1. Keep Off The Dietary Hot Plate
Donna M. Manring
Innovative Dining Solutions
Nothing stops an organization faster than people who believe that the way you worked yesterday is the
best way to work tomorrow. Jon Madonna
Leadership would be easy if we didn’t have to deal with people!
What is Leadership
Leadership is a process by which a person influences others to accomplish an objective and directs the
organization in a way that makes it more cohesive and coherent.
Human Conflicts in Leadership
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Inconsistency
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Dishonesty
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Inflexible
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Afraid to make decision
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Poor communicator
Human Conflicts in Leadership
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Self-centered
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Lack of trust
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Unrealistic expectations
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Doesn’t share recognition
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Refuses to admit errors
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Doesn’t listen
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Lacks enthusiasm
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Lacks respect for others
Change Agents
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You are the change agents.

People don’t want to hear cheerleading or corporate hype.
Resistance to Change 80% Are Resistant to Change.
Change creates a natural disconnect.

When addressing change; keep the conversation in the room not outside in the halls.

Give a positive, upbeat speech and then ask if there are any questions.

No one responds “in the room”. That’s where the negativity and fear is.
Change Template for Leaders
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Stress the urgency.
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Why do you have to make the changes;
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Loss of customers
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Decreased satisfaction
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Address concerns and fears.
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Present the challenges at the beginning not just the advantages.
Donna M. Manring
Innovative Dining Solutions
608.225.0126
Page 1

2. Concerns and Values


Talking about the most perceived concerns will help alleviate the problems.
Talk about what is not going to change to preserve the value.
Fierce Conversations

Failed or missed conversations.

The challenge with leaders is not having conversations to build relationships.
What Did They Say
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Listen to learn.
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Let silence do the heavy lifting.

Jim Sorenson
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Hearing is a courtesy.

Listening is a compliment.
Key Steps in Problem Solving

Identify the issue

Clarify the issue

Determine current impact

Determine future implications

Examine personal contribution to the issue

Describe the ideal outcome

Commit to action
Communication

Listen before reacting

Create communication systems and tools
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Use open ended questions
Communication and Training-Appreciative Leadership

Focus on the behaviors you want more of, be specific

Focus on the results

Shift your thinking to appreciate what is going right
New Ideas

Welcome new ideas.

Abolish the “this won’t work way of thinking.”

Can’t be done

This is stupid

Listen and process new ideas.
Forward thinking

We did it this way for years
Job Well Done

We all seek affirmation of a job well done.

Thank staff or employees for progress.

Verbal rewards are cheap and go far.

Keep the positive attitude cycle going.
Donna M. Manring
Innovative Dining Solutions
608.225.0126
Page 2

3. Positive Work Environment

Eliminate negativity from the workplace.

Establish the “no dumping policy”.

Sharpen your positive way of thinking.

Positive energy is contagious.

Provide consistent coaching on keeping it positive.
Recipe for Leadership

3 parts communication

1 part motivation

10 drops of honesty

Healthy Dash of humor

Immeasurable care

Pinch of creativity

Dollop of enthusiasm
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Top with commitment

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Mix all ingredients
Serve regularly
Time, Money and Budgets

Serving meals that look and taste good does not have to break the budget.

There are many simple changes and additions that can improve the look of foods.
Communication

Communicate your dining vision to everyone including residents and families.

Develop teams that include all levels of management, departments, residents and family.

Develop systems in communicating to keep care plans updated.

Communicate your dining vision to everyone including residents and families

Develop teams that include all levels of management, departments, residents and family.

Develop systems in communicating to keep care plans updated.
Plating Tips

If the old adage "you eat with your eyes" is true, then the manner in which we present food is of
paramount importance.

There are many factors and techniques to consider in food plating that affect the overall
customer experience.

When plating food attractively, it's important to remember the actual plate is critical to the final
presentation.
Keys to Food Presentation

Use different textures.

Match flavors-garnish with meal ingredients when possible.

Sauces should complement not cover.

Pay attention to scale-this applies to the plate arrangement as well as garnishes.

Do not overdo it.
Donna M. Manring
Innovative Dining Solutions
608.225.0126
Page 3

4. Ice Cream - Yogurt

Since ice cream goes with almost anything, keep your eyes peeled for possible toppings (or
yogurt/soft serve mix-ins).

Crumbled cookies
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Chopped fruit
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Cereal

Granola
Plating Tips

Piping foods onto plates

Ready cuts

Doilies under bowls or plates

Garnishes

Clean edges

Syrups or sauces
Comfort Memories

Mini ice cream parlors

Bistro setting

Café
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Deli
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Family style

Happy hour
Community Chef Events

Solicit chefs in your area to come and give you some ideas on food preparation.

