1. OHIO VETERANS HOME Don’t Touch the Food Pre-production Cart Building and Related Processes

2. GOALS OF PRE-PRODUCTION CART BUILDING  Enhanced Inventory Control & Ordering Practices  Simplified ordering process, less overstocking  Recipe Adherence  Provides direction to staff, enabling consistent products  Consistent Production Results  Eliminates guesswork, reduces personal preference of ingredients and amounts utilized  Cost Savings  Reduced overproduction of items  Efficient handling of ingredients

3. NUTRITION SERVICES HISTORY  2000-2006  No consistency with recipes that were in use  Many items did not have a recipe  Overproduction was prevalent  Limited structure  Cafeteria style service in both main dining rooms; table side service in the Nursing Home as needed, based on resident ability to self-feed  Tray line production of plated meals for delivery to unit dining rooms (9 FTEs)  Central Warehouse  Located in Columbus Ohio, provided nearly all dry, frozen, and refrigerated goods to OVH. This was accomplished by twice a month delivery of items, which were ordered by the Director of Nutrition Services and the OVH Warehouse Manager.  Bulk products purchased were not always consistent or of the highest quality.

4. NUTRITION SERVICES HISTORY  Central Warehouse Continued:  Changes were made that allowed OVH to purchase food items from a national supplier; one that carried quality, name-brand products  The department was able to order exactly what was needed and could be confident that they would receive the same product each order  Just In Time Delivery  Twice a week delivery became possible for a bulk of items  Able to order quality products and using them in standardized recipes greatly improved quality and consistence in meals served to the residents  Food-related complaints that the department would generally receive were greatly reduced

5.  Central Warehouse Continued:  Product lines and pack sizes would switch sporadically. The department needed consistent products to provide consistent meals to the residents.  Over handling of supplies  Central Warehouse would deliver to the OVH Warehouse, and OVH Warehouse staff placed items into storage, inside the OVH warehouse.  Nutrition Services would place an in-house order to the OVH Warehouse. OVH Warehouse staff would build the order onto pallets and deliver to the specified kitchen.  Nutrition Services staff would transfer the order to storage areas and/or shelves, located in kitchen storage rooms.  2006  April  Evaluated the department, to identify areas in need of improvement such as process efficiencies and quality standards.

6. NUTRITION SERVICES HISTORY  2007  Purchased new dietary software  Began designing cart building process  Residents could get most any item for any meal  Revamped menu  Seasonal menus rotating throughout the year…a 6-month Spring/Summer cycle and a 6-month Fall/Winter cycle. Lighter offerings during the warmer seasons and heartier choices in the cooler months.  Many signs of “food fatigue” were expressed by the residents who wanted to see more variety in their weekly menus. A fourth week was added to the menu cycle, allowing for seven more days of different meals.  Evaluated products (resident tastings)  Standardized Recipes  Changed direction from Central Warehouse supply method

7. CENTRAL WAREHOUSE DELIVERIES

8. NUTRITION SERVICES HISTORY  2008 through 2009  Refine practices.  Added hot alternate items  Review and re-evaluate menu items  Attended resident council meetings and ask for menu suggestions  Changed to table service in the Dom  Dealt with supplier changes  Changed from US Foodservice to Gordon Foodservice

9. CART BUILDING SYSTEM CORE REQUIREMENTS  Menu Planning  Product Selection  Recipes  Liberalized diets  Inventory Control & Ordering Practices  Cart Building Guides  Standardized Deliveries  Post-building Information (NIS)  Food Cost

10. MENU PLANNING  Devise menu with input from:  Customers (residents) – likes, dislikes, and wants  Dieticians – nutritional stand point, F tag issues, etc  Supervisors – fiscal aspect, ease of execution, impact on day to day item production  Staff – ease of execution, and flow of day to day production  The 4 Week Menu Cycle changes twice per year, one being a Fall/Winter cycle and the other a Spring/Summer cycle

11. MENU PLANNING  Dietary Software  Menu has to be entered into the system to generate recipes, production reports/guides  Software provides:  Recipes scaled to meet population size  Production reports  Meal delivery tickets  Nutritional information

12. PRODUCT SELECTION  Consistent products from a supplier (reduce possibility of substitutions and complaints from customers). Find items that are widely liked, and accepted  Obtain samples of products for resident tastings to determine best resident acceptance  Product sampling events for residents and staff  Determine needed unit of measure; pack size, case count, etc.  Maintain consistency of suppliers when possible; this reduces recipe variation

13. RECIPES  Scale to meet production needs.  Specify measurement type  i.e. Liquid, Dry (volume), or Weight  Must be easy to read and comprehend.  Protect from spills, and stains, by placing in plastic sheet protectors. Organize the protected sheets, aligned in order of the menu, in a 3 ring binder.

