

• Thin custard MAKING THICKENED FLUIDS A great variety of thickening powders are available to thicken fluids. Hardi Aged care uses precise thickener. Refer to manufacturer’s instructions on use.

Best practice in preparing thickened fluids is to have recipes. It is important to remember that the amount of thickener used will be different depending on:

• the type of fluid

• the thickening agent used

• the level of consistency required

• Fluids should not be aerated by over blending, as this gives a false consistency (thicker than it really is)

• Residents should be offered 1.2litres to 2 litres of fluid per day unless on special restrictions or requirements related to medical conditions.

• Provide cold drinks cold and hot drinks hot and full of flavour to enhance the resident’s experience of their drink.

• Jelly must be pre thickened, otherwise it is not safe for resident requiring thickened fluids. Some foods that can be substitutes for thickened fluids include:


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• Tapioca and sago pudding

• Baked custard

• Thick custard sauce – commercially prepared or homemade

• Thick pureed fruit – puree 2/3 canned pie pack fruit with 1/3 drained canned fruit

• Junket

• Blancmange

• Natural yoghurt

• Thick yoghurt-based products available commercially

• Commercially available thickening agents may be added to normal fluids as per instructions


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5.10 FULL LIQUID DIET This diet includes liquid foods that require no chewing and could be consumed through a straw (in theory). Indications:

• Short term, pre and post-surgery

• Short term management of fractured mandible

• Following oral or plastic surgery to the face

• Short term management of oesophageal strictures

• A temporary transition from clear fluids to a normal diet Fluids to be included daily in a full liquid diet are:

• All liquids listed under ‘Clear Fluids Diet’

• Milk and milk based drinks e.g. commercial egg flips, iced coffee

• Commercially available high energy drinks

• Plain Jelly*, junket, plain yoghurt, thin egg custard, ice cream

• Blended and strained porridge, semolina with milk and sugar – must be of a thin consistency that could theoretically be consumed through a straw

• Strained fruit and vegetable juices

• Tea, coffee with milk and sugar There should be constant revision of the resident’s condition to ensure the resident on this diet does not stay on this diet longer than necessary, and that he/she is encouraged to return to their usual regime. If the resident requires a long-term liquid diet, the medical officer and/or Dietitian will be consulted regarding the possible need for a vitamin and mineral/nutritional supplement to ensure adequate nutrition. Several liquid supplements are available from various pharmaceutical companies. These are usually made up to provide 1 to 2 calories per ml. They are usually based on soy milk, cow’s milk or juice. The aim is to prevent undesired weight loss or malnutrition. Examples are:

• Sustagen (1.0cal/ml)

• Proform (1.0cal/ml)

• Ensure (1.0cal/ml)

• Ensure Plus (1.5cal/ml)

• Fortijuice (1.5cal/ml)

• TwoCal HN (2.0cal/ml)


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5.11 CLEAR FLUID DIET This diet includes fluids that are liquid or liquefy at room temperature. All fat containing liquids are excluded. This diet is highly restrictive and is of little nutritive value. Hence, it should not be used as the sole means of nutritional support for more than three days, unless appropriate supplement drinks are used i.e. commercially available high energy, fat free, milk free drinks. Indications:

• Following gastrointestinal surgery as the first step in oral rehydration

• To reduce the amount of residue in the colon as a preparation for bowel surgery or barium enema

Recommendations include:

• Water

• Clear soup, clear stock, Bonox ®, Bovril ®, soup cubes

• Plain jelly

• Strained fruit juices

• Cordial, soft drinks

• Black tea/coffee with sugar

• Flavoured ice blocks

• Commercially available rehydration fluids

• Commercially available high energy, fat free, milk free oral supplements 5.12 CHOLESTEROL LOWERING DIET This diet is for residents with high cholesterol. The aims are to achieve a lipid profile within target ranges and to achieve optimal blood pressure. Older Adults living in Aged Care facilities do not need to follow a strict cardio-protective diet, and should be provided with full fat dairy products as the standard. Medical management to improve lipoprotein profiles and other risk factors is typically more appropriate than imposing dietary restrictions on individuals already at risk of malnutrition

Foods to Choose/Healthier Choices Foods to Select Less Often/Less Desirable

Breads and Cereals

• Wholegrain, wholemeal, soy, linseed and rye bread, high fibre white bread

• Wholegrain, bran/wheat/oat based cereals, porridge, muesli

• Wholemeal flour, high fibre pasta, brown rice

• Homemade cakes and biscuits made with cardio-protective ingredients

• White bread, croissants, Danish pastries

• Refined cereals e.g. cornflakes, Rice Bubbles ®

• Commercial pasta/rice dishes made with cream, butter and cheese

• Commercial cakes, pastry, biscuits

Fruits

• Fresh/stewed/canned/dried

• Fruit juice

• Fruit pies/pastries made with butter or partially hydrogenated oil


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Vegetables/Salads

• All vegetables and salad

• Roasted vegetables cooked with small amount of mono or polyunsaturated oil

• Fried/roasted vegetables cooked with saturated fat such as butter or dripping

• Vegetables and salads served with cream or cheese based sauces

Milk/Milk Products

• Low fat milk, skim milk

• Soy milk, soy yoghurt

• Non-fat/low fat yoghurt

• Low fat cottage/ricotta cheese

• Low fat ice cream Limit fat reduced (less than 25% fat) cheese

or ‘Light’ cheese to 1-2 serves or slices per week

• Full cream milk, full cream evaporated milk, full cream condensed milk

• Full cream yoghurt, cream, sour cream

• Full fat cheese e.g. Cheddar, cheese spread

• Full cream ice cream

Meat/Meat Alternatives

• Lean meat, chicken, fish, egg • Dried beans, peas and lentils • Soy products e.g. tofu, textured vegetable protein • Nuts e.g. pecans, walnuts, almonds • Seeds e.g. sunflower, pumpkin

• Fatty meat e.g. bacon, sausages, ham

• Offal e.g. liver, kidney

• Fish cooked in saturated fat such as butter

• Deep fried takeaway foods and snacks

• Salted nuts

• Salted seeds

Fats

• Mono and polysaturated margarine table spreads and oil e.g. canola oil, olive oil, safflower oil, sunflower oil

• Plant sterol enriched table spreads e.g. Logical ® and Proactive ®

• Mayonnaise and oil dressings made with poly and mono-saturated oils

• Butter, shortening, lard, dripping, suet, ghee, cooking margarine, coconut oil, coconut milk, palm oil

Beverages

• Water, tea, coffee

• Cordial and soft drink (diet if overweight)

• Fruit juice (in limited quantities)

• Full fat milkshakes

Miscellaneous

• Herbs and spices

• Artificial sweeteners

• Low fat gravies and sauces

• Sugar, jam and honey in small amounts

• Chocolate

• Potato crisps/chips


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5.13 DIABETIC DIETS AND THE GLYCAEMIC INDEX Guidelines for Healthy Eating and Diabetes in Aged Care: The following are useful guidelines for residents with diabetes. The same principles apply for someone requiring insulin. Provide regular meals and snacks with consistent amounts of carbohydrate included with each meal; aim for three meals and two to three snacks each day Incorporate low Glycaemic Index (GI) carbohydrates into the menu on a daily basis, trying to include

one low GI choice at every meal time

Sugar does not need to be avoided

Low fat diets are not recommended

Fortify the food for individuals identified at risk of malnutrition

Include high fibre products

Include at least three dairy serves each day

Provide a minimum of two fruit serves per day

Provide and encourage appropriate fluids

Glycaemic Index The Glycaemic Index (GI) is a measure of the effect different carbohydrate foods have on blood glucose levels. It describes the way our body digests and absorbs these foods on a scale from 0-100. Carbohydrates that are digested quickly and raise blood glucose levels faster have a high GI (≥70)

Carbohydrates that are digested and absorbed slowly have a lower GI (≤55). Low GI foods give

better control of blood glucose levels in diabetes by causing a slower but longer lasting rise in blood

sugar levels.