Recruit hospitality experts.

Involve your food purveyors to do food demo’s.

Cruise ship dining.
Color Considerations

Always consider color as an important part of plate presentation.

Always try to have a variety of colors on the plate.

People respond to certain colors more favorably than others.
Color is Important With Vegetables

Blanching and refreshing green vegetables ensures they are fresh and vibrant when served

Always complement green vegetables with other colored vegetables such as carrots, sweet
peppers and beets

Avoid clustering vegetables and arrange them more naturally around the plate to increase the
contrast in colors
Eight Keys to Food Presentation
Use complementary colors-avoid too much of the same color.

Arrange the food in interesting manner.

Use interesting shapes and garnishes-consider different shape options for each food.

Use different cuts and shapes of vegetables to add visual interest
Donna M. Manring
Innovative Dining Solutions
608.225.0126
Page 4

5. Food presentation: Make Meals Look Festive and Inviting

Colorful meals: Using small amounts of contrasting colors, pleases our eyes.

Add some bright green herbs or some yellow frozen corn to a dish of black beans or lentils and
save some to sprinkle on top for a garnish.

Cut some orange carrots and red tomatoes or peppers on a dark green leafy salad.
To Enhance Flavor:
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Lemon juice on grilled fish
Sesame oil, low-sodium soy sauce on
vegetables
Low-sodium chicken broth in rice
Peppermint slivers on fruit salad
Fresh berries on cereal with strawberries
Kick Up the Flavor
Try marinating or adding extra sauces or seasonings while cooking. These may add a little
"spice" to the food and enhance the flavor.
Using tart foods such as sherbet, orange juice, lemonade, relishes, vinegar and lemon juice as
seasonings may help intensify flavor
Marinades
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Barbecue Sauce
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Meat Marinade
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Beer

Mustard Catsup
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Soy Sauce
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Extracts and other flavorings
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Sweet & Sour Sauce
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Fruit
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Sweet Fruit Juice Herbs & Spices Sweet Wines

Italian Dressing
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Teriyaki Sauce
Mix and Match
Spicing up meals can be as easy as adding salsa to cooked meat.

For the "Mix and Match" theme, try adding salsa to cooked beef or chicken. Toss lightly to coat.

Then serve the meat with tortillas or taco shells. You have an instant Mexican meal.

For extra flair, serve a salad on the side.
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Cooking Tips
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Add low-sodium, no-salt stock to a sauce to make it taste like it has been simmering all day.

Cook rice in chicken or vegetable stock rather than water, and replace cream with stock when
making mashed potatoes for a flavorful, low-fat alternative.

Spice Up Your Menu
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Fresh herbs brighten the flavor of salads, dressing and sauces.

Add chopped basil to tomato soup.

Add parsley and thyme to chicken soup.

Loaded mashed potatoes.
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Grilled cheese with tomatoes, or a variety of cheeses.

Add veggies to macaroni and cheese
Donna M. Manring
Innovative Dining Solutions
608.225.0126
Page 5

6. Centers for Disease Control & Prevention
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The Centers for Disease Control and Prevention (CDC) estimates;
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Each year roughly 1 in 6 Americans (or 48 million people) gets sick from foodborne illness.

Of these, approximately 128,000 are hospitalized, and 3,000 die of foodborne diseases

These estimates, most recently updated by the CDC in 2011
Elderly at Greater Risk

The CDC Foodborne Disease Active Surveillance Network states that the deaths “from foodborne
illness among nursing home residents are 10 to 100 times greater than for the general population

The CDC Foodborne Disease Active Surveillance Network states that the deaths “from foodborne
illness among nursing home residents are 10 to 100 times greater than for the general population
Norovirus Striking Nursing Home Residents Nationwide

According to a spokeswoman for the U.S. Centers for Disease Control and Prevention (CDC), “It
appears that there is an upswing.”

The virus is highly contagious and can be transmitted through close contact with infected people
or by eating contaminated food.

Hand washing and good sanitation are recommended to prevent the virus from spreading.
Growing Senior Population

As the senior population grows, those who reside in residential care facilities will increase,
resulting in a greater numbers of seniors at risk for foodborne illness.

