Food Service Management for a Rural Hospital in Queensland, Australia

This report discusses the review of the current Food Service System (FSS) of a rural hospital in Queensland, Australia. It also provides recommendations for a new 'low-care' Residential Aged Care Facility (RACF) system for the residents, including Syrian Muslim refugees.

Food Service Management

PART B: Executive Summary
Review of the Current FS System
Theodore is a rural area of Queensland, Australia. Theodore, faced heavy rains during 2010,
December and 2011, February, which lead to flooding of businesses and homes in the town.
Many people became homeless and bankrupt. The current hospital is, fifty years old, which
facilitates food service for the residents. The hospital cares for the critical case patients and
can only provide the facility of 200 beds. The hospital also has other departments. The
kitchen is located at the ground level, and the floods of 2011 caused severe water damage and
devastated the kitchen. The kitchen space in the hospital is allocated as 13 metres by 8
metres. The present Food Service System (FSS) of the hospital follows a cyclic menu of 7
days. The current status of the kitchen is regarded as poor and criticized by the food safety
auditors. Moreover, it is observed that the menu is not planned according to the residents’
health conditions. 25 Syrian Muslim refugees are included in to the facility, where they are
risked with malnutrition, and are diagnosed with Type 2 Diabetes Mellitus and Hypertension.
Method of Analysis
The assumptions identified and considered includes consumption, age and population target.
Both qualitative and quantitative analysis are completed. The kitchen was flooded and the
condition of the kitchen was criticized by the food safety auditors. The menu redesigning,
kitchen layout designing are integral part for meeting the needs of the new residents. The
quantitative analysis focuses on the 3 days menu evaluation i.e., Monday, Thursday, and
Saturday analysis with the help of dietary analysis program (FoodWorks) and nutritional
standards (AGHE).
Results of Analysis
Results show that menu in Arabic language is necessary. AGHE serves, protein and energy
requirements are provided. The kitchen system audit analysis is completed. The food
premises standards 3.2.3 are appropriate for food produced, for helping with enough space to
perform the processes, to store equipment, to conduct activities, and to manage the food
facility’s capacity. The standards helps in easing kitchen cleaning, to provide prevention from
pests, dust and various contaminants. The local building standards are based on Building
Code of Australia (BCA). The necessary mandatory warnings or advisory labels are labelled
by FSANZ, which assists in knowing the safe ingredients of the packaged food. Thus, it saves
from misleading the users. The standards ensures adequately equipped design for suitable
accessibility in the new RACF.
Requirements for the New System
The new ‘low-care’ residential aged care facility (RACF) system in Theodore, Central
Queensland requires additional resources for nearly 25 Syrian refugees. Even these refugees
come in to the category of 60 to 80 years of age and are all Muslims. The new system
requires:
1) Supportive objects for the aged people to walk independently.
2) Proper medicines
3) Effective exercise programme.
4) Therapeutic diet plan
5) Alternate menu on the day when pork, Sausages and turkey are supplied, is highly
suggested.
6) Safe diet is suggested.
7) Language interpreters to help the new residents (with Arabic Language).
8) Separate male and female practitioners to monitor the health of the male and
female practicing Muslims, respectively ("Syrian food and cultural profile:
dietetic consultation guide", 2015).

9) Separate section for female Muslims.
Recommendations
New RACF is recommended, to help the new residents from Syria and the locals. The
important factors implemented in the new RACF include control diabetes, weight loss,
dental check-up, hearing test, vaccination, regular Blood Pressure and Cholesterol Levels
check-up. Decentralised production and distribution system with hot plating is suggested.
Therapeutic diet is based on hypertension, diabetes and age which suggests HE/HP and low sodium.
The implementations considered for the residents include:
1. Ensure meeting cultural, religious, and therapeutic nutritional dietary requirements for
a 2 week cyclic menu (at least 35 hot options, for each cycle).
2. Daily implement 35-40 minutes of fast walking.
3. Eat between time intervals.
4. Completely stay away from oily food.
5. In meals, increase more fiber, high protein and high energy foods.
6. Eat slowly and not fast.
7. The calorific requirement for the residents with normal weight must have 1400 to
1800 kcal.
8. Nearly 180 grams of carbohydrate must be consumed daily.
9. Approximately from 60 to 110 grams of protein must be included in the daily diet.
10. Implement 50 to 150 grams of fat intake, daily in the diet.
11. Monitoring diabetes medication of the new residents.
The following recommendation are for disaster and emergency management:
- For Disaster management it is recommended to include maps and directions that help
the staff and people to evacuate.
- For issues of flooding, it is recommended to raise the height of the building, to be the
same level of a truck’s wheels.
- Ensure Emergency management plan for safety during floods.
- The standards implemented are- Food Act 2006 (the Act) for food premises and
equipment to meet the standard of Food Safety, with the help of Food Premises and
Equipment (Standards 3.2.3), of the Australia New Zealand Food Standards Code
(FSANZ). Standard code 3.3.1 Food Safety Program for Food Service to Vulnerable
Populations is considered.

