Food Safety Control in residential aged care

Food Safety Control – Cooling and Reheating Meals

 

With the introduction of the Food Act 2014 and 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.

Main Points:

  • 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

 

Article contributed by:

Liz Beaglehole

NZ Registered Dietitian

Canterbury Dietitians

Email: liz@canterburydietitians.co.nz

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COVID-19: Can employees in aged care be required to get the vaccine?

Right now there are a lot of discussions happening around New Zealand asking “Can employees in aged care be required to get the vaccine?” Associate Jaenine Badenhorst of Rainey Collins Law has cleared up some of the confusion, with some of the below facts, as of September 07th 2021.

In Brief

Under the New Zealand Government’s vaccine campaign, it is not mandatory for employees to be vaccinated against the Covid-19 virus.  Employers can therefore not require their employees to be vaccinated, unless it is necessary for health or safety reasons for a particular role.

If an employee works in a role where the risk of exposure to Covid-19 is higher and/or the consequences of contracting Covid-19 is more serious, the role may demand employees who are vaccinated to fill it.  Due to the likely risk to the Health and Safety of aged individuals, it is highly likely to be reasonable for employers to require aged care worker roles to be filled be vaccinated individuals.

Health and Safety Laws

Persons conducting a business or undertaking (PCBUs) owe duties, under the Health and Safety at Work Act (“the HSW Act”) to ensure, as far as is reasonably practicable, the Health and Safety of its workers, patrons, customer and clients.

Covid-19 poses a risk to the Health and Safety of others, and therefore PCBUs are required to undertake a risk assessment in their particular work environment, so that they can implement safeguards and protocols to eliminate or reduce that risk.

Health and Safety risk assessments must be done in consultation with workers, unions, and other relevant representatives.

If a Health and Safety risk assessment of a particular role indicates that vaccination is necessary to comply with Health and Safety obligations, an employer may require whomever fills that role, to be vaccinated.

It is important to note that rather than any ‘employee’ requiring vaccination, it is the particular ‘role’ that requires a vaccinated employee to carry it out.

When is vaccination likely to be required for the performance of a role?

Under the COVID-19 Public Health Response (Vaccinations) Order 2021, some work at the border can only be done by vaccinated workers.  Employers in this case need not do individual Health and Safety risk assessments, as all work covered by the Order must only be done by vaccinated workers.

It is possible further Orders could be made to require other roles to be filled only by vaccinated individuals.  In the absence of an Order, it will be up to each PCBU to make a decision for their work place, based on the Health and Safety risk assessments they have completed.

At present, PCBUs in the aged care sector will have to individually assess each role to determine whether it should to be filled by a vaccinated person for Health and Safety reasons.

Health and Safety risk assessments will typically require vaccination if a role involves a high likelihood of exposure to Covid-19 in the workplace and/or significant consequences to others in regular contact with the individual performing that role.  Examples will include roles where employees have lots of contact with customers and clients or other employees, especially where contact will be with vulnerable people.

Workers in aged care roles are likely to have contact with many individuals each week, and these individuals are likely to be more seriously affected by the impacts of Covid-19 if they contract it.  It is therefore highly likely that many aged care worker roles will require vaccinated individuals to fill them, so that PCBUs are compliant with their obligations under the HSW Act.

In each case, however, the PCBU must assess the risk on a case by case basis.  It is also important for the PCBU to consult with the workers in these roles, to help the PCBU assess the risk and ways to best eliminate or minimise it.

Recruiting new employees:

An employer may require vaccination for new employees, however this must be reasonable for the particular role.

Additionally, employers must take care to ensure they are not unlawfully discriminating under the Human Rights Act or affecting the right to refuse medical treatment under the New Zealand Bill of Rights Act.

Does an employee have to tell their employer if they have been vaccinated?

If an employee refuses to inform their employer of their vaccination status, the employer may assume that employee is not vaccinated in order to manage its Health and Safety obligations.  If an employer makes this assumption, it must inform the employee of its intention to do so, and what the possible consequences may be.

What if vaccination is refused?

If an employee refuses vaccination following a risk assessment that identifies it as necessary for the employee’s role, an employer may consult with their employee to change their work arrangements, duties or leave, or restructure their work or employment conditions.