The person who manages the foodservice plays a vital role in protecting the residents in their
care from foodborne illness.
Sanitation Citations

In a study released in 2011 by the University of California, San Francisco, nearly 40 percent of
nursing homes had deficiencies in Food Safety and Sanitation (F 371) in 2009.8

Foodborne illness in the population we serve is a very important issue to address.
The Perfect Storm

Presence of a pathogen (bacteria, viruses, or parasites) in the food

Food to carry the pathogen

Conditions that allow the pathogen to survive, multiply, and produce a toxin

High-risk person who eats enough of the pathogen or its toxins to cause illness
Decreased Immunity

Our immune systems experience gradual changes as we grow older.

Those changes include a slower immune response and decreased immunity against pathogens.
Our gastrointestinal tract becomes more easily inflamed as we age.

As a result, we become more susceptible to a variety of foodborne illnesses, particularly such
pathogens as Salmonella and norovirus.
Increased Risk Factors

The elderly often have;

Chronic disease

A slower digestive process, reduced sense of taste and smell

Decreased effectiveness of antibiotics
Donna M. Manring
Innovative Dining Solutions
608.225.0126
Page 6

7. Complications from Foodborne Illness
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The elderly are more likely to contract and die from infectious disease than other groups.

Often it isn’t the disease itself that causes death, but the symptoms or other effects of the illness.

According to the CDC, people over 74 years of age are five times more likely to die from infectious
diarrheal disease than in the next highest group (children under four years of age). They are also 15
times more likely to die than younger adults
Foodborne Roulette
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
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Approximately one of four Americans may experience some form of foodborne illnesses each
year, according to Centers for Disease Control and Prevention
Challenges in Monitoring Illness
Public health challenges in monitoring foodborne illness include a rising number of multistate
foodborne outbreaks and new types of contaminated foods.
Many individual cases of acute gastroenteritis are not reported
Norwalk-like virus Outbreaks, 1997 – 2000

Factors for Increased Illness

Including the facts that many seniors are on antibiotics that kill beneficial bacteria

Long-term care facilities are confined environments where pathogens can spread easily.
Who Comes in Contact with Food

A food handler is anyone that comes in contact with the food in any part of their duties. Every
food handler has the obligation to avoid contamination of food;
________________________________
________________________________
________________________________
________________________________
Do Employees Have a Responsibility to Prevent Foodborne Illness?

Yes, food employees share the responsibility with management for preventing foodborne illness and
are required to know:

The relationship between their job responsibilities and the potential risks of foodborne illness;

How employee health is related to foodborne illness;

The need to immediately report symptoms of vomiting, diarrhea, jaundice, sore throat with fever.
Food Poisoning

Food poisoning is a general term for health problems arising from eating contaminated food.

Food may be contaminated by bacteria, viruses, environmental toxins, or toxins present within the
food itself, such as the poisons in some mushrooms.

Symptoms of food poisoning usually involve the prompt onset of vomiting and diarrhea. Some toxins
also affect the nervous system.
Spreading Germs

Cooked foods can also be contaminated after cooking by bacteria carried by food handlers or
from bacteria in the environment.

It is estimated that 50% of healthy people have the bacterium Staphylococcus aureus in their
nasal passages and throat, as well as on their skin and hair.
Donna M. Manring
Innovative Dining Solutions
608.225.0126
Page 7

8. Ways Food Can Become Contaminated
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Poor Personal Hygiene
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Leading cause of foodborne illnesses
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Improper handwashing
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Dirty work clothes
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Temperature and Time Abuse

No more than four hours in the danger zone

Cleaning and Sanitizing
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Commonly Missed Areas
Survival 101

Stay in shape. Inspectors and surveyors are trained to focus less on what you are doing the day
they walk in…and much more about what you do every day.

As a manager, you already understand that food safety is a commitment every hour of every day.
But do your employees know that, too?
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You can be sure inspectors will look for evidence of routine food safety management;
—documentation up-to-date
Policies and procedures
Temperature logs
Infection control records
In-service training rosters
Equipment maintenance records.
Train and Coach Staff

If someone on your team doesn’t know the answers, you can bet they are not carrying out the
practices either.

One routine you can implement is asking questions of employees, just as inspectors often do.

Training, of course, is more than acquisition of knowledge. Its real goal is behavior.
Map Out the Flow of Food

Because all food is potentially hazardous, it is important to establish a food safety program that
prevents, eliminates, or reduces the risk of food contamination at each point in the flow of food.

The flow of food is the route food takes from the time it arrives at the facility until it
reaches its final destination as part of a meal or snack.
Steps in the flow of food for in-house production

Purchasing

� Receiving

� Storing

� Preparing

� Cooking

� Holding and Serving
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� Cooling

� Reheating

Passing
Donna M. Manring
Innovative Dining Solutions
608.225.0126
Page 8

9. Homework

Identify and write standard food handling practices for each point in the flow of food.