The Glycaemic Index only applies to foods which contain carbohydrates. Therefore meat, fish,

chicken, eggs, cheese and fats do NOT have a GI ranking.

Low GI diets have been shown to improve both glucose and cholesterol levels in people with

diabetes (Type 1 and Type 2).

Including a low GI food at each meal will slow the digestion of other carbohydrate foods at that

meal.

A combination of a high GI and a low GI food will result in a medium GI meal.

Advantages of incorporating GI principles into menu planning:

• People with diabetes no longer need to feel they have such limited food choices. Removal of the harsh restriction on sugar means a wider variety of foods. Resident satisfaction may improve.

• Kitchen staff should find life easier e.g. it is no longer necessary to have two lots of custard, as custard sweetened with sugar is suitable for all.

• Products such as low joule jam, low joule jelly and artificially sweetened tinned fruit are no longer necessary. This should mean easier resource management and improved resident satisfaction. Low joule cordial can still be given as a thirst quenching liquid between meals.

• Some cakes and muffins (especially fruit muffins) have a low GI and so are suitable for all residents at mid meal times.

• Menu planning and food ordering is easier as dietary alternatives are not necessary.


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Sugar and diabetes Sugar has a moderate GI. Residents with diabetes should be served the regular desserts and snacks between meals. Moderate amounts of sugar can be used in recipes and served to all residents including those with diabetes. Residents with diabetes can be served: Ordinary desserts

Ordinary cakes and biscuits

Ordinary jam, marmalade, honey

Ordinary ice cream and jelly

Ordinary cordial and soft drink (limited amounts)

Milo

Experience shows that residents eat better when they are given less restrictive diets. It is appropriate to serve residents with diabetes an unrestricted diet from menus that offer a range of carbohydrates, including at least one with a low GI, at each meal and snack time. Improved meal enjoyment contributes to quality of life. It is often more important to make medication changes than to restrict food choices.


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Below is a sample list of foods that have been rated:

Low GI 55 (slow acting) Moderate GI (56-69) High GI 70 (fast acting)

Breads

Wholegrain/multigrain breads Burgen® Breads (except Oat Bran & Honey) Fruit loaf/raisin bread Soy and Linseed bread Pumpernickel Sourdough

Wholemeal bread Light Rye Bread Pita bread Crumpets Hamburger bun Croissants Burgen® Oat Bran & Honey Bread

White bread (including high fibre white) Brown bread Dark rye bread English muffins (white) Bagels Baguettes Plain scones

Breakfast cereals

Rice, oat & barley bran All-Bran Guardian Rolled Oats/porridge Sustain

Weetbix/Vita brits, Just Rights Plain Mini Wheats Shredded Wheat All-Bran Flakes Instant Oat Natural Muesli

Sultana Bran Coco Pops Corn Flakes Puffed Wheat Rice Bubbles Mini Wheats (fruit filled)

Cereal foods

Doongara rice Long grain rice (Mahatma) Pearl barley Pearl couscous All Pasta (white or wholemeal e.g. spaghetti / macaroni) Fresh rice noodles Cracked wheat (bulgur) Buckwheat Semolina

Basmati/ Arborio/ Wild/ Brown rice Dried rice noodles Popcorn (plain) Couscous (regular) Instant noodle (low fat)

All other white rice e.g. Jasmine rice Tapioca

Biscuits and crackers

Ryvita (seeds & oat varieties) Vita-Wheat Arnott's Snack Right fruit (slice/pillow) Arnott's® Jatz Oatmeal biscuits

Ryvita (original & sesame) Digestive biscuits Arnott’s® shredded wheat meal biscuits Milk Arrowroot biscuits

Water crackers Rice crackers Sao Rice cakes/corn thins Milk Coffee biscuits Pretzels


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Low GI 55 (slow acting) Moderate GI (56-69) High GI 70 (fast acting)

Fruit

Apples (fresh/dried) Pears Plums Peaches Apricots (fresh/dried) Mandarins Grapefruit Banana Mango Nectarines Oranges Grapes Kiwi fruit 100% Fruit juice Prunes Dates

Cherries Pawpaw Sultanas/raisins Figs (dried) Pineapple Rockmelon Lychee (fresh)

Watermelon Lychee (tinned in syrup)

Vegetables & legumes

Sweet corn Carisma potato Lentils, kidney beans, split peas, chick peas, baked beans, 3 or 4 bean mix

Sweet potato Broad beans

White potatoes Instant potatoes

Dairy products

Milk or soy milk Yoghurt/Fruché Custard Ice cream Milo in milk

Other

100% Fruit Jam Fructose Logicane sugar

All other sugar (sucrose) Honey

Malt (maltose) Glucose Jelly beans Sports drinks (Gatorade) Lucozade


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5.14 HIGH ENERGY, HIGH PROTEIN DIET This diet is used for residents where increased energy, protein and other nutritional requirements cannot be met by their diet alone. It is planned to provide small, frequent nourishing meals and snacks that are fortified with high energy, high protein additions with nourishing milk based drinks provided between meals. Indications: Protein energy under nutrition Malnutrition/risk of malnutrition identified by screening tool People with burns Poor wound healing Thyrotoxicosis It is essential to remember, that many residents who are at risk of or who are malnourished require assistance with their meal. It does not matter how rich a meal is in protein and energy, if it does not make it from the plate to the mouth then no benefit can be gained. It is essential that adequate time and assistance is provided to residents to ensure their oral intake is maximised. Commercial supplements maybe required if the food fortifications do not result in weight stabilisation or regain. The need for these can be assessed by an Accredited Practising Dietitian. There is a wide range of supplements differing in their concentration of nutritional values, price, milky or fruit-juice base, and volume etc. The choice is usually determined by the resident’s dietary needs, the availability and personal preference. Examples are:

• Sustagen (1.0cal/ml)

• Proform (1.0cal/ml)

• Ensure (1.0cal/ml)

• Ensure Plus (1.5cal/ml)

• Fortijuice (1.5cal/ml)

• TwoCal HN (2.0cal/ml) Food choices chart and preparation ideas

Food to Choose

Bread and Cereals – All

Preparation ideas to increase protein and energy:

• Serve cereals with milk fortified with skim powder

• Prepare hot cereals/porridge with milk fortified with skim milk powder

• Add cheese/mono or polyunsaturated margarine/oil to rice/pasta dishes

• Add variety to the diet by offering raisin toast, crumpets, croissants

Fruits – All


• Add commercially available glucose polymer to stewed/canned fruit

• Add blended fruit to milkshakes

• Offer fruit bars, muesli bars, dried fruit and nuts

Vegetables/Salad – All


• Serve with sour cream, natural yoghurt, grated cheese, white sauce with added skim milk powder

Milk/Milk Products

• Full cream milk, cheese, yoghurt


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• Skim milk powder

• Evaporated milk Preparation ideas to increase protein and energy:

• Add milk powder to dishes e.g. white sauce, milk drinks, creamed soup

• Add skim milk powder and glucose polymer to milk desserts e.g. custards, rice pudding etc.