Table of Contents
1. Introduction.................................................................................................................................1
1.1 Review of Current FSS........................................................................................................1
1.2 Background of Residents.....................................................................................................1
1.3 Review Nutritional Requirements of Residents.................................................................2
1.4 Review Other Requirements of Residents..........................................................................4
1.5 Summarise Impact of Location on FSS..............................................................................5
1.6 Evaluation of Existing Menu...............................................................................................5
2. Aims and Objectives....................................................................................................................6
2.1 Aim........................................................................................................................................6
2.2 Objectives.............................................................................................................................6
3. Methodology.................................................................................................................................7
3.1 Assumptions.........................................................................................................................7
3.1.1 Consumption Assumption...........................................................................................7
3.1.2 Age Assumption...........................................................................................................7
3.1.3 Population Target Assumption...................................................................................7
3.2 Qualitative Analysis.............................................................................................................7
3.3 Quantitative Analysis..........................................................................................................8
3.4 Menu Analysis......................................................................................................................9
3.5 Kitchen Analysis................................................................................................................10
4. Results........................................................................................................................................10
4.1 Established Service Standards..........................................................................................10
4.1.1 Standards for Food Premises....................................................................................10
4.1.2 Standards for Local Building....................................................................................11
4.2 Results of Menu Analysis..................................................................................................11
4.2.1 Therapeutic Diet Menu..............................................................................................12
4.2.2 AGHE Serve...............................................................................................................12
4.3 Kitchen System Audit Analysis.........................................................................................14
4.4 New Kitchen Plan..............................................................................................................14
4.4.1 Process Flow in New Kitchen....................................................................................14
5. Discussion and Recommendations............................................................................................15
5.1 Discussion...........................................................................................................................15
5.1.1 Disaster Management................................................................................................16
5.2 Recommendations..............................................................................................................17
References..........................................................................................................................................18

Appendices.........................................................................................................................................22
New Kitchen Layout Plan.................................................................................................................22

1. Introduction
1.1 Review of Current FSS
The facility is located in a rural area and lacks accessibility for effective facilities for
the aged people. At present, the hospital’s Food Service System (FSS) follows a cyclic menu
of 7 days. The breakfast menu has optional cereals, milk, whole wheat bread toast, one type
of fruit, eggs and coffee or tea. The cereals provided as option are 2 x Weetbix, ¾ cup of
Cornflakes, ¾ cup of Special K, or ½ cup Uncle Tobys Muesli. The breakfast items are same,
throughout the seven days. Milk is included in the diet. Fruits like banana, Apple, pear and
orange are included. Only on Saturdays fruit salad is supplied. The menu is not planned based
on the health condition of the residents.
The current status of the kitchen is regarded as poor and criticized by the food safety
auditors. As the kitchen is located at the ground level, the floods of 2011 caused severe water
damage and devastated the kitchen. The kitchen space in the hospital is allocated as 13 metres
by 8 metres. Earlier, the refugees wanted to settle in the rural areas of Queensland, and at
present Theodore comprises of refugees (Kravchenko, 2010). These refugees are diagnosed
with malnutrition, Type 2 Diabetes Mellitus and Hypertension. Therefore, the development in
the surrounding towns demanded a new facility even in Theodore. So, it initiated to renovate
the hospital to deliver RACF (Residential Aged Care Facility) in the town.
1.2 Background of Residents
Theodore is a small town of Australia, which is located in Shire of Banana,
Queensland. It has a population of less than 500 (i.e., 452 according to 2011 census). In
Theodore, there were heavy rains in the year 2010 and 2011, during December and February
respectively which caused floods. The floods damaged various businesses and houses. The
residents became homeless ("Theodore", 2018). The present hospital of this place is, fifty
years old. It offers various services for the residents. Generally, it takes care of critical case
patients and has the capacity to provide food facility for 200 beds. The accident and
Emergency services are the critical cases handled by this hospital. It has qualified and caring
nursing staff. The hospital comprises of other general departments ("Theodore Multipurpose
Health Service - Hospitals - Banana Community Directory", 2018). Hundred aged men and
woman are from the local area, whose age ranges from 60 to 80 years. The facility had to add
25 aged Muslim refugees from Syria. As they have had unstable survival there are chances
that they may or may not have nutritional issues like malnutrition. Even the refugees’ age is
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between 60 and 80. The Facility is advised that none of the refugees need any texture
modified diets and they don’t have any food allergies. Instead they are observed to have Type
2 Diabetes Mellitus and Hypertension. The Syrian Refugees might have wounds, which is
risky for the diabetes patients (Dlewati, 2016).
The past residents were the local residents of Theodore. The considered standard for the
meals and menu includes QH Nutrition Standards. It had no Emergency and disaster plans.
The future or new residents include 100 local Anglo-Saxon farmers, both males and females;
and 25 Syrian refugees aged between 60 to 80 years. The rural location will increase the
delivery issues, where it is difficult to get the safe products and some specific food items.
The Residential Aged Care Facility (RACF) includes approachable and experienced
clinicians who have the understanding of ACFI documentation and processes. On the other
hand, the RACF partners eases the pressure of the managers and the staff, in related
operations. The following are the set of facilities that the RACF can provide and which the
hospitals fall to provide ("Residential Aged Care Facilities (RACF)", 2018) -Strategies for
fall prevention; Complex Care along with Pain Management Clinics (4A & 4B); assessment
after their fall; training programme to manage falls and learn balancing; Reviewing their
mobility status; Walking Programs; Exercise Programs; Prescription on Gait Aid; Staff
Education on training and assessment of patients, OH&S, and fall prevention; Optimizing the
ACFI funding; Assessment of New Residents; Plan Implementation and Workplace OH&S
Assessment ("Facilitating Residential Aged Care Development", 2017).
1.3 Review Nutritional Requirements of Residents
The patients with type 2 diabetes must manage A1C, Blood pressure, blood sugar levels
and Cholesterol ("UpToDate", 2018). For health benefits of all the residents they need the
following (McCary, 2008):
1) Vitamin C
2) Vitamin D
3) Vitamin K
4) Vitamin B6
5) Calcium
6) Zinc
7) Less sodium
8) Potassium-rich food, to help from bone loss.
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Due to hypertension high risks has to be faced if the salt intake is high, because it can lead to
high blood pressure (Mansoor, Vora & White, 2005) (Ayala, Gillespie, Cogswell, Keenan &
Merritt, 2012). Each day, just 1,500 mg of sodium is sufficient. i.e., 3/4 teaspoon of salt. The
labels must be read to know and manage the intake of salt. The food which have sodium
greater than 20 percent must be avoided. However, both sodium and potassium have serious
impact on blood pressure, so in food 4.7 grams potassium can be consumed each day.
