With the introduction of the Food Act 2014and the requirement for most aged care facilities to have registered their food control plan (FCP) by March 2018, I thought I would write this article on a common kitchen practice that will require review.
FCP’s are included in the policy and procedure documentation provided by HCSL specifically designed for residential care facilities.
In many facilities the main meal is served in the middle of the day and the tea meal served at night. The main cook of the day will prepare the tea meal earlier in the afternoon, and then finish his or her shift. The tea meal will be reheated by the afternoon staff and served to the residents.
The process of cooking, cooling and reheating requires careful control of the food safety risk. Many tea options are protein or carbohydrate based; macaroni cheese, egg dishes, savoury mince, chicken options – all of which are high risk foods for bacteria growth.
Foods need to be cooled quickly to avoid time and temperature abuse, which may allow bacteria growth. The guidelines state that when cooling hot cooked foods, the food must cool to at least 21° within the first two hours, and then cool to below 5° in four more hours. Overall, the food must be out of the danger zone (between 5°C and 60°C) within six hours.
A functioning chiller should allow cooked foods to cool within this timeframe. Using domestic fridges that are overcrowded, may mean the cooling guidelines are not met. Using shallow dishes rather than large deep dishes will also allow foods to cool faster.
The food control plan will specify the process the site kitchen must follow with regards to cooling of cooked food. Temperatures during cooling will need to be checked and recorded to ensure the time / temperature targets are met.
Prior to serving, the food must be reheated to above 75°C.
Some sites choose to hold the prepared food hot until service. Food must be held hot at a temperature of at least 60°C, usually in a bain-marie or oven at 70°C. Any food held below 60°C for more than 2 hours, must be thrown out. Note that holding foods hot for this period of time may affect the food quality.
Food safety risk with cooling and reheating foods must be managed with FCP
Cool cooked food to below 21°C in 2 hours and below 5°C in 4 hours
Reheat foods to above 75°C before service
Hold hot prepared foods at 60°C or more
Document food temperatures and any corrective action
Review corrective action implementation to ensure they have been effective
Boards of any organisation should be well placed to provide strong and transparent governance. This means the members of the board all need to understand the organisation structure, strategy, finances, client base, market changes and employees for the context in which they are operating. This includes knowledge of behaviours, culture and ethics. The behaviours of all organisational board members gets reflected in employees to set the culture within the workplace which is experienced by the clients and those advocating for them, their family/whanau and friends.
The skill of judgement is necessary for board members to base decision-making on a set of agreed standards or a clearly defined constitution, organisation vision/mission or philosophy. To have a progressive Board, there is the need to recruit board members with greater skills than already exist within the board. This ensures progressive diversity of thinking and culture based on more than gender and ethnicity. A greater diversity is needed to also include creativity, innovation, current commercial practice knowledge, information givers and information seekers to increase depth of conversation and concepts being explored. The Board member profile could do well to include these attributes, abilities and skills. Collectively they need to advance the organisation purpose, vision/mission or philosophy in a way that meets client current and future needs.
Boards are not the place for the faint-hearted or those at the end of career who simply ‘want to give back’ who may base todays decisions on yesterday outdated models. Diversity will become a more visible part of boards with the introduction of the new Health and Disability Service Standards later this year. While they are currently in draft, it seems clear the final version will require more diversity within boards. This will include increased desire for Maori representation and inclusion on Boards. As American diversity advocate and activist Verna Meyers says, “Diversity is being invited to the party, inclusion is being asked to dance”.
If Maori representation isn’t part of your board make-up, it may be advantageous to look at forming relationships with local Iwi who fit the attributes needed to fit your board member profile. All Board members will need to be available, ethics driven, commercially aware and able to contribute. The Board Chair will need to show these same attributes and also provide consistent innovative, clearly communicated strategic leadership. The Board as a whole will also need to be agile in their response to unplanned events. 2020 and the emergence of COVID-19 reminded us of this. It appears 2021 and into the foreseeable future will also present the need for agile thinking and innovation. I suggest now is the right time to review how your board is made up and how effectively they perform. How can this be improved in your organisation?
As a RN, Facility Manager and Consultant in Aged Care I have used various Aged Care software packages over the years.
Feedback I have received from RNs and caregivers using HCSL system includes the following:
Takes less time to find information about residents
More resident focused and less task focused than using tick box task lists.
Able to edit information quickly.
Easy to upload and save information in the documents folder.
Easier to do monthly quality analysis as the information is quicker to find.
I am very impressed with HCSL software as I have found it delivers in the following ways and is:
Intuitive and timesaving – the software prompts the operator – for example to create a short term care plan if documenting an adverse event such as wound care. The one click action means less time taken trying to open a new screen or change functions such as finding care plans or progress notes.