• Add glucose polymer to fruit yoghurt

Meat/Meat Alternatives – All


• Serve meat with tasty gravy or sauces

• Add skim milk powder to meat/fish patties mixture

• Serve scrambled/poached eggs for breakfast

• Serve dishes with grated cheese/white sauce

• Offer ham and cheese omelette

Fats – All (Fats are an excellent source of energy (kJ))

Soups – All


• Add skim milk powder, egg, cheese or evaporated milk and cream to soup

Food to Choose

Snack ideas

• Cream cheese/peanut butter on hot toast

• Jam/honey/marmalade on toast

• Dried fruit/nuts

• Yoghurt

• Sandwiches

• Crackers and cheese

Beverages – All

• Encourage milk, milkshakes, juice

• Cordial and soft drinks also provide energy

• Limit fluids that do not provide energy (e.g. water, tea and coffee)

• Commercial supplements may be indicated

5.15 LOW LACTOSE DIET A low lactose diet is recommended for residents who have a deficiency or absence of the intestinal enzyme lactase. Lactose is a sugar found exclusively in milk. Absorption of lactose is dependent upon the enzyme lactose. Undigested lactose remains in the intestinal lumen and is fermented by bacteria in the gut. This fermentation can cause abdominal cramps, distension, increased motility and osmotic diarrhoea. Lactose from milk and milk products and other foods is restricted to a level where an individual is symptom free. Alternatives to dairy products must be provided. It is not acceptable for example to simply remove custard from a dessert; custard made from soy milk fortified with calcium or low lactose milk would be a suitable alternative. People who do not consume adequate soy milk fortified with calcium or low lactose milk should be encouraged to take calcium supplements.


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Recommendations: • Limit all milk and milk products • Limit processed foods that contain lactose • Read labels for the presence of whey and non-fat milk solids because they contain lactose •Be aware that casein, the protein content of milk, may contain small amount of lactose – consume as individual tolerance allows • Provide suitable alternatives to milk and other dairy products to ensure adequate calcium, magnesium and protein is provided.


Breads and Cereals

• Milk free bread and bread rolls

• Cooked and ready-to-serve cereals

• Pasta, rice, sago, tapioca, flour, cornflour

• Most cracker biscuits, crisp breads

• Milk bread or protein enriched bread

• Commercial biscuits, cakes, scones, pastries made with milk or added milk solids

• ‘High Protein’ cereal products, muesli containing milk solids

Fruits

• All fruit and fruit juices • Nil


Vegetables/Salads

• Fresh/frozen/canned/dried vegetables

• All salad vegetables

• Vegetables prepared with milk, white sauce or cheese sauce made with butter or margarine that is not milk free

• Salads with dressings containing milk

Milk/Milk Products

• Commercial soy milk products fortified with calcium

• Low lactose milk

• Cow’s milk treated with commercially available products that hydrolyse lactose e.g. Lactaid

• Rice milk (may contain negligible calcium and little protein)

• Cow’s milk, evaporated powdered/condensed whole milk, skim milk, buttermilk

• Goats milk

• Yoghurt, cottage cheese, hard cheese, cream cheese

• Ice cream, milk pudding, custard


• Lean meat, chicken, fish, eggs • Dried peas, beans, and lentils • Tofu • Nuts

• Canned meat products containing milk solids

• Commercial meat/chicken/fish/egg dishes containing milk, milk solids, white/cheese sauces

• Pizza, bacon and egg pie, quiche, pastry

• Foods covered with batter or breadcrumbs containing milk

• Scrambled eggs made with milk

Fats

• Milk free mono and polysaturated margarine e.g. Nuttelex or oil

• Butter, other margarine

• Cream, sour cream


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Beverages

• Water, tea, coffee, Bonox ®, Bovril ® • Milo®, Ovaltine®, Aktavite®, chocolate drinks, flavoured milks, milkshakes

Soups

• Broths, vegetable soups, clear soup, milk free soup cubes

• Commercial canned or dried soups with milk or milk solids

• Creamed made with milk or cream


Miscellaneous

• Jam, honey, marmalade

• Boiled lollies, nuts

• Tea, coffee, cordial, soft drinks

• Herbs, spices, vinegar, garlic, chilli

• Mayonnaise, creamy sauces

• Chocolates, toffee, caramels

5.16 LOW FAT DIET This diet is moderately restricted in fat. It limits intake to less than 45 grams of fat per day. It is intended for people with impaired fat digestion and absorption. Indications: • Pancreatic enzyme replacement remains the primary treatment for steatorrhoea associated with chronic pancreatitis. Reduction of dietary fat may also be needed. • A low fat diet may assist the control of diarrhoea, and increase macronutrient and some mineral absorptions following surgery for Short Bowel Syndrome • Moderate restriction of fat should be sufficient to lessen gallbladder contractions induced by fat • Chronic radiation enteritis Contraindications: • Restriction of fat in uncomplicated hepatitis is unfounded. • Fat restriction has been found to be of little benefit in controlling bowel actions associated with Cystic Fibrosis • Malnutrition or at risk of malnutrition Recommendations: • Choose lean meat, poultry, fish, and trim all visible fat from meat and poultry • Choose low fat milk and milk products i.e. less than 1% fat content •Limit added fat intake e.g. butter, margarine, table spread, oil, mayonnaise, dressings, fatty sauces etc.


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5.17 RESTRICTED FIBRE A restricted fibre diet is aimed to decrease the bulk of the stool. It provides less than 10 grams of fibre per day. This diet is not nutritionally adequate. Nutrients that may need additional supplementation include: folate and magnesium. Indications:

• During acute phase of diverticulitis and ulcerative colitis as medically directed

• Severe radiation enteritis as medically directed

• Transition from liquid to a normal diet, following some gastrointestinal surgery as medically directed

Contraindications: • use only while acute symptoms of gastric stress persist as this diet is not curative. • In irritable bowel syndrome and diverticulosis, a restricted fibre diet may aggravate the symptoms, and is contraindicated unless the lumen of the colon is narrowed. Note: Occasionally fruit juices, milk and other dairy products and spices may need to be restricted. These foods are low in fibre, but may stimulate the bowel in some people.