Potassium rich food includes vegetables, fruits and low-fat or fat-free milk products. Reduced
intake of sodium can help to decrease Blood Pressure and also helps to control hypertension
in aged people (Appel et al., 2001). Weight loss is also needed to help control Blood pressure
(Ohta, Tsuchihashi, Onaka & Miyata, 2010).
Mate is consumed for health benefits like weight loss, where it also consists of caffeine,
antioxidants and polyphenols ("Syrian food and cultural profile: dietetic consultation guide",
2015).
The difference in food and culture of the new and local residents are listed below
("Syrian food and cultural profile: dietetic consultation guide", 2015):
1) The diverse culture in intake of food and living.
a) The Syrian refugees prefer fresh food instead of packaged goods.
b) They don’t prefer frozen vegetables and fruits, as they are aware of its
nutrient loss.
c) Instead of pork they would rather prefer lamb, beef and chicken, because of
religious reasons they avoid eating pork.
d) They use olive oil or ghee for cooking their food.
e) They prefer vegetables pickled in salt and vinegar to consume with their
meals, which is not good for diabetes.
f) They often drink tea and coffee with lots of sugar, which again has negative
impact on their health.
g) New residents use hands to eat instead of spoons. This increases the need
for good hygiene. Whereas, the locals use spoons.
2) There might be amputations and war injuries, along with psychological conditions
like- depression, post-traumatic stress disorder and insomnia. Whereas, the locals
have no such issues.
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3) The psychological distress in the refugees is expected to have eating disorders.
Whereas, the locals have no such issues.
4) The type 2 diabetes refugee patients must be taken care on the following factors
(Spencer, 2017) ("UpToDate", 2018) (Oberg, 2018):
a) Ensure weight loss
b) Avoid any further weight gain.
c) Cut down intake of calorie.
d) Include exercise, Vitamin D and calcium.
e) Starchy vegetable
1.4 Review Other Requirements of Residents
The new ‘low-care’ residential aged care facility (RACF) system in Theodore, Central
Queensland requires additional resources for nearly 25 aged Syrian refugees. The highlighted
point is the age of all the residents i.e., between 60 and 80 years. This new residents require
the following:
1) The other requirements include dietary, cultural, religious and social
requirements with Islamic values (i.e., safe foods, High Energy/High
Protein and low sodium diet).
2) Supportive objects to walk independently.
3) Proper medicines
4) Effective exercise program
5) For Muslim residents, alternate menu on the day when non-safe food is
supplied, is highly suggested.
6) Language interpreters (For Arabic Language) ("Syrian food and
cultural profile: dietetic consultation guide", 2015)
7) Separate male and female practitioners to monitor the health of the
male and female practicing Muslims, respectively ("Syrian food and
cultural profile: dietetic consultation guide", 2015).
8) Separate section for female Muslims.
Food Provision
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The new residents will eat with the old residents in the redesigned kitchen. The current
facility has inappropriate place for the new refugees, based on cultural differences. (i.e., male
and female sitting areas are always separate in the Muslim culture).
Residential aged care facility (RACF) system is the best method to deliver food for the
local Anglo-Saxon residents and for the Syrian refugees. Because, RACF is partnered with
other Groups which ensure to provide the required facilities.
1.5 Summarise Impact of Location on FSS
The selection of RACFs based on spatial distribution has vital factor for the aged
people. The negative impacts of location on the FSS are listed below:
a) The location is affected by floods. Thus, it requires emergency and disaster plans.
b) The rural location of the FSS increases the delivery issues. For instance, safe
foods are difficult to be delivered for the FSS.
-
1.6 Evaluation of Existing Menu
The existing menu lacks the Syrian food eating practice and they have hypertension,
age and diabetic.
The new residents can adapt to the following Australian Diet menu ("Syrian food and cultural
profile: dietetic consultation guide", 2015):
1) Spinach is a substitute for Mulukhiyah/molokhia (corchorus olitorius) leaves
in Australia.
2) They can use oil instead of olive oil as a substitute.
3) The can adapt to fresh fruits and vegetables that are available in Australia.
4) Baked food can be used instead of frying.
5) Extra caution from chocolate, biscuits and cake is needed in their diet
("Diabetic Meal Plan for Type 2 Diabetes – overweight; diet only", 2018).
6) It is better to include low fat, salt, low sugar or sugar free products and high
fibre food in their diet ("Diabetic Meal Plan for Type 2 Diabetes – overweight;
diet only", 2018).
It is required to avoid the following dietary foods (Oberg, 2018):
a) Processed carbs like white bread, saltines, pasta and chips.
b) Trans fats like butter, mayonnaise, bakery goods, packaged sauces and certain
salad dressings.
c) High-fat dairy products like ice cream, whole milk, cream and cheese.
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d) Highly processed foods like candies, novelty sweets, cookies, kettle corn and
chips.
2. Aims and Objectives
2.1 Aim
The overall aim of the FSS is to offer unique service for the new aged residents with
standard clinical care and proper diet menu.
To accomplish the aim, the data from the current hospital, kitchen layout, menu and
foodservice system will be assessed and necessary changes will be implemented to ensure
that the new RACF is suitable for the new residents.
2.2 Objectives
The objectives are listed below:
1) To evaluate and design the kitchen, for producing efficient food product flow.
2) To evaluate the staff operations.
3) To meet the Local Building Standards.
4) The standards like Food Act 2006 (QLD), FZANDS Food Standards Code 3.2.3
and 3.3.1 Food Safety Program for Food Service to Vulnerable Populations will
be considered. Because, timing is very important in such circumstances.
5) To deliver variety in meals.