Quality Assurance is able to be maintained in a timely and comprehensive manner with an internal audit system and corrective action logs in addition to monthly analysis of adverse events and infections.
NZ ARC compliance requirements are continuously updated – in care
planning, and resident information requirements documentation and procedures and policies in the individualised Facility Documentation library.
Very responsive service- the HCSL team quickly respond to questions and seek and use client feedback to continuously develop and extend the software capabilities. HCSL is New Zealand based so information is relevant to nursing and care giving in New Zealand.
Developed and managed by a very experienced NZ Nursing leader in aged care who has comprehensive knowledge of and experience in quality and compliance systems in NZ aged care.
I must say I love HCSL Version 2 software from an Admin perspective – It’s really simple to navigate through and I have added our Accountant as a user as well as she accesses Resident NOK information for sending accounts to etc.
It has also meant we have been able to delete a lot of Excel Spreadsheets we had in place for some of the information that is already gathered for us by your software automatically and all in one place!
Village Manager – Springlands Lifestyle Village (Blenheim)
Bench-mark in real-time – specific to resident type, event type, date and time of day.
Have automated default reports to save you time analysing your data trends and patterns
Drill down into your data easily to identify opportunities for continuous improvement
Complete your internal audits online and have the corrective actions auto-populate into a corrective action log
Log and manage adverse events
Bench-marking of adverse events against other aged care providers
Support evidencing an active Health & Safety programme is in place
Log and manage infections – automatic outbreak registers
Bench-marking of infections against other aged care providers
Log and manage your complaints with time-frame, investigation and response prompts
Dashboard view options for level of care and any chosen 3 monthly time-frame review
Dashboard view option of adverse events or infections
Logs (event registers) appear with individual events in one colour when open and change to another colour when the event is closed. This allows you to see quickly the status of events.
Use in conjunction with your current policies / procedures or update to the HCSL site specific created policies and procedures.
Your organisation policies and procedures and related documents (if created by HCSL) are also accessible through the Facility Documents tab on the left of the screen for remote anytime, anywhere access. The keyword search option on the policies and procedures in addition to precise indexing and coding of documents makes it very quick and easy to locate information for staff to reference.
You can also upload your own documents for confidential safe storage.
This is what Rhonda Sherriff, NZACA Clinical Advisor says about using the HCSL QA system:
“I am very happy to endorse your system as the information is invaluable for CNMs to analyse the data/information and make informed decisions on best practice and innovation to decrease hazards, improve outcomes, and mitigating factors for resident welfare.I’m pleased you are delving into the data to the level you are, as it’s time saving for sites in many respects, and so easy to dice and slice the information to get the trends. CNM’s used to spend hours just writing up the collective information before the analysis, so hugely time saving”
To view a brief video explanation of the system click here. This programme has been operating in NZ Aged Care since mid 2016 so now has many thousands of pieces of data to compare yourself against.
I operate a medical practice that specializes in aged-care facilities in Auckland. In the last two years most have adopted a system for keeping medical file notes electronically. There are a number of systems on the market and I have experience of four. None appear to have consulted end users when developing their functions. All of them have problems, which hopefully will be ironed out over time.
HCSL is one them. The vital medical problem list is buried within the system and clunky when you find it. Some of its navigation is not intuitive. However, compared to the others it has a clean and uncluttered feel.
The tab buttons and the boxes for inserting text are large and easy to use. The ability to find previous medical file notes within all the nursing and caregiver entries (a vital consideration) is ahead of the pack. It is also smooth as silk to access from an offsite computer.
The team behind it are much easier to access, and more responsive to feedback, than anyone else. From what I know, HCSL is the system I would use if I was running an aged-care facility.
We have been working with Gillian and Healthcare Compliance Solutions Ltd (HCSL) for more than 4 years.
Compassion, quality of care services and their drive for excellence inspired by the quest for excellence in care put Gillian and her team at HCSL in a league of Its own.
In the ever evolving science of aged care, HCSL systems and aged care software program has proven itself not only as a world class quality health system but also demonstrates that it’s person centred and current best practice. It is designed and developed based on scientific evidence to ensure the delivery of best quality of care and supporting best quality of life to all our clients.
The inclusive, consultative and the facility specific approach of Gillian and her team is absolutely outstanding with constant follow up on changes. These include new improved plans to ensure the best quality of care, practices and bench-marking incorporating the latest best practices, outcome based, with the main focus on quality of care and safety for our residents and staff at all times.
Using HCSL and all the quality services it provides ensures we are up to date with the latest policies and procedures relevant to the current care practices. It also gives us peace of mind that we are audit ready at any given time.
Based on these systems, our residents are cared for in the best possible way resulting in the high demand for our care services and Holly Lea being a highly sought after facility.