Foods to Choose Foods to Avoid

Breads and Cereals

• White bread or white toast

• Strained porridge, semolina

• Rice bubbles/puffs, cornflakes, Special K®

• White flour, white rice, pasta

• Cornflour, custard powder

• Plain cakes, biscuits, scones, muffins, made with white flour

• Wholemeal, wholegrain or rye breads

• High-fibre ‘white’ breads

• Wholegrain, bran and wheat-based cereals, porridge, muesli

• Wholemeal flour, brown rice, high-fibre pasta, wholemeal pasta

• Cakes, biscuits, scones, muffins made with wholemeal flour, dried fruit, coconut, nuts, bran


Fruits

• Daily Fruit Allowance = 1 serve

• Canned apple, canned fruit salad without pineapple, canned lychee, canned mango, canned plums, grapes (seedless with skins removed), honeydew melon, watermelon

• Strained fruit juice

• Fruit above allowance

• All other fresh/canned fruits

• All dried fruits

• All berry fruits

• Prune juice


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Vegetables/Salads

• Daily Vegetable Allowance = 3 serves

• Well-cooked cauliflower tips, marrow, potato (peeled), pumpkin, young zucchini or squash, tomato paste

• Vegetables above allowance

• All other vegetables and salads

• Vegetable juices

Milk/Milk Products

• All milks, custard, white sauce

• Plain yoghurt, cheese, ice cream

• Fruit yoghurt

• Ice cream containing fruit or nuts


• All lean meat/fish/poultry, eggs

• Casseroles or dishes containing vegetables other than those allowed

• Stir fry dishes, pizza, pastries

• Peanut butter, nuts, seeds, baked beans, lentils, dried peas and beans

Fats

• Mono and polyunsaturated margarine, oil, salad dressing, mayonnaise

• Nil

Beverages

• Water, soda water

• Tea, coffee

• Bonox®, Bovril®

• Soft drinks, cordial

• Milo®, Aktavite® etc

• Nil


Soups

• Strained broths

• Strained creamed soups

• Clear soups, beef tea, soup cubes

• Pea/minestrone/onion soup

• Unstrained vegetable or barley soup

Miscellaneous

• Gravy, white sauce

• Sugar and honey

• Lollies and chocolate

• Vegemite®

• Clear jelly, clear jams, lemon butter, cheese spread, fish and meat paste

• Jam/marmalade with skins, seeds, peel

• Peanut butter


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5.18 HIGH FIBRE DIET This diet is aimed to increase stool bulk and soften the stool. It provides more than 30 grams of both soluble and insoluble fibre per day. A generous water intake (at least 2-3 litres per day) must accompany a high fibre diet. Indications: • Prevention and treatment of constipation • Uncomplicated diverticular disease Contraindications: •Excessive amounts of bran (more than 1 tablespoon per day) may reduce the absorption of iron, calcium and zinc • Inflammation that has caused narrowing of the lumen Foods to select less often/less desirable: • White bread, white flour • Refined breakfast cereals e.g. Cornflakes, Rice Bubbles® • Refined biscuits and cakes, low fibre crackers Foods to choose/healthier choices: • Wholegrain, wholemeal, soy, linseed and rye bread, high fibre white bread • Wholegrain, bran/wheat/oat based cereals, porridge, muesli • Wholemeal flour, high fibre pasta, brown rice • Wheatmeal, oatmeal, peanut, coconut and fruit biscuits • Fruit and wholemeal scones, wholemeal muffins, fruit and nut cake • Oat bran, rice bran, 4 bran mix, psyllium •All types of fruit: fresh/frozen/canned/dried. Include skins where possible.

HIGHEST FIBRE FRUITS: apple, apricot, banana, fig, kiwifruit, mandarin, orange, paw-paw, pear, plum, rhubarb

• All berry fruits e.g. blackberries, raspberries • All dried fruits e.g. apricots, dates, figs, sultanas • All vegetables and salads: fresh/frozen/canned. Include skins where possible.

HIGHTEST FIBRE VEGETABLES: asparagus, beans, beetroot, broad beans, broccoli, cabbage, carrot, coleslaw, corn, mushrooms, parsnip, peas, potato (with skin), spinach, sweet potato, turnip

• All milk, custards, white sauces, yoghurts, cheese • Lean meat, chicken, fish, eggs • Dried peas, beans and lentils • Soy products: e.g. tofu, textured vegetable protein • Mono and polyunsaturated margarine, oil, salad dressings, mayonnaise Fibre supplements: Metamucil (Flavoured) or Benefibre (tasteless) may be taken to increase intake of soluble fibre. Use as directed


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5.19 RESTRICTED OXALATE DIET This diet is planned to limit oxalate intake to approximately 100mg per day by limiting intake of all foods containing oxalate. It is indicated for individuals with recurrent calcium oxalate kidney stones ONLY. This diet is not nutritionally complete. Nutrients which may need additional supplementation include: potassium, magnesium, and fibre. A moderate protein and sodium intake and high fluid diet (at least 2.5 litres per day) is also recommended. Dietary calcium should not be restricted. Foods to AVOID completely: Breads and cereals: wholemeal and wholegrain breads, soy bread, bran-based cereals (e.g. All-Bran®, muesli, unprocessed bran, Sultana Bran ®, Nutrigrain®), egg and soy noodles, 2-minute noodles, chocolate biscuits, fruit cake, wholemeal flour Fruits: dried fruit, figs, kiwi fruit, mandarin, mango, rhubarb, fruit juice (except orange juice, apple juice and pineapple juice) above 1 cup Vegetables: vegetable juice, baked beans, beetroot, carrots, celery, capsicum, eggplant, leek, okra, parsley, parsnip, potato, spinach, silver beet, squash, sweet potato, tomato Milk/milk products: full cream milk, full cream yoghurt, all soy products (e.g. soy milk, soy yoghurt), chocolate flavourings Meat/meat alternatives: soy products: textured vegetable protein, tofu, baked beans, dried peas, beans, lentils, nuts, sesame seeds, poppy seeds Beverages: cocoa, Milo ®, drinking chocolate, Ovaltine ®, draught beer, stout, red wine Miscellaneous: table salt, sea salt, vegetable salt, vegemite ®, soy sauce, Worcestershire sauce, gravy mixes, monosodium glutamate (MSG), Bonox ®, Borvil ®, potato crisps/chips, chocolate, black pepper in large amounts Note: Any food not listed above is allowed in moderation


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5.20 LOW POTASSIUM DIET Low potassium diet is indicated when serum potassium is raised or as medically directed. Conditions include renal disease and heart disease. This diet limits potassium intake to less than 60mmol per day (2345mg/day). Recommendations:

• Avoid foods high in potassium

• Limit milk, meat, poultry, fish, shellfish, most fruit and vegetables as they contain potassium

• Increase the energy value of meals by adding extra mono or polyunsaturated oil or margarine when preparing salads and vegetables and by providing extra margarine for spreading on bread

• Encourage the use of boiled lollies, soft drink, cordial, jam and honey to help increase energy intake

• If the suggested menu is followed, this diet will not be nutritionally adequate. Nutrients may require additional supplementation include: fibre, magnesium, calcium and zinc.