6) To deliver suitability for the new RACF residents aged between 60 to 80 years
and for the RACF staff.
7) To develop culturally, religiously, and therapeutically appropriate dishes for 100
local residents and for 25 Syrian refugees.
8) To encompass protein and energy requirements.
The objectives work to put efforts for creating solutions that, reflect the requirements of the new
residents in the rural area. To ensure effective management of various sub-systems that work
together, team management, disaster management, cost control methods are operated for helping
with proper distribution, kitchen space management for food service system, for easy planning and
evaluation of multiple chain operations, for Dish washing management, and for monitoring and
controlling the activities in the system. These objectives help to successfully implement a new
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Residential Aged Care Facility (RACF) and allows to redesign an effective and therapeutic diet menu
for the new residents.
3. Methodology
3.1 Assumptions
The assumptions considered for the current set of projection includes consumption, age
and population target. Totally, 25 Syrians aged Muslim refugees are included in the facility,
which already has 100 local residents of same age group (i.e., between 60 to 80 years).
3.1.1 Consumption Assumption
For projecting the food consumption, the number of people included in the facility are
determined and reported to the RACF executive. The consumption of different variety of
food for energy, in the household of Syrian mob and for the local residents are evaluated by
the Australian Guide to Healthy Eating (AGHE) serve, depending on the environmental,
social and cultural background. After gathering the required data, the food consumption is
analysed to represent the total food consumption rate. The food consumption rate will be
included in the planning and budget management for the facility.
3.1.2 Age Assumption
For projecting the age are determined and reported to the RACF executive, from the
demographic projections of Syrian population and age. The refugees’ age is analysed along
with their physical and mental health measures, to note down the facilities required for each
individual. The age factor will be included in the menu planning and budget management, for
facilitating the new residents. Moreover, the age factor is considered to take care of their
health.
3.1.3 Population Target Assumption
For projecting the population target includes to increase the nutritional intake in the
RACF. The Syrian refugees’ war background, their cultural and religious differences are
researched. The gathered data help to provide sufficient nutritional intake in their diet, to
improve their mental and physical health.
3.2 Qualitative Analysis
The following are the qualitative analysis questions for 7 days menu analysis:
1) Why there must be repetition and options in the menu, for items?
2) What item has to be repeated?
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3) How many hot choices are required?
4) Where are the hot choices applied?
5) When does the hot choices appear in the week?
6) Which residents have cultural and religious differences?
7) How the nutritional intake can be increased in the RACF?
3.3 Quantitative Analysis
The quantitative analysis focuses on the 3 days menu evaluation i.e., Monday,
Thursday, and Saturday analysis with the help of dietary analysis program (FoodWorks) and
nutritional standards (AGHE). The High protein/ high energy supplement might contain
commercial supplements or fortified milk drinks.
1) Does the premises meet the QH-nutrition standards?
2) Does it have a process work flow?
3) Does the staff have dressing and toilet facility?
4) Does the kitchen meet the local building standards for the new premises?
5) Does the kitchen meet the food safety standards?
6) Are the service standards mentioned?
7) Are the AGHE serves, protein and energy requirements provided?
8) Does the diet suggested for Monday, Thursday, and Saturday meet the dietary
analysis program (FoodWorks) and nutritional standards (AGHE)?
9) Which standards are used for menu designing?
MID MEALS
Morning Tea,
Afternoon
Tea and
Supper
Per day Per cycle Per day Per cycle Today’s
Choice
Choice
across the
cycle
High
protein/energ
y supplement
0 0 1 3 Chocolate
milk
Chocolate
milk,
Fortified
fruit juice
supplement,
high protein
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milk
supplement
3.4 Menu Analysis
From the menu analysis the following are determined:
1) A new menu for the therapeutic diets like high energy/high protein,
hypertension, low sodium and T2DM is required.
2) From the methodology, it is determined that in 7 days menu cycle two lunch
items appear on the menu and an alternative items are available if requested.
This is also repeated.
3) Nutritional information is easily available on the menu.
4) The menu is required in both Arabic and English languages.
5) One Arabic speaking social worker is required.
6) The products in the menu must have safe ingredients, according to the religious
rulings. For instance- In yoghurt, gelatin (which is free from pig fat.).
According to Australian Guide to Healthy Eating (AGHE):
1) To decrease the processed food consume seasonal fruits and vegetables. Then, for
decreasing the food waste adapt a diet filled plant-based diet than meat-based (Selvey
& Carey, 2013).
2) The fortified option is provided for extra nutrition in some meal like hot cereals and
vegetables. Because, it increases energy and protein in the food.
3) Totally, 35 hot choices are included– 3 lunch, 2 dinner.
4) In 7 day menu cycle, two lunch items appear on the menu – an alternative item is
available if requested. This is repeated.
5) Nutritional information is made available on the menu.
6) The menu is required in both Arabic and English languages.
7) The products in the menu must have halal (safe) ingredients. For instance- Gelatin
which is free from pig fat is used in yoghurt.
8) Daily, minimum two vegetarian/ one vegan option must be present according to the
Nutrition standards for Meals and Menus. The option are, hot meals, salads and
sandwiches ("QUEENSLAND HEALTH Nutrition Standards for Meals and Menus",
2015).
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9) However, daily one hot vegetarian/vegan choice will be provided, according to the
Nutrition standards for Meals and Menus.
10) Various protein sources must be included, like cheese, egg, legumes, tofu, nuts, seeds
and textured vegetable protein products.
11) Milk alternatives are soy milk, which will befortified with calcium and B12.
3.5 Kitchen Analysis
According to the Standard 3.2.3 and Australian Standard 4674-2004 on Design,
construction and fit-out of food premises, it is necessary to know the needs of the Standard
with solutions that are satisfactory and to know how they achieve the required results
("Design and fit-out guide for food businesses", 2015).
