Current Status of Hospital’s Food Service System

Discuss about the Design and Fit-Out Guide for the Food Businesses.

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.

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 The new RACF has 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 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).

Challenges Faced in Providing Food for the New Residents

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).

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):

• Vitamin C
• Vitamin D
• Vitamin K
• Vitamin B6
• Calcium
• Zinc
• Less sodium
• Potassium-rich food, to help from bone loss.

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).

Cultural Differences in Food and Eating Practices Between New and Old Residents

The difference in food and culture of the new and local residents are listed below (“Syrian food and cultural profile: dietetic consultation guide”, 2015):

• The diverse culture in intake of food and living.

1. The Syrian refugees prefer fresh food instead of packaged goods.
2. They don’t prefer frozen vegetables and fruits, as they are aware of its nutrient loss.
3. Instead of pork they would rather prefer lamb, beef and chicken, because of religious reasons they avoid eating pork.
4. They use olive oil or ghee for cooking their food.
5. They prefer vegetables pickled in salt and vinegar to consume with their meals, which is not good for diabetes.
6. They often drink tea and coffee with lots of sugar, which again has negative impact on their health.
7. New residents use hands to eat instead of spoons. This increases the need for good hygiene. Whereas, the locals use spoons.

• 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.
• The psychological distress in the refugees is expected to have eating disorders. Whereas, the locals have no such issues.
• The type 2 diabetes refugee patients must be taken care on the following factors (Spencer, 2017) (“UpToDate”, 2018) (Oberg, 2018):

1. Ensure weight loss
2. Avoid any further weight gain.
3. Cut down intake of calorie.
4. Include exercise, Vitamin D and calcium.
5. Starchy vegetable

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:

• 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).
• Supportive objects to walk independently.
• Proper medicines
• Effective exercise program
• For Muslim residents, alternate menu on the day when non-safe food is supplied, is highly suggested.
• Language interpreters (For Arabic Language) (“Syrian food and cultural profile: dietetic consultation guide”, 2015)
• 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).
• Separate section for female Muslims.

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.

            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:

1. The location is affected by floods. Thus, it requires emergency and disaster plans.
2. The rural location of the FSS increases the delivery issues. For instance, safe foods are difficult to be delivered for the FSS.

   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):

• Spinach is a substitute for Mulukhiyah/molokhia (corchorus olitorius) leaves in Australia.
• They can use oil instead of olive oil as a substitute.
• The can adapt to fresh fruits and vegetables that are available in Australia.
• Baked food can be used instead of frying.
• Extra caution from chocolate, biscuits and cake is needed in their diet (“Diabetic Meal Plan for Type 2 Diabetes – overweight; diet only”, 2018).
• 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):

1. Processed carbs like white bread, saltines, pasta and chips.
2. Trans fats like butter, mayonnaise, bakery goods, packaged sauces and certain salad dressings.
3. High-fat dairy products like ice cream, whole milk, cream and cheese.
4. Highly processed foods like candies, novelty sweets, cookies, kettle corn and chips.

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.

The objectives are listed below:

• To evaluate and design the kitchen, for producing efficient food product flow.
• To evaluate the staff operations.
• To meet the Local Building Standards.
• 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.
• To deliver variety in meals.
• To deliver suitability for the new RACF residents aged between 60 to 80 years and for the RACF staff.
• To develop culturally, religiously, and therapeutically appropriate dishes for 100 local residents and for 25 Syrian refugees.
• 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 Residential Aged Care Facility (RACF) and allows to redesign an effective and therapeutic diet menu for the new residents.

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).

Objectives for Implementation of New RACF System

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.

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.

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.

The following are the qualitative analysis questions for 7 days menu analysis:

• Why there must be repetition and options in the menu, for items?
• What item has to be repeated?
• How many hot choices are required?
• Where are the hot choices applied?
• When does the hot choices appear in the week?
• Which residents have cultural and religious differences?
• How the nutritional intake can be increased in the RACF?

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.

• Does the premises meet the QH-nutrition standards?
• Does it have a process work flow?
• Does the staff have dressing and toilet facility?
• Does the kitchen meet the local building standards for the new premises?
• Does the kitchen meet the food safety standards?
• Are the service standards mentioned?
• Are the AGHE serves, protein and energy requirements provided?
• Does the diet suggested for Monday, Thursday, and Saturday meet the dietary analysis program (FoodWorks) and nutritional standards (AGHE)?
• 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/energy supplement	0	0	1	3	Chocolate milk	Chocolate milk, Fortified fruit juice supplement, high protein milk supplement

From the menu analysis the following are determined:

• A new menu for the therapeutic diets like high energy/high protein, hypertension, low sodium and T2DM is required.
• 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.
• Nutritional information is easily available on the menu.
• The menu is required in both Arabic and English languages.
• One Arabic speaking social worker is required.
• 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.).

• 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).
• 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.
• Totally, 35 hot choices are included– 3 lunch, 2 dinner.
• In 7 day menu cycle, two lunch items appear on the menu – an alternative item is available if requested. This is repeated.
• Nutritional information is made available on the menu.
• The menu is required in both Arabic and English languages.
• The products in the menu must have halal (safe) ingredients. For instance- Gelatin which is free from pig fat is used in yoghurt.
• 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).
• However, daily one hot vegetarian/vegan choice will be provided, according to the Nutrition standards for Meals and Menus.
• Various protein sources must be included, like cheese, egg, legumes, tofu, nuts, seeds and textured vegetable protein products.
• Milk alternatives are soy milk, which will be fortified with calcium and B12.