Bread and Cereals

• White bread, muffins • Most breakfast cereals e.g. porridge, Weeties, Weet-Bix ®, cornflakes, Rice Bubbles ® • Rice, pasta • Plain crackers and biscuits e.g. Sao, Milk Arrowroot, Morning Coffee • Plain cake

• Fruit bread, raisin bread, wholegrain and wholemeal bread •Bran-based cereals e.g. All-Bran ®, muesli, unprocessed bran, cereals with dried fruit • Chocolate biscuits • Chocolate cake, fruit cake

Fruits

• Daily fruit allowance = 3 serves • Choose from the fruits listed in the low and medium potassium lists below • Drain liquid off all stewed and canned fruit

•Fruit above allowance • All other fruit • Fruit canned in natural juice • Fruit juice, dried fruit

Vegetables/Salads

• Daily vegetable allowance = 3 serves • Choose from the vegetables in the low and medium list below • NB: To reduce the potassium content of vegetables, boil in a large volume of water, do not roast, bake, steam or microwave vegetables

• Vegetables above allowance • Sweet potato, broccoli, mushrooms, tomato, silver beet • Baked beans, dried peas, beans and lentils • Hot chips, potato wedges • Vegetable soup, vegetable juice

Milk/Milk products

• Daily allowance = 2 serves • Milk and milk products above allowance • Evaporated milk, condensed milk, milk powder • Soy milk


• Daily allowance = 2 serves • Meat and meat alternatives above allowance • Bacon, sausages, pies, pasties • Baked beans, dried peas, beans and lentils • Nuts

Fats

• Mono and polyunsaturated margarine/oil • Nil

Beverages

• Tea, water • Milo ®, cocoa, fruit juice, vegetable juice, soup


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• Cordial, soft drinks • Limit instant coffee to 3 cups per day

• Freshly brewed coffee • Wine

Miscellaneous

• Sugar, jam, honey, marmalade • Boiled lollies • Herbs, spices, vinegar, garlic, chilli • Vegemite ®, Marmite ® (scrape only)

• Peanut butter • Chocolate • Potato crisps/chips • Tomato paste, sun dried tomatoes, treacle • Coconut • No or low salt substitutes • Bonox ®, Worcestershire sauce, soy sauce, monosodium glutamate (MSG) • Chutney, pickles and gravy powder

Potassium content of some common fruits and vegetables

Food Group Low (<150mg/

<4mmol/serving) (1/2 cup)

Medium (150-250mg,

4-6mmol/serving) (1/4 cup)

High (>250mg,

>6mmol/serving) (Avoid)

Fruit Fresh Apple Pear Feijoa Persimmon Passionfruit Tangelo Nashi Pear Cherries Paw Paw/Papaya Strawberries Raspberries Blueberries Blackberries Canned Apple, Pear Pineapple Mandarin Plums Mango Guava Cranberries Lychee Paw paw/papaya Peaches

Fresh Lemon Mango Orange Plums Tamarillo watermelon

Fresh Apricots Nectarines Peaches Grapefruit Grapes Pineapple Kiwifruit Bananas Coconut-fresh Honeydew melon Rockmelon Avocado Rhubarb Dried Apricots Dates Figs Prunes Raisins Sultanas

Vegetables Cabbage Cauliflower

Potato - boiled Pumpkin - boiled

Potato - baked Fried/chips - instant,


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Green beans Bean sprouts Celery Cucumber Lettuce Peas Marrow Courgette Spinach Garlic Spring onion Radish Turnip Eggplant Mixed vegetables Watercress Puha Swede Choko

Asparagus Broad beans Beetroot Sweet corn Leeks Parsnip Brussels sprouts Lentils Chickpeas Onion

roasted, microwaved Pumpkin - roasted Sweet potato Broccoli Mushroom Tomato Silver beet Dried beans Kidney beans Breadfruit Green bananas Cassava/Yam Taro Taro leaves Baked beans


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5.21 HIGH POTASSIUM DIET Potassium is an essential nutrient used to maintain fluid and electrolyte balance in the body. A deficiency in potassium causes fatigue, irritability, and hypertension (increased blood pressure). A high potassium diet may be needed for residents with hypokalaemia. Those who need to increase their potassium intake can select foods from the high potassium food summary list. Refer to the tables under LOW POTASSIUM DIET. It is not necessary to take potassium supplements, to achieve a high level of potassium nutrition. 5.22 CONTROLLED PROTEIN DIET Controlled protein diet - 40g, 50g, 60g and 70g, are indicated for acute or chronic kidney disease with a reduced glomerular filtration rate whereas controlled protein - 20g is indicated for metabolic disorders (e.g. maple syrup urine disease). Precaution: • Protein restriction may lead to inadequate energy intake.

• These diets must only be used when ordered by a physician and under the supervision of

a Dietician.

Controlled protein diet Nutritional adequacy/Nutrients at risk

20 grams Inadequate for thiamine, riboflavin, niacin, folate, iron and calcium

40 grams

50 grams

60 grams

70 grams Nutritionally adequate

Suggestion meal structure

20 grams 40 grams 50 grams 60 grams 70 grams

Breakfast <5g <10g <10g <12g <20g

Morning tea <2g <2g <5g <2g <5g

Lunch <5g <10g <15g <20g <20g

Afternoon tea <2g <2g <2g <2g <5g

Dinner <5g <10g <15g <20g <20g

Supper <2g <2g <2g <4g <5g

Important: At least half the protein should be from foods with high biological value (e.g. meat, eggs and dairy), with grains, vegetables and fruit providing the rest.


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5.23 HIGH PROTEIN DIET

• Generally a high-protein diet aims to provide more protein than the full diet alone (greater than 1g per kg of body weight). It is usually a full diet plus the addition of extra foods and supplements. •The energy level provided should be equal to or greater than the resident’s energy requirement to ensure the protein is not used as an energy source •Meals should be regular and frequent e.g. 3 main meals plus 3 mid meals each providing a nutritious snack. •High protein /energy supplements (e.g. Sustagen) are a very convenient and acceptable way of increasing the protein and energy level of the diet •Low protein foods should be avoided e.g. fruit or jelly served without milk dessert, clear soups •Salads should be offered once a day only •Typical default mid-meals are:

AM Half sandwich + flavoured milk + extras as desired

PM Cheese and biscuits + flavoured milk + extras as desired

Supper Portion-control liquid nutritional supplement + extra as desired

5.24 LOW PURINE DIET

This diet is generally for the resident with an acute attack of gout as it reduces the level of uric acid in the blood. Recommendations:

• Achieve and maintain a healthy body weight. Weight loss should be gradual

• Limit alcohol intake to 1-2 standard drinks per day with two alcohol free days per week

• Include three serves of low fat dairy products daily

• Limit high fructose drinks e.g. fruit juice

• Limit high purine foods

• Consume adequate fluid – 1.5 to 2 litres per day unless contraindicated (e.g. on fluid restriction)

• High purine foods to limit:

