Nursing Home Dietary Safety Questionnaire

Dear participant,

We are conducting a study to improve understanding and application of dietary practices in nursing homes. Your feedback is critically important in informing our improvements. Please take a few moments to complete this questionnaire which is specifically designed to evaluate dietary safety measures in a nursing home.

Instructions: Please answer the following questions to the best of your knowledge and ability. Ensure that all questions are answered before submitting the questionnaire.

Facility Information

Nursing Home Name:
Location:
Contact Person:
Contact Email:
Contact Phone:

Food Safety Practices

1. Food Storage

• Refrigerators are maintained at a temperature of 40°F (4°C) or below.

• Freezers are maintained at a temperature of 0°F (-18°C) or below.

• Perishable items are properly rotated, with older items used first.

• Raw meats are stored separately from ready-to-eat foods.

• Proper storage containers are used to prevent cross-contamination.

2. Food Handling

• Staff members wash their hands with soap and water before handling food.

• Disposable gloves are worn when handling ready-to-eat foods.

• Food preparation surfaces are cleaned and sanitized regularly.

• Cutting boards and utensils are sanitized between uses.

• Staff members are trained on proper handwashing and food handling procedures.

3. Food Preparation

• Foods are cooked to the recommended internal temperatures (e.g., poultry to 165°F).

• Cross-contamination between raw and cooked foods is prevented.

• Leftovers are properly labeled with date and contents and discarded after the recommended time.

• Food waste is disposed of in a sanitary manner.

Menu Planning and Nutritional Adequacy

1. Variety and Balance

• Menus offer a variety of options for each meal.

• Special dietary needs and preferences are accommodated.

• Vegetarian, vegan, and other specialized diets are available upon request.

• Menus are reviewed regularly for nutritional adequacy and variety.

2. Nutritional Content

• Meals provide appropriate portions to meet residents' nutritional needs.

• Calorie and nutrient content of meals are monitored and documented.

• Dietary supplements are provided as prescribed by healthcare professionals.

Special Dietary Needs

1. Management of Medical Conditions

• Individual dietary plans are developed for residents with medical conditions.

• Staff members are trained on dietary requirements for residents with diabetes, allergies, dysphagia, etc.

• Special diets are implemented according to physician orders.

2. Dietary Assistance

• Staff members are trained in feeding techniques for residents who require assistance.

• Adaptive equipment and utensils are provided as needed for residents with mobility or cognitive impairments.

Meal Service and Dining Environment

1. Mealtime Assistance

• Adequate staff-to-resident ratio is maintained during meal service.

• Residents who need assistance with eating receive prompt and respectful support.

• Staff members are trained to provide assistance with dignity and respect.

2. Dining Environment

• Dining areas are clean, comfortable, and accessible for residents.

• Residents have opportunities for social interaction during meals.

• Special accommodations are made for residents with mobility impairments.

Staff Training and Education

Training Requirements

• New staff members receive orientation on food safety and dietary guidelines.

• Ongoing education is provided to staff on dietary requirements and mealtime assistance.

• Staff competency is assessed regularly through training and evaluations.

Resident Satisfaction and Feedback

Feedback Mechanisms

• Residents have opportunities to provide feedback on food preferences and satisfaction.

• Surveys or interviews are conducted to gather resident input on dining experiences.

• Resident feedback is used to make improvements to dietary services.

Documentation and Recordkeeping

Maintenance of Records

• Menus, recipes, and food production records are documented and maintained.

• Special dietary needs and mealtime assistance provided to residents are recorded.

• Records are kept confidential and accessible only to authorized personnel.

Quality Improvement and Compliance

Addressing Deficiencies

• Deficiencies identified through inspections or resident feedback are addressed promptly.

• Corrective action plans are implemented to improve dietary safety and quality.

• Continuous quality improvement initiatives are in place to monitor and enhance dietary services.

Thank you for completing the Nursing Home Dietary Safety Questionnaire. Your cooperation in ensuring the safety and quality of dietary services is greatly appreciated.

Nursing Home Templates @ Template.net