Redundancy or dismissal should be considered as final options after changes to the employee’s duties or redeployment to other roles have been considered.  Without consideration of all reasonable alternatives, dismissal of an employee who refuses to be vaccinated will nearly always be unjustified.

Any changes, dismissals, or risk assessments must be carried out in good faith.

If there are concerns in your business in relation to employees receiving the Covid-19 vaccination, it is wise to speak with a professional experienced in the area.

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Moreh Home HCSL
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Testimonial – Moreh Home

Thank you, Gillian, for all your support. The Healthcare Compliance Solutions Ltd (HCSL) aged care program gives a structured clear pathway through the obstacle course of Certification.

The HSCL program was extremely user friendly and appears very nicely laid out and easy to locate care plans and patient’s information. The general feedback from the staff has been positive.

The policies and procedures were easy to follow, and well presented. We appreciated how thorough these policies were, and how much work had gone into developing them.

We all felt well supported throughout, and it was so nice knowing that you were on the end of the phone/email or zoom. Even when we met in person, you were incredibly positive and encouraging, thank you!

We would recommend this system to anyone needing assistance with the challenge that is Certification.

Barbara Adams

Board Chair-person /Acting Manager.

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 by hcsl

Celebrating the COVID-19 vaccination

The following is contributed by Infection Prevention and Control Consultant (RN) Ruth Barrett –

I am 61 years old, a practicing nurse and recently I had a little celebration. I received my 2nd COVID-19 vaccination from a lovely team in Ashburton Hospital in Canterbury.

I feel like celebrating because I have played a small part towards helping New Zealand (and the world) fight this pandemic and get it under control. By having the vaccine, I am helping to keep my whanau and friends safe from catching the virus from me if I get infected, especially if I don’t have any symptoms. It also means I am happier to continue to look after vulnerable people, knowing I won’t be passing on the virus. It is reassuring to know that the vaccine will stop me getting really sick and ending up in hospital or worse. So, if we do have another large outbreak, my hospital bed can go to someone else.

We are lucky in New Zealand to have access to a vaccine that is very safe and very effective, and recent reports show that it is also works against the new variants that are out there.

I was a little nervous about getting the second dose and how I would feel afterwards. Although I have the influenza vaccine every year without any side effects, this time I needed two jabs. But in the end it was all good – I only needed two paracetamols about 6 hours later, had a good sleep, and then, apart from a sore arm for a day and a half, I felt fine.

Of course, I know that vaccinations are not the only thing that keeps us safe – all our public health measures and infection prevention and control activities are just as important. But if you are a healthcare worker, a parent, a partner, a friend, a child, a sibling, a grandchild or other, you can make a difference in your community by having the COVID-19 vaccine.

 

Ruth Barratt RN, BSc, MAdvPrac (Hons), CICP-E

Infection Prevention and Control Consultant

Christchurch, New Zealand

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 by hcsl

Avoiding Personal Grievance claims

One thing new and seasoned managers often fear is having a staff member raise a personal grievance against them.  We asked Rainey Collins Law Associate Jaenine Badenhorst for some ideas to support management avoid personal grievances.  The following advice was the response:

We would recommend that you do these key things to help avoid a personal grievance being raised against you/your business. 

 

  1. The first key thing to do is to hire the right candidate in the first instance. (Yes, we know that isn’t always easy)!  You want to make sure you have a robust interview and reference checking system in place.  You could also consider your existing team meeting the candidate to make sure there is a good personality fit.  There is also the possibility of a work trial or probation period, depending on the circumstances.

2.   Have a written employment agreement which clearly sets out the parties expectations (for instance about work hours, flexibility, responsibilities, reporting lines, raising problems, and so on).  It is helpful for these matters to be discussed beforehand, so that everyone is on the same page.  This helps to avoid confusion and misunderstandings.  Employee manuals can also be very helpful to cover more detailed rules and guidelines (for example internet use, health and safety, bullying and harassment, etc.).

3.   Keep accurate employee records and files.  This should cover hours worked, leave taken, superannuation or other agreed deductions, discussion around various work conditions and so on.  The employee file should also cover any issues with performance or misconduct (detailing fair processes followed, and outcomes reached). 