• Offal e.g. brains, kidney, liver, heart

• Shellfish, herrings, mackerel, sardines and anchovies

• Bovril ®, Bonox ®

• Vegemite ®, Promite ®, meat based gravy and meat extracts

• Fruit juice

• Alcohol drinks • More than 1.5 serves of meat/meat alternatives


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5.25 MONO-AMINE OXIDASE INHIBITORS (M.A.O.I) This diet is restricted in the tyramine content and is needed by residents taking monoamine oxidase inhibitor (MAOI) medications (e.g. Parnate, Nardil). It aims to prevent adverse reactions such as severe headache, tachycardia and hypertension in patients on those MAOI medications. Many foods once thought to be dangerous are now allowed. This diet should continue for two to three weeks after MAOI medications has ceased. The following foods are HIGH in tyramine and should be AVOIDED from the resident’s diet: • Any dishes containing cheese, e.g. cheese omelettes, lasagne, spaghetti bolognaise, mornay, quiches, crepes • Fermented sausages, e.g mortadella • Any dishes made with beer or red wine, meat or yeast extracts, or shrimp paste • Soybean products, including textured vegetable protein (TVP), soy sauce, tamari • Many commercial gravies and sauces • Soy sauce • Any vegetables/starchy vegetables/pasta/rice prepared with cheese sauce e.g. cauliflower cheese • Sauerkraut, snow peas, broad beans • Soups 5.26 NO ADDED SALT DIET Eating salty foods may cause the body to retain water and may cause high blood pressure in hypertensive people. This diet omits foods that are high in sodium. Recommendations:

• Avoid adding salt to food at the table and minimise the use in cooking. Flavour with herbs, spices, wine, lemon juice, mustard, curry powder, onions, garlic, ginger, chilli, etc

• Avoid obviously salty food and high salt processed foods

• Select foods labelled ‘no added salt’ or ‘low salt’ (no more than 120mg sodium per 100g)

• Choose ‘reduced salt’ products if these are the lowest salt options available

• Increase potassium-rich food sources e.g. fruit and vegetables Avoid the following foods that have high sodium content:

• Salty breads with added sundried tomatoes, olives, etc

• Salted crackers/biscuit/ potato crisps/chips/ nuts

• Commercially prepared pasta and rice dishes e.g. spaghetti in sauce, dehydrated/frozen/canned commercially prepared foods

• Vegetables served with soy sauce, cheese sauce, and vegetables canned with salt

• Pickled olives/onions/cucumbers, sauerkraut, dried tomatoes

• Hard cheese, cheese spreads, feta cheese, processed sliced cheese

• Salted meats e.g. bacon, ham, corned beef, luncheon meats, smoked/pickled


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meats

• Fish pastes, anchovies, smoked fish

• Takeaway meals e.g. pizza, Chinese food

• Table salt, vegetable salt, Vegemite ®, regular margarine, butter

• Commercial sauces and soups, soup cubes, Bonox ®, Bovril ®, soy sauce, Worchester sauce, chutney, pickles, monosodium glutamate (MSG), pesto, savoury dips, sundried tomatoes

Note: Do NOT use a salt substitute without medical advice 5.27 VEGETARIAN DIET Vegetarian is a term used as a broad description of people who rely on plant foods e.g. cereals, vegetables, fruit and nuts to meet their nutritional requirements. Some vegetarians eat eggs and milk products. There are three groups of vegetarians:

▪ Vegans No meat, fish, poultry, eggs, dairy products or other animal products. Foods derived from plants are eaten e.g. grains, vegetables, dried peas, beans, lentils, nuts, soy products, vegetables and fruit.

▪ Lacto-Vegetarians

No meat, fish, poultry or eggs. Dairy products and foods derived from plants are eaten.

▪ Lacto-ovo Vegetarians

No meat, fish or poultry. Dairy products, eggs and foods derived from plants are eaten.

Recommendations:

• Ask every vegetarian person which foods, including protein sources, are acceptable to them.

• Include an acceptable source of protein at EVERY main meal e.g. egg, cheese, soy milk enriched with calcium, yoghurt, nuts, dried peas, beans, lentils and soy products (e.g. tofu, tempeh and textured vegetable protein)

• Dairy products should not be relied upon as the only protein source due to their lack of iron; iron is a more limiting nutrient than protein in vegetarian diets

5.28 VEGAN DIET V Vegan diets do not contain any animal products. To ensure an adequate intake of protein, minerals and some vitamins, it is important that the vegan menu is planned to include a combination of different acceptable foods – grains, vegetables, dried peas, beans and lentils, nuts, soy products, soy milk fortified with calcium, fruit and vegetables. High protein plant food should be available at every main meal.Care must be taken to ensure that vitamin B12 and vitamin D needs are met.


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• Milk free bread and cereals, preferably wholegrain or wholemeal

• Rice, oats, millet, maize (corn), buckwheat, wheat flour

• Pasta/noodles made without egg

• Milk and animal fat free cakes and biscuits

• Milk bread, croissants etc containing butter/milk/egg

• Biscuits containing butter/milk/eggs/animal fat

• Pasta/noodles containing egg

• Pasta dishes containing meat/cheese/milk

• All fresh/canned/stewed fruits

• All fruit juices

• Jellied fruit prepared with agar

• Fruit desserts containing dairy/custard/ice cream

• Desserts containing regular gelatine/jelly

• All vegetables and salads • Vegetables in cheese/white sauce

• Vegetables roasted/fried in animal fat

• Salad dressings with egg or milk products (e.g. non-vegan mayonnaise)

• Soy milk fortified with calcium and vitamin B12 (check labels)

• Soy yoghurt, soy ice cream, soy cheese

• Rice milk fortified with calcium

• Milk, cheese, yoghurt, unfortified soy milk

• Milkshakes, white sauce

• Ordinary ice cream

• Products containing animal rennet e.g. junket

• Soy cheese containing caseinate


• Dried peas – whole or split peas, pea flour, chickpeas

• Dried beans – haricot, lima, mung, pinto, red kidney, soy

• Lentils

• Tofu, textured vegetable protein

• Soy cheese (check for presence of milk)

• Peanut butter, all nuts

• Baked beans in tomato sauce

• All meat, fish, chicken

• Eggs

• Pizza containing cheese, meat, etc

• Hamburgers, meat pies, sausage rolls

• Foods prepared with gelatine

• Baked beans in ham or cheese sauce

• Nuts – all varieties

• Seeds – sesame, sesame seed paste, sunflower, pumpkin (pepita)

• Nil

• All mono and polyunsaturated oils

• Milk free salt reduced mono or polyunsaturated margarine e.g. Nuttelex ®

• Milk free mayonnaise

• Butter, ordinary margarine, cream, lard, ghee

• Salad dressings, mayonnaise containing milk, egg or animal fat

• Water, mineral and soda water, juice, fortified soy milk, cordial, soft drink, tea, coffee

• Aktavite ®, Ovaltine ®, Bonox ®, Milo®, milk, iced-coffee, chocolate milk

• Vegetable based gravies, sauces and stocks

• Sugar and jam

• Gelatine, jelly

• Stocks and gravies derived from meat

• White sauce

• Honey


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Preparation Hints for Vegan Diets

• Avoid offering the usual ‘meat & vegetable’ meal without the meat. Vegetables alone do not make a balanced meal.