For peace of mind and knowing you are dealing with the best quality system in Healthcare we cannot recommend HCSL highly enough.
Thanks so much for the help at Rosewood. You did a fantastic job.
I have four facilities using HCSL. I have been impressed with HCSL. I frequently access it from home and on my phone. Because remote access is via the internet it enables me to interchange between HCSL and the medication chart easily unlike other systems that require remote access in via Citrix which “takes over” the computer. Log in is secure but quick.
Residents are easily searched for and once a file is open it immediately directs me to produce a new progress note. Care planning functions are easy to review and there is a simple tool for medical classifications with common conditions in a drop down list with room for free text below. On the whole this is an easy tool to access and one of the less cluttered programmes I have used.
The below question and answer were published in the New Zealand Aged Care Association industry ‘In-Touch’ newsletter (19th February 2016).
Question:A member asks “if we purchase a comprehensive quality management system from a provider how assured are we that the system will meet full compliance, come certification and surveillance audit time, as requirements and compliance expectations change frequently?
NZACA Clinical Advisor Answer: “You should be purchasing a complete quality management system that will comply with the Health and Disability Standards specifications, health and safety requirements and meet DHB/ARRC contractual requirements.
The provider of the system would normally initially tailor the full quality management package to reflect accurately the site specifications, H.R. component, and best practice guidelines, after consultation with the owner and management on site. These documents need to be site specific. The provider will normally contract to the site, which sets out obligations between the provider and the site management.
The contract will include the full review and updates of policies and procedures on a bi-annual basis, unless specified more frequently, to keep documents accurate and reflective of best practice. There may be an educational element provided within the contract as well, to benefit staff knowledge and skills. There is normally a good document control system in place and cross referencing of information where required.
Quality management systems are reliant on the skills and knowledge of the site personnel working with them, the way the system is managed and the outcomes/reviews, content and information extricated from the use of the system to improve quality care provision/outputs. The documentation system is reflective of the people using them, and the depth to which documentation and information is created, analysed and utilised for improvements.
Auditors on site rely on the provision of robust up-to-date policies and site adherence to them. Partial attainments can sometimes result from staff deviating from, or not following, their sites actual policies or processes as outlined in their quality management system.”
Where can you get such a system?
Here at Healthcare Compliance Solutions Ltd we provide the services described above and noted as being optimal for achieving excellence in care and audit outcomes. To see a brief video about the Aged Care software update and now in use by over 3,800 users in NZ, click here.
We asked a random group of clients for their responses in relation to using HCSL Aged Care Cloud based software.
What do you like best about the HCSL software and your current use of it? Below is their responses:
I like the layout of the LTCP and being able to load and access documents in the one programme.
At the end of the month the stats are all there done without me having to calculate; the system does that itself, love it, I print off the bar graphs for the staff to see each months results with the related information written up to show the story behind the data
The advantage of having HCSL software in our facility means enabling quick access to residents records for more coordinated, efficient care and securely share information with residents and other clinicians. Holly Lea is in the process of having most of the documentations online. Moving to electronic significantly improved our archiving processes and the need for physical storage space for paper records is also significantly reduced. Being able to search for a file or document from the computer rather than manually dig through a filing cabinet saves time for all of us.
Know it is kiwi made and covers aged care in NZ requirements
Analysis of data and logs for complaints and incidents
Ease of access and user friendly
Log in pages are bright and cheerful.
Everything is in one spot and easy to access.
Audit system, ease of use, easy access to forms.
Its clear and easy to use.
The Long Term Care Plan (LTCP) is much more concise, great feedback from the care staff, easy to read and understand.
Able to compare to the average when reviewing falls or infection rates.
Ability to analyse present the information e.g falls.
I like the ease of use – the easy to generate reports – everything being in a logical order that ties in very well with the paper files
Used correctly the system does pass audit, meets all the requirements of the MOH Standards.
Receiving the continual updates we know we always have the most updated material available to meet our MOH requirements
This is a central point for data gathering. We have the potential to have most information on line.
The system is new to our team, it is still getting established here. We are finding it quite easy to use.
Its web based which means I can look at it anytime and am fully up-to date always with whats happening
The audits are detailed, and clear
The bench-marking is great and easy – saving time – great reporting
All of it, Everything on the website is easy to find and I like the bench-marking.
I don’t think we utilize enough of the paperwork some things I am discovering now after 5 years of using it!
I like the simplicity of the software.
I like that it is integrated with quality documentation.
I like that it is cloud based.
I like the flat fee for use, rather than a fee the number of devices (tablets).
The ease of uploading resident photo and easy layout
Ability to easily track trends in adverse events.
The straight forward user friendly interface, the data analysis, the way corrective actions populate straight to the corrective actions log,