Keep Up to Date

Read your state agency’s newsletter and/or agency meeting minutes, many of which are posted
online.

State agencies sometimes issue meeting minutes and/or memos clarifying interpretations of
highrisk practices, such as dishwashing sanitation, refrigeration temperatures, and handling of
hazardous food products. (Try searching your state name plus “department of aging”.)

You can also check the Nursing Home Compare website (www.medicare.gov/NHCompare) to
see what health issues have been cited recently in your area.
Sample Questions

When do you need to change your gloves?

What temperature should the baked fish be before it goes to the buffet?

What is the procedure for thawing frozen chicken?

Try writing these on colorful 3 X 5 cards and have each work team pick a card from a hat every day.

Let them practice answering questions and coach each other with the help of a qualified supervisor.
It’s a fun way to reinforce knowledge while preparing everyone for real interviews
Active Learning

Learning is not a spectator sport.

The more actively engaged the learner is, the more learning takes place.

Different instructional methodologies have greater rates of retention.
Increase Learning By
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Quiz

Games
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Role-playing
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Brainstorming
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Group problem-solving
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Lecture
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Simulation
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Case Study
Training Employees is a Forever Job.

Typically employees most likely handle food at work the same way they do at home.

Some employees do not bring safe food handling practices to the job, and habits are hard to
change.

Cross Contamination

From hands to unclean surfaces is one of the leading contributing causes of the spread of
pathogenic organisms

Eliminate bare hand contact with RTF

Proper hand washing

Hand sanitizers do not take the place of hand washing in the kitchen with food preparation
Training Employees is a Forever Job

Centers using employees to work in more than one area (for example, personal care and food
service) must train these individuals on safe food handling practices to prevent cross-contamination
of foods.
Donna M. Manring
Innovative Dining Solutions
608.225.0126
Page 9

10. Tips To Increase Food Safety

Ensure food safety starts at menu planning.

What PHF foods do you serve?

What PHF foods will you be serving in the future?

What are the risks in your facility?

Is everyone in your facility trained on risks?

Talk to high-risk patients about food safety.
Together We Keep Foods Safe

Despite the focus on that short and stressful timeframe when inspection teams enter your
operation’s doors, the reality is that food protection requires daily, concerted effort.

With commitment and leadership, you and your entire team can be ready to survive any day of
the year!
Interview-Survey

During the course of the survey, interview the staff who performs the task about the procedures
they follow to procure, store, prepare, distribute, and serve food to residents.

• 42 CFR 483.35(b), F362, Standard Sufficient Staff to Determine if the facility employs sufficient
support personnel competent to carry out the functions of the dietary service.
Survey Observations

Provision of meals that are not consistent in quality (such as color and texture of vegetables or
meats, the preparation and presentation of mechanically altered foods.

Determine if each resident is provided with nourishing, palatable, attractive meals that meet the
resident’s daily nutritional and special dietary needs.
Survey Objectives

To determine if the dining experience enhances the resident’s quality of life and is supportive of
the resident’s needs, including food service and staff support during dining.

General observations of the dining service/dining room.
Dining Room/Meal Times

During the meal service, observe the dining room and/or resident’s room for the following:

Comfortable sound levels

Observe for institutional medication pass practices that interfere with the quality of the residents’
dining experience.
Is Your Facility Ready For Survey

Ask yourself if you have systems in place to protect your residents & your facility?

What can you do to improve?

There is not a better time to be in our field. Make the survey process work for you.
Train and Coach Staff

Look for evidence.

If you continuously train and coach your work team, your operation will be in a stronger position to
survive inspections.

If someone on your team doesn’t know the answers, you can bet they are not carrying out the
practices either.

One routine you can implement is asking questions of employees, just as inspectors often do.
Donna M. Manring
Innovative Dining Solutions
608.225.0126
Page 10

11. Major Food Safety Subject Areas

Personnel

Food

Equipment, facilities, related supplies

Compliance & enforcement

5 Identified Major Risk Factors

Poor personal hygiene

Improper holding temperatures

Inadequate cooking:

Such as undercooking raw shell eggs

Contaminated equipment

Food from unsafe sources
Take a Breath & Apply Common Sense

While an inspector or surveyor is on site, it’s easy to overlook the obvious.

Keep tabs on the team, and correct any concerns on the spot as possible.