• Include at least one serve of bread or cereal based food with either nuts or seeds, or a meat alternative at each meal

• Make sure that vegetarian meals look and taste interesting. Monotonous, bland tasting, meatless meals are less likely to be consumed

• Always provide ample bread (preferably wholemeal) with main meals

• Make meals interesting and more nourishing by adding sauces made with soy milk and low fat soy yoghurt

• Do not assume that vegetarians eat only salads. Make an effort to provide hot main meals unless salads are requested

• Replace cow’s milk with soy milk in cooking

• Replace butter or margarine with milk free margarine in recipes 5.29 WEIGHT REDUCTION DIET Weight loss should not be the goal for anyone in residential aged care unless their BMI is very high (above 35), and then only after dietetic consultation to ensure that it is appropriate. Weight loss diets lead to a loss of muscle which can be dangerous in the sedentary population. Losing muscle rather than fat weakens the person further and accelerates the development of malnutrition. It also contributes to falls and inability to fight off infections such as colds and flus. When a Weight Reduction diet is recommended, the diet should:

• Provide a nutritionally balanced diet of less calories / energy content.

• Ensure adequate nutrition by providing a variety of foods

• Decrease the energy content of the diet below normal requirement to achieve loss of weight

• Avoid foods high in energy but low in nutritive value See Low Fat / Low Cholesterol - Foods to Avoid 5.30 GLUTEN FREE DIET A gluten free diet is followed by residents with coeliac disease, dermatitis herpetiformis or non-coeliac gluten intolerance. The only treatment for coeliac disease is a strict lifelong gluten free diet. Gluten is a protein found in the grains: • Wheat (including spelt) • Oats •Barley • Rye


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Identifying gluten free products: There are 3 groups of foods that are suitable for those on gluten free diet: • Naturally gluten free Some foods are naturally free of gluten • Fresh fruit and vegetables • Unprocessed meats • Poultry and eggs • Fish • Nuts and legumes • Milk (some flavoured or soy milks may contain gluten, so check the ingredients) • Oats and oils • Gluten free grains (see table below)

Gluten-containing grains Gluten free grains and starches

WHEAT Atta Bourghal/Burghal Couscous Dinkel Durum Farina German Wheat Graham flour Kamat/Kamut Semolina Spelt Triticale (wheat and rye hybrid) BARLEY Malt (barley) RYE Pumpernickel OATS Pilcorn

Amaranth Arrowroot Buckwheat Chickpea Coconut Lentil Maize/Corn Millet Potato Quinoa Rice Sago Sorghum Soy tapioca

2. Labelled gluten free Some foods are labelled ‘gluten free’. If a food carries this label, it must contain NO detectable gluten. There is no need to be concerned about the product’s ingredients.

The ‘gluten-free’ label overrides the ingredient listing. 3. Gluten free by ingredient Some foods are gluten free because they do not contain any gluten derived ingredient. If an ingredient is derived from wheat, rye, barley or oats, then this must be declared. If the source grain of an ingredient is not identified, or the source identified is gluten free, the ingredient will be gluten free.


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If you don’t see wheat, rye, barley, oats or gluten on a food label, there are no ingredients derived from gluten containing grains.

IMPORTANT: Some products are so highly processed that they are gluten free even though gluten free is not indicated

Glucose syrup (from wheat) or Wheat Glucose Syrup Caramel Colour (150) from wheat Dextrose from Wheat

ARE GLUTEN FREE

Summary Statements These are used to summarise which allergens (including gluten) are present in the ingredients of a product. If individual ingredients are identified as being derived from a gluten source, then the ‘contains’ statement refers directly to these ingredients. If a ‘contains’ statement is used which includes wheat (or gluten) and there are no individual ingredients identified with a gluten source, then the product should be avoided.


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Cross Contact Statements Some products use advisory statements, such as ‘May contain gluten’ or ‘Manufactured on the same line as gluten containing products’. These statements are used to indicate a risk of inadvertent contamination from gluten containing products. Foods with statements such as these should be avoided, as there is no way of knowing how much, or how little gluten may be in the product.

Oats... A controversial issue! The two main concerns surrounding oat consumption relates to the following: • Commercial oats are generally contaminated with wheat or barley making them unsuitable. •There are now some ‘wheat free’ oats available that are ‘pure’/’uncontaminated’. BUT some people with coeliac disease react to pure oats. The current recommendation if you wish to trial oats:


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i. A biopsy should be performed prior to commencing oat consumption ii. A trial with pure oats for 3-6 months iii. A follow up biopsy to determine tolerance

Remember: You can’t rely on the absence of symptoms to confirm tolerance.

Avoiding Contamination It is important to prevent contamination of your gluten free food. Common sources of contamination and ways to avoid these may include: • Toasters can collect crumbs which can come into contact with your gluten free bread. Make sure the crumb tray is emptied regularly and there are no visible crumbs on the toaster racks • Use separate butter/margarine and spread containers if there is a risk of crumbs remaining in the spread • Chopping boards may have crumbs on them which can be simply wiped off. There is no need to use separate boards, so long as they are kept clean • Cooking utensils may have remnants of gluten on them, but this will be removed with normal cleaning. Ensure utensils are cleaned before preparing a gluten free meal Common Nutrient Deficiencies Due to the small bowel damage present in untreated coeliac disease, nutrient deficiencies are common at the time of diagnosis. Supplementation may be required to initially correct these deficiencies. Different parts of the small bowel are responsible for the absorption of different nutrients. Each person diagnosed with coeliac disease may have damage to differing parts of their small bowel. Subsequently, not everyone will suffer from obvious malabsorption and depending on the location and severity of the inflammation, some coeliacs may malabsorb one nutrient and not another. It is important to remember that once a diagnosis of coeliac disease is confirmed and a gluten free diet is commenced, any damage to the bowel should repair with time, and the absorption of nutrients will return to normal. Below are the nutrients that are commonly deficient in untreated coeliac disease. It is important to ensure that adequate dietary sources of these nutrients are included.

Nutrient Why do you need it Where is it found

Folate Essential for the nervous system and proper brain function. Reduces the risk of neural tube defects while in the womb.

Green leafy vegetables (best source), legumes (e.g. kidney beans and chickpeas), oranges

Iron Helps to carry oxygen around the body, requirement for many metabolic processes

Red meat (best source), fish, poultry, legumes, leafy vegetables

Calcium Maintenance of teeth and bones, muscle activity, blood clotting

All dairy foods (best source), fresh vegetables, meat and meat products, fruit and fruit juices

Vitamin D Controls absorption and excretion of calcium

Sunlight (best source), margarines, cereal products,


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oily fish (e.g. salmon and tuna)

Vitamin B12 Essential for growth and the production of energy from fatty acids, DNA synthesis, normal nerve function, regeneration of red blood cells

Animal sources only: meat and meat products (best source), milk and dairy products, fish, eggs

5.31 NUT FREE DIET This diet is indicated for residents with nut allergy by eliminating peanuts (ground nuts), tree nuts and their products. Characteristics:

• Avoids all nuts, nut products and traces, including peanuts (also known as

groundnuts), cashews, walnuts, pecans, almonds, brazil nuts, macadamia nuts,

hazelnuts, pistachios and pine nuts.