The local building standards based on Building Code of Australia (BCA)
According to standards 3.3.1 of Food Safety Program for Food Service to Vulnerable
Populations ("A guide to Standards 3.3.1 - Food Safety Programs for Food Service to
Vulnerable Persons", 2018). The vulnerable people includes aged residents, and they receive
the required service from the facility ("Food Safety Programs for Food Service to Vulnerable
Persons", 2008). For vulnerable people, a set of guidelines are provided by the Food
Authority for helping the industry with food safety program, which complies with the NSW
Food Regulation 2015 ("Guidelines for Food Service to Vulnerable Persons", 2015).
Thus, the kitchen analysis determines that, lack of food and equipment standards
decrease food and waste’s safe flow and can decrease the food and equipment contamination
risks. Moreover it ensures food and waste management for food safety. All the residents of
RACF can be benefited by these standards.
4. Results
4.1 Established Service Standards
The food premises and equipment standards 3.2.3 are considered appropriate for to
manage the facility’s capacity, for food produced, for prevention from dust, contaminants and
pest, for storage of equipment, to ease in cleaning the kitchen, for conducting activities and
for helping with enough space to perform all the activities of the process flow.
4.1.1 Standards for Food Premises
The standards 3.2.3 for Food premises and equipment demands the following ("Standard 3.2.3
Food Premises and Equipment", 2001):
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The walls and ceilings should be present wherever required, for protecting the food
from any kind of contamination. Based on the sub clause (2), the walls and ceilings should be
sealed, for preventing any dust, pest and dirt on the food; the walls and ceilings should not be
able to absorb any food particles, grease and water; the walls and ceilings should be adapted
to cleaning. The walls and ceilings should not be viable to pest. No hiding place for the pests
must be provided. The ceilings must have washable paint, with a smoot and finished texture.
Its construction must be continuous to avoid any joint or spaces. The ceiling must have access
panels if the space is accessed, and it must be tightly fixed.
4.1.2 Standards for Local Building
According to Food Act 2006, approval from local government or private certifier is
necessary according to the standards of local building. Then, from the relevant local
government’s plumbing department plumbing approval is required for using the water. Trade
waste approvals are required for grease traps from the relevant water and sewerage supply
("Design and fit-out guide for food businesses", 2015).
4.2 Results of Menu Analysis
The therapeutic diets like high energy/high protein, hypertension, low sodium and
T2DM are regulated based on the Australia New Zealand food standards code (fsanz).
Because, it helps in using right ingredients which helps in facilitating with right vitamins and
minerals. Australian Government's Health department established Food Standards Australia
New Zealand Act 1991 (FSANZ Act). Food Standards Code cover the dairy, meat and
beverages consumption. The necessary mandatory warnings or advisory labels are labelled by
FSANZ. This helps to know the safe ingredients of the packaged food ("About FSANZ",
2018) ("Food Standards Australia New Zealand (FSANZ)", 2018).
Food service system suggests redesigning the menu, by considering all the aspects of
nutritional value, standards of FSANZ Act. Because, daily choices of healthy intake can have
good impact on the health (Ducak & Keller, 2011).
1) Include fruits like cherries, grapes, peach, other citrus fruits, apricots, apples,
mandarins, berries, figs, dates, plums and watermelons.
2) They need nuts like- pistachios and green almonds.
3) They prefer vegetables like- tomato, cucumber and eggplant.
4) Mate is consumed for health benefits like weight loss, where it also consists of
caffeine, antioxidants and polyphenols.
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4.2.1 Therapeutic Diet Menu
The new therapeutic diet menu with high energy/high protein for hypertension, low
sodium and T2DM is provided below:
Standards of Therapeutic diet includes:
1) Identify the patients who need Therapeutic Diet.
2) Therapeutic diet must be integrated with the standard menu.
3) At least 10% of diet must need special foods (SFSKPI).
4) Quality and taste/acceptability must not be compromised because of the
integration of therapeutic diets. For instance, reduced fat and less salt.
4.2.2 AGHE Serve
Minimum AGHE Serve includes:
Meal Item Quantity
Breakfast milk
Cereal
yoghurt
bread
juice
Margarine
jam
sugar
100ml
21 g
100g
2 slices
125ml
2x5g
2x5g
1g
Morning tea Cheese
Savoury biscuit
3g
2 biscuits
Lunch Sandwich
Soup
side salad
Tinned fruit
Custard
Starchy vegetable + protein
and plant-based fat
4 points
160ml
140g
50g
50ml
1 cup
Afternoon tea Half Sandwich
tea
2 points
100ml
Dinner Vegetables
Meat
3x50g
100g
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Fresh Fruit
Bread
Margarine
125g
1 slice
1x5g
Supper Milk
Sweet biscuits
150 ml
2 Biscuits
High-Protein and High Energy
High protein dose in aged people has same benefits as in young adults. However only
30 to 35 percent can prove as benefiting. It is necessary to include easily digestible and
quality proteins which has large proportion of EAAs which decreases the very high content of
protein (Baum, Kim & Wolfe, 2016).
Low-carbohydrate and high-protein diet ensures healthy weight loss in healthy adults.
Thus, this diet can be included for the local residents as they are healthy adults (Johnston,
Tjonn & Swan, 2004).
Protein for
diabetic
residents
2 gram
Protein for
healthy
residents
60 to 110
grams
Potassium
for diabetic
residents
4.7 grams
Sodium for
diabetic
residents
190 mg
Sodium for
healthy
residents
2100 mg
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4.3 Kitchen System Audit Analysis
From the kitchen system audit analysis the following are determined:
1) Serving timings, labour management, equipment management, food resources
and service management needs modification.
2) Lacks staff, plating and distribution management, for easily managing 125
residents.
3) QH-nutrition standards are not present.