4.   Act in good faith towards each other (by being honest and approachable; as well as open and communicative).  Being a good employer, and having a relationship with employees where they feel free to raise issues early on is the best way to resolve problems before they turn into formal grievances.  Regular catch-ups (like weekly or monthly meetings) is a good way of checking in with employees, and letting them know if there are any issues with their conduct or performance. 

5.   Knowing your obligations around the law and the contract you have with your employee is also very important.  This way you are less likely to cause issues which will turn into grievances.  If you are unsure of your obligations, you should seek professional advice. 

Thanks Jaenine, we hope that helps managers of services who might be struggling with this issue. Following due process and keeping accurate records will also support why you have made decisions and how.  Even with the best processes in place, sometimes you cannot completing avoid a grievance but follow professional advice and you can certainly minimise risk of a claim against you or your organisation.

There will be further articles published here supplied by Rainey Collins Law in relation to supporting your employment processes.

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Care Technology HCSL
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Aged care going digital a raging success!

Receiving emails from our clients who have made the transition from paper-based to digital give us a lot of satisfaction. One provider who had been under DHB monitoring after an audit that didn’t achieve as well as they could have said they saved $100,000 after implementing the HCSL programme.  They had been spending a lot of time researching, writing and submitting corrective actions to audit findings for quite some time.  This doesn’t happen anymore. They have no findings!

Comments which reflect how very easy they found the process of transition reinforce our concept of where possible we opt for one click instead of two in our design processes.  Some client had used other digital packages in the past which they described as cumbersome and clumsy.  Those packages didn’t integrate with other packages so to find all the information needed, staff had to use multiple sources of information.  This made some reluctant to try something new.  Arriving on site at a client one day Gillian was taken to meet two care staff.  Both were very excited to tell her how due to them both having dyslexia, neither had been able to write their own notes before.  Now with the simplicity combined with spell-check in the digital progress notes, they were able to write their own notes.

The co-design of solutions with our clients maintains the philosophy of simplicity being as easy to use as a basic mobile phone or Facebook.

Early on we identified inequity between the resources available to corporate owned multi-site providers and independently or small group owned aged care services. This inequity, in conjunction with shortages of staff led us to work alongside aged care, retirement village and community services to design a one-stop-shop programme and in 2015 HCSL aged care software  went LIVE.  It has continued to be developed since then to a fully cloud based solution.

Clients said they’d like everything in one place. Despite there being other options we were continually pressured to create a NZ specific product that supports not only benchmarking, quality and risk but also all aspects of providing care while incorporating compliance throughout each aspect of the programme.

The integration with Medi-map medication administration systems will further streamline access to resident care information for remote assessment and treatment planning.  More integrations are underway currently to support as seamless flow of resident information regardless of where those needing information to provide care are situated. Clinical records are now accessible and able to be updated from anywhere with an internet / wi-fi connection.

Having been appointed as the step-in temporary manager at Rosewood Resthome and Hospital during the COVID-19 outbreak, Gillian Robinson was able to implement HCSL cloud-based software for telehealth support.  This programme was literally set up overnight and being used by staff with no training as there simply wasn’t time.  The great test for the system was to note the staff were able to successfully use the digital online care-planning and progress notes without any training other than to be supplied their login.  The uploading of a photograph of a wound for the doctor to review remotely was able to done easily after watching the 5 minute instructional video on ‘how to’.

Community, Disability services and mental health residential services along with retirement villages throughout NZ are now enjoying efficient cloud based records.  To find out how you can use this ready to use, NZ specific programme contact us.

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 by Gillian Robinson

Governing Boards and Diversity

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?  

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Testimonial – Nurse Consultant

Nurse consultant Healthcare Compliance Solutions Ltd

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.

Anne Sheard, RN.

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Testimonial – Love your new admin function

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!

Thanks

Naomi Nailor

Village Manager – Springlands Lifestyle Village (Blenheim)

November 2020

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 by Gillian Robinson

Bench-marking – Aged Residential Care

his New Zealand designed web based (on-line / in-the-cloud) Bench-marking and quality management system from Healthcare Compliance Solutionhttp://www.hcslqms.co.nz/s Ltd allows you to:

  • 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.  

To find out more contact us here.

 

Making monitoring your service remotely in LIVE time easy!

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Testimonial – Holly Lea

Juliane

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.

 

Juliane Brand (RN, MPH)

General Manager

Holly Lea Village

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