• Does not exclude coconut.

Precautions: Reactions to nuts can be severe; the labels of all packaged products must be checked

carefully. Nut oils (e.g. peanut, walnut or macadamia oils) should not be used for cooking

or in salad dressings. Products with advisory statements that they contain traces of nuts,

or are manufactured on the same line as products containing peanuts, are NOT suitable.

All packaged food with nut ingredients must carry a mandatory warning statement under

Standard 1.2.3 of the Food Standards Code and should therefore be able to be identified

on food labels. Particular care is needed in food handling and preparation to avoid cross-

contamination.

Allowed – but check all labels Not allowed

Hot main dishes All others, including plain cooked beef, lamb, pork, poultry and fish

All dishes including nuts (e.g. satay, chicken and cashews), or made with peanut oil, pesto or nutmeat

Sauces, gravies Other sauces – check labels Satay sauce, other nut sauces

Starchy vegetables/pasta/ rice

All

Vegetables All

Soups Other soups – check labels Asian soups with peanuts or peanut oil

Allowed – but check all labels

Not allowed

Sandwiches All others Peanut or cashew butter


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Salads, dressings Others – check labels Any with nuts (e.g. waldorf salad) or nut oils (e.g. peanut, walnut, hazelnut oil)

Breads, cereals All nut-free breads Rice, oats, pasta and noodles Nut-free muesli and most other breakfast cereals

Walnut bread Breakfast cereals with nuts (e.g. Crunchy Nut Corn Flakes®, Sustain®, Nut-Feast®, some muesli)

Spreads Butter, margarine, jam, honey Peanut or cashew butter Nutella®

Hot breakfast choices All

Fruit All –check labels

Yoghurt All – check labels

Desserts All other desserts, including custards, ice-cream, jelly, nut-free cakes and puddings

Desserts containing nuts (e.g. fruit crumble with nuts, carrot or almond cake, pecan pie, praline, baklava)

Milk and cheese All

Beverages All

Biscuits Other nut-free biscuits Any with nut ingredients (e.g. butternut)

Miscellaneous Seeds – unless allergic Coconut

Chocolate


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5.32 PORTION CONTROL GUIDE The size of a meal can be stipulated by the doctor or Dietician. Portion size should be considered when the resident has been placed on a special diet.

Food Safety Manual – September 2018

Copyright - Hardi Nursing Home Management Pty Ltd

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5.33 MENU PLANNING It is important to ensure menu planning so that the menu is:

• Appropriate, providing maximum enjoyment for residents

• Nutritionally adequate for all residents

• Varied so that meals offer sufficient variety of colour, texture, flavour and shape

• Flexible enough to be suitable for texture modified or special diets

• Culturally appropriate

• Affordable for the facility The table below demonstrates the minimum number of serves from each food group required to meet the nutritional needs of elderly residents in aged care facilities, however actual serves will be determined by the appetite of residents. Dietary guidelines – minimum serves from each food group Breads and Cereals 1 serve =

3 - 5 serves daily Preferably choose wholegrain varieties

2 slices bread, 1 roll, breakfast cereals e.g. 1 cup cooked porridge, 40g (½ cup) ready to eat cereal, 1 cup cooked noodles, spaghetti or macaroni, ⅔ cup cooked long grain rice (e.g. Doongara)

Vegetables 1 serve =

Starchy 1 medium potato 1 -2 serves daily ½ cup sweet potato ⅓ cup sweet corn (or ½ cob)

½ cup cooked dried beans, lentils or baked beans (legumes)

Non-Starchy (aim for 5 serves a day) Fresh, frozen and canned varieties are suitable. Choose the low salt tinned varieties.

½ cup of cooked vegetables or 1 cup of salad. Cabbage, beetroot, broccoli, carrot, cucumber, green beans, lettuce, mushrooms, onions, peas, pumpkin, spinach, tomato, cauliflower, etc

Fruit 1 serve =

2 - 3 serves daily Any fruits are suitable. Choose fresh, canned or dried.

1 apple, 1 small banana, 20 grapes, 1 orange, 1 pear, 2 slices pineapple, 1 tablespoon sultanas, 6 dried apricots, ¾ cup tinned fruit (drained), 120ml fruit juice



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Milk products 1 serve =

3 serves daily 300ml milk - fresh, dried, UHT (long life) 300ml soy milk (with added calcium) ½ cup evaporated milk 1 cup custard 200g yoghurt - plain or fruit 40g cheese 2 scoops of ice cream

Choose full cream varieties as the standard but offer low fat options

Protein foods 1 serve =

1½ serves daily

65 - 100g lean meats such as beef, lamb, pork or poultry without skin

120g fresh or canned fish 2 small eggs ½ cup cooked lentils, legumes, dried beans, etc

Fat 1 serve =

Choose unsaturated types for cooking and at the table. Add extra fats to boost energy (kilojoules or calories) when weight gain is required.

Oils & Margarines Best choices are polyunsaturated or mono-unsaturated margarines and oils e.g. sunflower, canola, or olive. Animal fats e.g. butter, lard, dripping, sugary creams are higher in saturated fats but provide valuable energy (calories or kilojoules). Other Unsaturated Fats Nuts and seeds, peanut paste, avocado, olives

5.34 References: 1. Dieticians Association of Australia. Nutrition manual. 8th ed. Canberra: DAA; 2009. 2. Dieticians Association of Australia. Texture-modified foods and fluids as used for

individuals with dysphagia: Australian standardised labels and definitions. Nutrition and Dietetics. 2007; 64 (Suppl. 2): S53-S76.

3. Diabetes Outreach. Healthy eating and diabetes: a guide for aged care facilities. Diabetes Outreach, Country Health South Australia, Adelaide, 2012.

4. Bartl R, Bunney C. Best practice food and nutrition manual for aged care facilities. Gosford: Australian Nursing Home and Extended Care Association 2004.

5. Priority Research Centre for Gender, Health and Ageing. Encouraging best practice in residential aged care: nutrition and hydration. Tool kit – introductory materials. University of Newcastle in collaboration with UnitingCare Ageing and Baptist Community Services. 2009.

6. ACI Nutrition Network. Therapeutic diet specifications for adult inpatients. NSW Agency for Clinical Innovation. 2011

7. The Coeliac Society. Patient Education material. 2010/2011



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SECTION 6 SUPPLIER INFORMATION

HARDI supplier’s contract list is maintained by head office. The spreadsheet is accessible on the Hardi website at all times. Chef holds list of current catering contractors. Certificates for suppliers are held at head office.

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SECTION 7 REPORTS

• NSW Food Authority Reports

• External Reports

• Annual Internal Audit report that reviews all systems

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