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).

Assumptions Considered for Projection

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.

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.  

The standards 3.2.3 for Food premises and equipment demands the following (“Standard 3.2.3 Food Premises and Equipment”, 2001):

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.

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).

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).

Factors Affecting Food Consumption

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).

• Include fruits like cherries, grapes, peach, other citrus fruits, apricots, apples, mandarins, berries, figs, dates, plums and watermelons.
• They need nuts like- pistachios and green almonds.
• They prefer vegetables like- tomato, cucumber and eggplant.
• Mate is consumed for health benefits like weight loss, where it also consists of

caffeine, antioxidants and polyphenols.

The new therapeutic diet menu with high energy/high protein for hypertension, low sodium and T2DM is provided below:

Standards of Therapeutic diet includes:

• Identify the patients who need Therapeutic Diet.
• Therapeutic diet must be integrated with the standard menu.
• At least 10% of diet must need special foods (SFSKPI).
• Quality and taste/acceptability must not be compromised because of the integration of therapeutic diets. For instance, reduced fat and less salt.

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 Fresh Fruit Bread Margarine	3x50g 100g 125g 1 slice 1x5g
Supper	Milk Sweet biscuits	150 ml 2 Biscuits

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

From the kitchen system audit analysis the following are determined:

• Serving timings, labour management, equipment management, food resources and service management needs modification.
• Lacks staff, plating and distribution management, for easily managing 125 residents.
• QH-nutrition standards are not present.
• Process work flow lacks space, coordination, time management for tasks like washing schedule and so on.
• The cooking area in the kitchen is centralized, it increased the obstacle of space and smooth process flow.
• The premises don’t have local building standards and food safety standards.
• Staff for Arabic language interpretation is required, for easily serving the menu.

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.

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.

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.

Population Target to Increase Nutritional Intake

 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):

• Include dental check-up, because diabetes patients tend to have gum disease.
• Ensure hearing test.
• Necessity of Therapeutic diet for residents based on hypertension, diabetes and age HE/HP and low sodium are suggested.
• Due to high risks of complications from flu, ensure to provide vaccine for both the new and old residents.
• Ensure to regularly check Blood Pressure and Cholesterol Levels.
• Religiously take diabetes medication.
• Ensure to test the glucose levels, because the diabetes patients tend to have the symptoms of hypoglycemia which includes dizziness, confusion, sweating and hunger.
• Eat healthy diet and avoid salt, oil and sugar content.
• Provide exercise sessions to manage their weight and to stay active (“15 Exercise Tips for People With Type 2 Diabetes”, 2015).
• At times insulin injections are required to help the residents.

The rural location is the main issues that is encountered. The limitations of the new facility in the rural area are listed below:

1. The rural area increases difficulties for developing a new kitchen.
2. Issues to develop a new menu.
3. It includes issues for emergency procedure.
4. Safety issues
5. Food delivery issues.
6. It is difficult to have good coordination between the old and new residents, due to cultural differences.
7. It is difficult for the new residents to adapt to the Australian food eating culture.
8. The facility has to add many checkup monitoring facilities, to ensure both mental and physical health of the residents.
9. It is difficult for the new residents to adjust to the new dietary control.

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):

• Check the pattern in weather.
• Don’t go near creeks, drains and rivers, instead move to high ground level.
• Check warnings from Meteorology bureau, and take immediate actions based on the severe storms or cyclones warnings, because it leads to flooding.
• Activate the emergency plan and keep the emergency kit always ready.
• The follow the evacuation plan.

1. The emergency kit, must have warm clothes, mobile phone, required medicine, important documents, mementos and photos in a waterproof bag.
2. Turn off gas, electricity power and water taps.
3. Make use of fridge, furniture, tables and bed to raise from the ground level.
4. Make sure to empty the refrigerators and freezers. Then, keep its doors open.
5. The indoor drains like toilet bowl and bathroom must be blocked with sandbag, for preventing the backflow of sewage.
6. Take steps to lock the doors of your houses, before proceeding with the evacuation routes suggested for the area.
7. Avoid walking on floodwater, because it is very dangerous to step into the floodwater.

The following are the recommendations to meet the unique requirements of the new residents (Hess-Fischl MS, 2015):

1. Facilitate dental check-up, hearing test, vaccination, regular Blood Pressure and Cholesterol Levels check-up.
2. Monitor diabetes medication of the new residents.
3. Develop exercise programs to control their weight.
4. It is suggested to check the glucose levels of the new residents to overcome the symptoms of dizziness, hunger and so on.
5. It is mandatory to avoid more salt, oil and sugar content in their diet.
6. Decentralised production and distribution system with hot plating is suggested.
7. 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):

1. Daily implement 35-40 minutes of fast walking.
2. Eat between time intervals.
3. Completely stay away from oily food.
4. In meals, increase more fiber foods.
5. Eat slowly and not fast.
6. The calorific requirement for the residents with normal weight must have 1400 to 1800 kcal.
7. Nearly 180 grams of carbohydrate must be consumed daily.
8. Approximately from 60 to 110 grams of protein must be included in the daily diet. 
9. Implement 50 to 150 grams of fat intake, daily in the diet.

The following recommendation are for disaster and emergency management:

1. For Disaster management it is recommended to include maps and directions that help the staff and people to evacuate.
2. 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.

• 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

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