4) Process work flow lacks space, coordination, time management for tasks like
washing schedule and so on.
5) The cooking area in the kitchen is centralized, it increased the obstacle of
space and smooth process flow.
6) The premises don’t have local building standards and food safety standards.
7) Staff for Arabic language interpretation is required, for easily serving the
menu.
4.4 New Kitchen Plan
A new kitchen floor plan includes QH-nutrition standards, work flow, including staff
area, local building standards and food safety standards as mentioned in the below section.
The local building standards are based on Building Code of Australia (BCA) for toilet
facility. Further, it covers fit-out, mechanical ventilation for maintaining the quality of air,
which can keeps the premises smell good and secure from contamination by pathogens,
toxins and micro-organisms. Along with ventilation, clean toilets and hands-free taps falls
under the BCA requirements by the Australian Standard 1668’s Parts 1 and 2 ("Standard 3.2.3
Food Premises and Equipment", 2001).
Walls and ceilings of kitchen are painted and are safety from pest, dirt, dust and food
particles. Washable wall and ceiling are preferred. The standards ensure safety of food and
waste management.
4.4.1 Process Flow in New Kitchen
The food service system starts from the process flow from cooking area, after cooking, plating
bench is used and trolleys are used for serving the Syrian residents and local residents. Directions for
respective sections is followed by the hand wash facility. The dirty dishes are collected by the FSS
management and staked in the washing area. Then, the dishes are washed and stored in the provided
shelves.
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5. Discussion and Recommendations
5.1 Discussion
The results impact broadly on the new RACF, by considering the new residents’ needs,
where the Therapeutic dietary requirements for residents (High Energy/High Protein, low
sodium, in consideration of hypertension, diabetes and age) will be facilitated. Moreover,
certain dietary requirements like safe food, assumptions of no vegetarians and no allergies are
fulfilled. The layout of the kitchen is considered along with the number of staff, for
increasing the productivity, for decreasing the cost, for avoiding cross-contamination, for
incidence of food-borne illness, and for decreasing the injury risks. The kitchen is suggested
to have two refrigerators and freezers for storing different food items of both the old and new
residents. Storage shelves for halal items and for non-halal items.
Refurbish the kitchen based on the Local Building Standards, Food Act 2006 (QLD),
FZANDS Food Standards Code 3.2.3 and 3.3.1 Food Safety Program for Food Service.
Building Code of Australia (BCA) is suggested for the local building. The Standards and
AGHE are considered.
The new residents require the following facilities (Hess-Fischl MS, 2015):
1) Include dental check-up, because diabetes patients tend to have gum disease.
2) Ensure hearing test.
3) Necessity of Therapeutic diet for residents based on hypertension, diabetes and
age HE/HP and low sodium are suggested.
4) Due to high risks of complications from flu, ensure to provide vaccine for both
the new and old residents.
5) Ensure to regularly check Blood Pressure and Cholesterol Levels.
6) Religiously take diabetes medication.
7) Ensure to test the glucose levels, because the diabetes patients tend to have the
symptoms of hypoglycemia which includes dizziness, confusion, sweating and
hunger.
8) Eat healthy diet and avoid salt, oil and sugar content.
9) Provide exercise sessions to manage their weight and to stay active ("15
Exercise Tips for People With Type 2 Diabetes", 2015).
10) At times insulin injections are required to help the residents.
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The rural location is the main issues that is encountered. The limitations of the new facility in
the rural area are listed below:
a) The rural area increases difficulties for developing a new kitchen.
b) Issues to develop a new menu.
c) It includes issues for emergency procedure.
d) Safety issues
e) Food delivery issues.
f) It is difficult to have good coordination between the old and new residents, due to
cultural differences.
g) It is difficult for the new residents to adapt to the Australian food eating culture.
h) The facility has to add many checkup monitoring facilities, to ensure both mental and
physical health of the residents.
i) It is difficult for the new residents to adjust to the new dietary control.
5.1.1 Disaster Management
In Queensland, floods often occur. As a safety plan for the flooding ensure the
following when heavy rains occur in the locality ("Flood", 2018) ("Managing floods in
Queensland", 2015):
1) Check the pattern in weather.
2) Don’t go near creeks, drains and rivers, instead move to high ground level.
3) Check warnings from Meteorology bureau, and take immediate actions based on the
severe storms or cyclones warnings, because it leads to flooding.
4) Activate the emergency plan and keep the emergency kit always ready.
5) The follow the evacuation plan.
a) The emergency kit, must have warm clothes, mobile phone, required medicine,
important documents, mementos and photos in a waterproof bag.
b) Turn off gas, electricity power and water taps.
c) Make use of fridge, furniture, tables and bed to raise from the ground level.
d) Make sure to empty the refrigerators and freezers. Then, keep its doors open.
e) The indoor drains like toilet bowl and bathroom must be blocked with
sandbag, for preventing the backflow of sewage.
f) Take steps to lock the doors of your houses, before proceeding with the
evacuation routes suggested for the area.
g) Avoid walking on floodwater, because it is very dangerous to step into the
floodwater.
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5.2 Recommendations
The following are the recommendations to meet the unique requirements of the new
residents (Hess-Fischl MS, 2015):
a) Facilitate dental check-up, hearing test, vaccination, regular Blood Pressure and
Cholesterol Levels check-up.
b) Monitor diabetes medication of the new residents.
c) Develop exercise programs to control their weight.
d) It is suggested to check the glucose levels of the new residents to overcome the
symptoms of dizziness, hunger and so on.
e) It is mandatory to avoid more salt, oil and sugar content in their diet.
f) Decentralised production and distribution system with hot plating is suggested.
g) Ensure meeting cultural, religious, and therapeutic nutritional dietary requirements for
the new residents.