15. LIBERALIZED DIETS  Reduced diet types from 9 to 2  Reduced inventory/ordering  Simplified food production/distribution  Allowed all residents to enjoy the food of their choosing  Increased overall resident satisfaction

16. INVENTORY CONTROL & ORDERING PRACTICES  Standardize and simplify ordering process; this enables multiple staff members to place orders during absences of others.  Master list of items, containing:  Item name  Unit of measure  Item description  Vendor name  Ingredients are standardized and consistent.

17. CART BUILDING GUIDES  All ingredients are gathered on a designated cart, to permit quick production of food items; no hunting for ingredients.  Foundation for well built carts.  Three cart building guides used per day; one for frozen goods, one for refrigerated goods, and one for dry goods.  Lists items needed, along with quantities.  Items grouped by meal period, further separated by recipes.

18. CART BUILDING SHEETS

20. BUILT CARTS OF DRY GOODS

21. STANDARDIZED DELIVERIES  During the receiving process, utilize cart building sheets to determine assembled cart needs.  Reduces double handling (receive, store on shelf, place on cart)  Storage  Cooler  Freezer  Dry Stock Room

23. POST BUILDING ACTIONS  N.I.S. List (Not In Stock)  List of items not received from suppliers, provided by staff that builds carts.  Evaluate need for item substitution or menu change.  Review menu cycle to verify information.  Make necessary adjustments with staff; based on staff & resident input.

24. POST BUILDING REVIEW  Input from staff  What worked?  What was good, bad, or difficult?  Suggestions and ideas.  Supervisors & Dieticians  Discuss staff concerns regarding building process, and potential changes to recipes, and menus.  Review menu items and menu cycles. Menus evolve based on customer feedback, nutritional needs, product availability, etc.

25. FOOD COST  Reducing food cost was accomplished through:  Implementing inventory & ordering controls  Use of production guidelines  Tracking post meal waste  Use of standardized recipes  Serving foods that our customers like

26. CURRENT OPERATION  Conducted a month trial on 2 units, serving food directly to residents, eliminating use of a tray line  Meals received sooner than they were during service from the tray line  Food was served hotter, and fresher, versus food from the tray line  The residents were able to select which items they wanted  The residents were able to get additional servings immediately  There was less food waste at the end of the meals  The Dietary and Nursing staffs were able to work together in a cooperative manner  Construction began to relocate and enhance the unit kitchenettes

27.  Domiciliary  Short order grill production began in the Domiciliary Kitchen. In addition to the daily menu, available items included sandwiches, wraps, salads, and daily soup choices.  Phased out the traditional walkthrough serving line.  Implemented table side service.  Expanded dining hours from1.5 hours per meal period, to an open dining experience encompassing 0600-1800 hours.  Nursing Home  Tray line was removed.  Kitchenettes were relocated into the unit dining rooms.  Began serving meals from unit kitchenettes, directly to residents on each unit.  Expanded dining hours from1.5 hours per meal period, to an open dining experience encompassing 0600-1800 hours.  Dining On Demand in Nursing Home Kitchen.

28. BREAKFAST MENU

29. LUNCH/DINNER MENU

30. FACILITY & PRODUCTION STATISTICS  1800 meals, on average, prepared daily.  Kitchens  Main kitchen located the nursing facility.  Secondary kitchen located in the Domiciliary.  11 Kitchenettes  Food served directly to residents.  Nutrition Services is responsible for stocking all items.  Dining Rooms  1 Nursing Home Main Dining Room  1 Domiciliary Main Dining Room  11 Nursing Unit Dining Rooms  5 primary food vendors  Sysco, US Foods, Produce, Dairy, Bread

31. QUESTIONS?????