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
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.
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 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,
I was first introduced to Gillian Robinson of Healthcare Compliance Solutions Ltd (HCSL) in 2016 when I took up the Facility Manager position at Terrace View Retirement Village.
The facility had HCSL in place but were not fully utilising Healthcare Compliance Solutions policies. The first thing to do was to get Terrace View fully operational under Healthcare Compliance Solutions. Gillian was very supportive during this change providing education to myself, Clinical care manager and our team.
HCSL aged care software is easy to find your way around. Our Nurses have reported that care planning in HCSL is saving them time. Everything is in a logical order.
Features that make my role easier are the ability to track trends in adverse events and infection control. To be able to bench-mark our data within the industry to see how we are trending against our peers.
Terrace View is very excited to be moving to HCSL aged care software version 2 so we can become fully electronic. To be able to search a file or document from the computer saves all the team time.
Gillian’s knowledge of the aged care industry and how the sector works is reflected in the software she has developed and is designed to increase nursing team efficiency in a very time restricted environment.
This month we look at the discussion around whether mandated staffing levels in aged care, as a ratio of care hours to residents, would improve care services?
Rather than numbers of personnel alone, to provide safe and appropriate nursing services, staffing skill-mix (taking into consideration the workforce diversity) is essential to ensuring appropriate effective staffing. These factors are not taken into account or provided for within the industry funding levels which puts additional pressure on those working in aged care services.
While performing statutory (temporary) management roles over past years, adequate numbers of staffing alone hasn’t guaranteed safe and appropriate care. Nursing outcomes for residents have been reliant on a mix of highly skilled staff working in conjunction with newer or less experienced staff to guide and mentor. There could be 10 staff on duty but if none of them have had previous experience working in aged care services, these staff are set-up to fail in performance of their duties, and the resident care outcomes are likely at risk.
Outdated for the acuity of residents needs in 2019 and onward, the 2005 guidelines didn’t take into account a range of factors. For example the size and physical layout of the facility, location of resources, the leadership structure and how work teams are configured, economy of scale and appropriate cover. The minimum staffing requirements in the ARRC is well below that sufficient to meet resident needs. Having been implemented in 2005 (SNZ HB 8163:2005) when resident needs were less complex than they are now, it’s well past time to review how staffing skill-mix is determined and more importantly how the industry will be funded for increased staffing to meet the increased needs of residents.
HCSL developed a 5 step acuity assessment tool in response to providers requests after being frustrated by using the two tier InterRai assessment which give outcomes of resthome or hospital level of care. InterRai doesn’t reflect the range of acuity represented in SNZ HB 8163:2005 from a care level perspective. As reported by numerous registered nurses working in aged care, the complex clinical presentation of residents being admitted into care is not accurately reflected in InterRai which is why they still need to supplement InterRai at times with more detailed clinical assessments.
Achieving desired outcomes for residents and the timeliness of appropriate care support based on individual assessed needs should be the aim for the allocation funding to ensure adequate staffing levels.
Managing Contractors from a Health and Safety Perspective
Managing Contractors from a Health and Safety Perspective is a vital component of having external trades people at your workplace.
The use of contractors is unavoidable in retirement villages and any aged care facility as we look to engage external expertise for specialised work and maintenance tasks.
Section 34 of The Health and Safety at Work Act 2015 provides that all persons conducting a business or undertaking (PCBU) who have duties imposed by the Act in relation to the same matter must, so far as is reasonably practicable, consult, co-operate and co-ordinate their activities with all the other PCBUs who have duties that overlap with them.
There are four main points to remember about overlapping duties:
You have a duty to consult, cooperate with and coordinate activities with all other PCBUs you share overlapping duties with, so far as is reasonably practicable.
You can’t contract out of your health and safety duties, or push risk onto others in a contracting chain.
You can enter into reasonable agreements with other PCBUs to make sure that everyone’s health and safety duties are met.
The more influence and control your business has over a workplace or a health and safety matter, the more responsibility you are likely to have.
WorkSafe have made it clear that they expect PCBUs at the top of a contracting chain to be leaders in encouraging good health and safety practices throughout the chain. They also expect these PCBUs to use sound contract management processes.
There are six key health and safety steps when it comes to managing your contractors:
Scoping – understand what the body of works is, the risks involved, the training and competencies required, the working environment and any additional measures required.
Selection – select the right contractor for job, utilise a contractor selection process that considers the values and systems of the contractor from a safety perspective.
Induction – provide the contractor with basic information regarding site hazards, site rules and emergency evacuation procedures.
Safe system of work – the contractor must provide (and you must review) safety management information for the job. You must be confident that the contractor has appropriately controlled the risks associated with their works.
Monitoring – while the contractor is on site, check that they are carrying out their works in accordance with the safety management information they provided.
Review – Examine what went right as well as what can be improved so that both parties may continually improve on their health and safety performance, this should fed-back into future scoping and selection decisions.
It’s easy to forget to check contractors staff changes and ensure your risk managing contractors on site is ongoing. Recently I was on site at a care facility when a sub-contractor was working there. When spoken to, he appeared to speak very limited English. He left empty boxes, a Stanley knife in the main hallway and wet glue and loose carpet at the entrance to a resident’s room. No signage, no clean-up. I couldn’t help but ask the provider what the contractor knew about health & safety legislation, his responsibilities and risks to residents as a result of his work practices.
The Health and Safety at Work 2015 increased the responsibility on PCBU’s in relation to risk management in the workplace. When using the services of contractors, there are likely to be overlapping responsibilities. While residents reside in residential care facilities and therefore it’s their home, the legislation defines residential care as a workplace. As such, contractors coming into your environment must provide evidence of following a health and safety policy and processes which reflects current legislation.
A copy of their document should be kept on file along with verification of contractors (and sub-contractors) orientation to site and confirmation of their acknowledgement of health & safety responsibilities. These documents are included in the Safe and Appropriate Environment policy manual for services using HCSLin hardcopy and in-the-cloud online. Documents should be re-signed by contractors annually or when changes to the environment occur or a contractors personnel have changed.