The following implementations are considered for the new residents (Prasad Mehrotra, 2018):
a) Daily implement 35-40 minutes of fast walking.
b) Eat between time intervals.
c) Completely stay away from oily food.
d) In meals, increase more fiber foods.
e) Eat slowly and not fast.
f) The calorific requirement for the residents with normal weight must have 1400 to
1800 kcal.
g) Nearly 180 grams of carbohydrate must be consumed daily.
h) Approximately from 60 to 110 grams of protein must be included in the daily diet.
i) Implement 50 to 150 grams of fat intake, daily in the diet.
The following recommendation are for disaster and emergency management:
i. For Disaster management it is recommended to include maps and directions that
help the staff and people to evacuate.
ii. For issues of flooding, it is recommended to raise the height of the building, to be
the same level of a truck’s wheels.
iii. Ensure Emergency management plan for safety during floods.
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The following standards must be considered:
1) Food Act 2006 (the Act) for food premises and equipment to meet the standard of
Food Safety, with the help of Food Premises and Equipment (Standards 3.2.3), of the
Australia New Zealand Food Standards Code (FSANZ).
It allows the RACF with the option of “Finger food” for the required residents.
References
15 Exercise Tips for People With Type 2 Diabetes. (2015). Health.com. Retrieved 4 April
2018, from http://www.health.com/health/gallery/0,,20425548,00.html#get-a-move-on
A guide to Standards 3.3.1 - Food Safety Programs for Food Service to Vulnerable Persons.
(2018). Foodstandards.gov.au. Retrieved 4 April 2018, from
http://www.foodstandards.gov.au/code/userguide/Pages/aguidetostandards3314569.aspx
About FSANZ. (2018). Foodstandards.gov.au. Retrieved 5 April 2018, from
http://www.foodstandards.gov.au/about/Pages/default.aspx
Appel, L., Espeland, M., Easter, L., Wilson, A., Folmar, S., & Lacy, C. (2001). Effects of
Reduced Sodium Intake on Hypertension Control in Older Individuals. Archives Of
Internal Medicine, 161(5), 685. http://dx.doi.org/10.1001/archinte.161.5.685
Ayala, C., Gillespie, C., Cogswell, M., Keenan, N., & Merritt, R. (2012). Sodium
Consumption Among Hypertensive Adults Advised to Reduce Their Intake: National
Health and Nutrition Examination Survey, 1999-2004. The Journal Of Clinical
Hypertension, 14(7), 447-454. http://dx.doi.org/10.1111/j.1751-7176.2012.00632.x
18

Baum, J., Kim, I., & Wolfe, R. (2016). Protein Consumption and the Elderly: What Is the
Optimal Level of Intake?. Nutrients, 8(6), 359. http://dx.doi.org/10.3390/nu8060359
Design and fit-out guide for food businesses. (2015). Food Act 2006, State Of Queensland.
Design Guidelines for Queensland Residential Aged Care Facilities. (1999). Retrieved from
https://www.health.qld.gov.au/__data/assets/pdf_file/0025/151099/qh-gdl-374-8.pdf
Diabetic Meal Plan for Type 2 Diabetes – overweight; diet only. (2018). Mealplansite.com.
Retrieved 4 April 2018, from https://www.mealplansite.com/medical/diabetes-type-2-
diet-overweight.aspx
Dlewati, H. (2016). Diabetes Patients Battle for Insulin in Syria. Syria. Retrieved 4 April
2018, from https://www.newsdeeply.com/syria/articles/2016/08/16/diabetes-patients-
battle-for-insulin-in-syria
Ducak, K., & Keller, H. (2011). Menu Planning in Long-Term Care: Toward Resident-
centred Menus. Canadian Journal Of Dietetic Practice And Research, 72(2), e126-e133.
http://dx.doi.org/10.3148/72.2.2011.e126
Facilitating Residential Aged Care Development. (2017). Retrieved from
https://www.planning.vic.gov.au/__data/assets/pdf_file/0029/89462/RACF-Proposed-
reforms-to-the-VPP.pdf
Flood. (2018). Qld.gov.au. Retrieved 4 April 2018, from
https://www.qld.gov.au/emergency/dealing-disasters/flood
Food Safety Programs for Food Service to Vulnerable Persons. (2008). Australia New
Zealand Food Standards Code. Retrieved from
https://www.foodstandards.gov.au/code/userguide/Documents/Std%20331-Food
%20Safety%20Prog%20Vul%20Pers-guideFNL1.pdf
Food Standards Australia New Zealand (FSANZ). (2018). Betterhealth.vic.gov.au. Retrieved
5 April 2018, from https://www.betterhealth.vic.gov.au/health/healthyliving/food-
standards-australia-new-zealand-fsanz
Guidelines for Food Service to Vulnerable Persons. (2015). Department Of Primary
Industries Food Authority. Retrieved from
19

http://www.foodauthority.nsw.gov.au/_Documents/industry/guidelines_vulnerable_perso
ns.pdf
Hess-Fischl MS, A. (2015). 9 Ways Older People Can Manage Their Diabetes to Stay
Healthier. EndocrineWeb. Retrieved 4 April 2018, from
https://www.endocrineweb.com/guides/diabetes-older-people/staying-healthy
Johnston, C., Tjonn, S., & Swan, P. (2004). High-Protein, Low-Fat Diets Are Effective for
Weight Loss and Favorably Alter Biomarkers in Healthy Adults. The Journal Of
Nutrition, 134(3), 586-591. http://dx.doi.org/10.1093/jn/134.3.586
Kravchenko, M. (2010). History of the Russian Community in Queensland and in
Brisbane. qrcc.com.au. Retrieved 3 April 2018, from http://www.qrcc.com.au/history-
of-the-russian-community-e
Managing floods in Queensland. (2015). Callide Creek Flood Review. Retrieved from
https://www.igem.qld.gov.au/callide/wp-content/uploads/2015/06/CCK_Chapter.5_MA
NAGING-FLOODS-QLD_6pp_31May_HLinx_WEB.pdf
Mansoor, G., Vora, C., & White, W. (2005). Sodium intake in elderly hypertensives and
outpatient compliance with low sodium diet. American Journal Of Hypertension, 18(5),
A215-A215. http://dx.doi.org/10.1016/j.amjhyper.2005.03.589
McCary, J. (2008). Good Nutrition for the Golden Years. www.ideafit.com. Retrieved 5 April
2018, from http://www.ideafit.com/fitness-library/good-nutrition-golden-years
Oberg, E. (2018). Type 2 Diabetes Diet Guidelines: Foods to Eat, Foods to
Avoid. MedicineNet. Retrieved 4 April 2018, from
https://www.medicinenet.com/diabetic_diet_for_type_2_diabetes/article.htm#what_type
_of_fats_are_recommended_for_a_type_2_diabetes_diet_plan
Oberg, E. (2018). Type 2 Diabetes Diet Guidelines: Foods to Eat, Foods to
Avoid. MedicineNet. Retrieved 4 April 2018, from
https://www.medicinenet.com/diabetic_diet_for_type_2_diabetes/article.htm#what_type
s_of_diet_or_meal_plans_are_recommended_for_people_with_type_2_diabetes
Ohta, Y., Tsuchihashi, T., Onaka, U., & Miyata, E. (2010). Long-Term Compliance of Salt
Restriction and Blood Pressure Control Status in Hypertensive Outpatients. Clinical And
Experimental Hypertension, 32(4).
