Food Service System Review & Redesign: Theodore Hospital, Sem 1, 2018

This report presents a comprehensive review of the food service system at Theodore Hospital, focusing on its current state, challenges, and recommendations for improvement. The review encompasses an analysis of the existing 7-day cyclic menu, the condition of the kitchen (which suffered flood damage), and the nutritional needs of the residents, including newly arrived Syrian Muslim refugees with specific dietary requirements like managing Type 2 Diabetes Mellitus and Hypertension. The methodology includes both qualitative and quantitative analyses, utilizing dietary analysis programs and nutritional standards. Key recommendations include implementing a new residential aged care facility (RACF) with a decentralized production and distribution system, therapeutic diet plans catering to hypertension and diabetes, culturally sensitive menu options, and disaster management strategies to mitigate future flood risks. The report also emphasizes the importance of adhering to food safety standards and building codes to ensure a safe and efficient food service operation.

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
1

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.
2

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.
3

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
4

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.
5

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
6

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?
7