Always have your thermometer and your food safety records ready.
Conduct Mock Audits

A mock audit is the perfect routine for keeping your operation in shape day in and day out.

Involve your team, rotating who plays the role of “inspector”.

This builds familiarity and buy-in from the team.

Audit forms should reflect the guidance you are accountable for.
Have fun With Practice Interviews

Create interview questions for associates.

When do you need to change your gloves?

What temperature should the baked fish be before it goes to the buffet?

What is the procedure for thawing frozen chicken?

Try writing these on colorful 3 X 5 cards and have each work team pick a card from a hat every
day.
Dietary Out of the Kitchen

The people who were always on the serving line, always making up trays, now get into the dining
room and actually meet people

Many homes have brought the kitchen staff out of the kitchen, with many stories of relationships
forming and staff members realizing things like, “Why would we serve that to Mary? She doesn’t
like it; never has.”
Mission or Vision

Creating Team Vision

Propose possible visions to get people going and have the team build on the vision.

After you have decided on a vision print it and post it. Make sure everyone sees it every day.
The more they see it the more they will absorb it.
Donna M. Manring
Innovative Dining Solutions
608.225.0126
Page 11

12. Department Vision

Does the department “get it”?

Is this a mission people can buy into? The team as to be on board for the mission to work.
Establishing a Management Mission
Your management mission statement will need to provide the team with:
1. Support
2. Fair leadership
3. Training with day to day coaching
4. Goals for the future
Teams as Partners

Your team members are your partners in business, challenges and successes.

Team members should have a clear understanding of how the financial statement works.

Teams need to clearly understand profit and loss.

Motivation & Empowerment

People have to have a reason for what they do. We can impact the reason.

Treat team members as you do your boss. Eliminate or limit the term employee.
Determine the Motivators for Your Team:

Money

Status

Just because I have to
Get In Touch

If staff or residents have an attitude, what is the attitude really about

Go beyond the anger or hostility

Think with your head and your HEART

Find the connection
Inspire and Transform

People must be inspired to change before a transformation can take place

Key factor=making the connection

Identify what the client/staff triggers are to initiate the transformation
Building Great Teams

Recruit and hire team players that share your vision.

Train and develop, coach and support the team.

People who feel good about the job they are doing are productive and creative.

Provide career development.
Anyone Can Coach

Develop a team of coaches.

Everyone can be accountable for outcomes.

Coaching identifies problems and discovers solutions.
Donna M. Manring
Innovative Dining Solutions
608.225.0126
Page 12

13. Benefits Of Humor

Humor reduces stress.

Increases productivity.

Humor eases tension.

Relieves boredom.

Breaks up the negative cycle.

Profits increase.

Keep energy high and create fun ways to get the job done.
Successful Leaders

Try to hire potential successful leaders

Train your team to think like leaders

Learn to delegate
Teach By Example

To be a leader you have to inspire, not control and then allow transformation.

Leaders constantly “coach” and fuel the process.

Attitude and actions are contagious.

Never set a rule that you yourself are not willing to follow.
Leaders on all Levels

Leadership can be anyone that impacts others.

Successful leaders develop other leaders on every level.

Performance coaching and leading results in successful teams.
WIFM

Try to use beneficial language that highlights the benefits to the individual while remaining
realistic.

Throughout, ask the other person for their input into the task and objectives. The sooner that you
empower the person in the shared responsibility of the task the more likely their motivation will
increase

IKT or IDC
New Ideas

Welcome new ideas.

Abolish this won’t work way of thinking.

Can’t be done

This is stupid

Listen and process new ideas.

Forward thinking

We did it this way for years
Good Job

Thank you with continual affirmation for a job well done is an integral part of keeping the
momentum going.

The ability to retain a good team could very well be one of your most important skills as a
manager. Keeping team members satisfied will keep them from looking at other opportunities
elsewhere.
Donna M. Manring
Innovative Dining Solutions
608.225.0126
Page 13

14. Did They Hear What I Said

Everyone has a perception of what they thought they heard.

Communication is the number one tool in problem solving and having an aligned culture

Keep the lines of communication open.
Positive Work Environment

Eliminate negativity from the workplace.

Establish the “no dumping policy”.

Sharpen your positive way of thinking.

Positive energy is contagious.
Leadership Deals With

Change

Inspiration

Motivation

Influence

Allows for transformation
SMART Goals

Specific

Measurable

Action Steps

Realistic

Timely
Mean What You Say

Authentic

Sincere

Speak forthrightly

Honest
Donna M. Manring
Innovative Dining Solutions
608.225.0126
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