20

Parker Gordon, J., & Butler, N. (2016). Diabetes and Watermelon: Is It Safe to
Eat?. Healthline. Retrieved 4 April 2018, from
https://www.healthline.com/health/diabetes/watermelon-and-diabetes#research
Prasad Mehrotra, D. (2018). Diet Chart For Diabetes Patient. Lybrate. Retrieved 4 April
2018, from
https://www.lybrate.com/topic/diet-chart-for-diabetes-patient/f59bcec6711921f4c1757df
1f011ee92
QUEENSLAND HEALTH Nutrition Standards for Meals and Menus. (2015).
Residential Aged Care Facilities (RACF). (2018). Unitedphysiogroup.com.au. Retrieved 4
April 2018, from http://www.unitedphysiogroup.com.au/aged-care-services/residential-
aged-care-facilities-racfs/
Selvey, L., & Carey, M. (2013). Australia’s dietary guidelines and the environmental impact
of food “from paddock to plate”. The Medical Journal Of Australia, 198(3), 140.
http://dx.doi.org/10.5694/mja12.10528c
Spencer, B. (2017). A three-month crash diet can reverse Type 2 diabetes, study shows. Mail
Online. Retrieved 4 April 2018, from http://www.dailymail.co.uk/health/article-
5149557/Three-month-diet-reverse-Type-2-diabetes.html
Standard 3.2.3 Food Premises and Equipment. (2001). AUSTRALIA NEW ZEALAND FOOD
STANDARDS CODE.
Syrian food and cultural profile: dietetic consultation guide. (2015). State Of Queensland
(Metro South Health). Retrieved from
https://metrosouth.health.qld.gov.au/sites/default/files/content/dietetic_profile_syria.pdf
Theodore Multipurpose Health Service - Hospitals - Banana Community Directory.
(2018). Mycommunitydirectory.com.au. Retrieved 3 April 2018, from
https://www.mycommunitydirectory.com.au/Queensland/Banana/Health_Services/
Hospitals/13054/118655/Theodore_Multipurpose_Health_Service
Theodore. (2018). Queenslandplaces.com.au. Retrieved 3 April 2018, from
http://queenslandplaces.com.au/theodore
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UpToDate. (2018). Uptodate.com. Retrieved 4 April 2018, from
https://www.uptodate.com/contents/type-2-diabetes-mellitus-and-diet-beyond-the-basics
Appendices
New Kitchen Layout Plan
A new floor plan with QH-nutrition standards, work flow, including staff area, local building
standards and food safety standards.
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Enlarged kitchen area of 17 metre by 10 metre.
1. Installed floor wastes on the floor, for easy cleaning.
2. Mechanical exhaust ventilation
3. fittings and fixtures
(Mention *square meter floor space for dining area and number of residents)
4. Staff dressing area
5. Wash room with hands-free taps.
6. Lobby
7. Closed Bins
8. raw food storage
9. cooked food storage
10. Hand washing facilities with hands-free taps.
11. Other storage facilities
12. Prep Bench
13. Bench space for Muslim 10 ladies.
14. Ceiling Partition for Muslim ladies
15. Bench space for Plating (Syrian Men, approximately 15)
16. Bench space for Plating (local residents)
17. Sufficient space for the trolley storage.
18. Wall Supportive handles to walk independently for the aged people.
19. Emergency evacuation route map for the staff,
20. Delivery area (Opening of door and window)
21. Sign board for the bench space of local and Syrian residents.
22. Hand wash Sink with hands-free taps.
23. waste disposal area ( In outers section of the plan)
24. Fire extinguisher
25. Meat slicers
26. Slop sink
27. Dirty Trolley Bay
28. Dirty dish stacking area
29. Sink with hands-free taps and Dishwasher
30. Cleaning schedule sheets
31. 2 Pot wash areas
32. Cleaned dishes
33. Cleaning product storage
34. Cooking area with wall and ceiling (Decentralized production and distribution system with hot plating.)
35. Bratt Pan
36. Deep fryer
37. Small blast chiller
38. Salamander
39. Oven with a cook top
40. Combi oven / steamer
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41. Utensils storage shelves
42. Small Freezer and fridge for Syrian residents.
43. Big Freezer and fridge for local residents.
24