Janna NeitzelSage Dietetic InternFood Service ManagementSpring 2014Menu Project

1. The food preferences of residents at Baptist Health Nursing and Rehab Center reflect comfort foods are widely accepted and serve as the focal point for the 8-week rotating menu. Foods such as liver are often served and the larger meal of the day is served at lunch, whereas dinner is typically comprised of soup and sandwiches. Survey results varied greatly, as two vastly different populations were used to collect data on the current acceptability of the menu utilized at Baptist. While the food preferences and dietary needs of residents differs from that of staff, there are additional outside considerations that could be taken into account when assessing the current menu and whether it meets the needs of the facility as a whole. Overall ideas for improvement of the menu to better meet the facility’s needs include offering a meat-free option at all meals, increasing fruits and vegetables offered and incorporated into meals, decreased total fat content, and offering caloric content that is in line with the current Dietary Guidelines for Older Adults.

Resident survey results reflect a wide variety of opinions regarding meals, meal service, and ideas for improvement. Some similar complaints included food temperature not being enjoyable, limited variety of meal options, undesirable appearance of the meal/tray, and the time it took for meals to arrive often being lengthy. While the current 8-week cycle menu has been in place for over a year, residents are still uncertain of foods that are offered frequently. They ask what certain foods are that they see on their tray and how it is meant to be consumed as an element of the meal. One example of this situation occurred when “Under the Sea Salad” was offered with a pineapple glaze/sauce, the glaze of which was meant to go with the ham steak that was being served as the main entrée. Meal presentation included the sauce in a mini cup along side the ham and residents were unsure how it was meant to be consumed. Many ended up trying to eat it solo and disliked the food item on its own; complaints resulted. The menu currently in place is clearly out-dated and was never well-liked or well-received upon placement of the 8-week cycle.

a) Waste is produced as a result of foods that are not consumed due to dislike, foods not consumed due to poor execution of meal/customer service, overproduction of food, poor control of food rotation to prevent spoilage, incorrect estimation of usage, and incorrect ordering of product. Accurate forecasting, frequency of inventory assessment, and proper ordering of product can help minimize waste of resources and utilization of product prevents unwanted turnover and waste. This precision of tracking resources makes sure that allocation of funds and budgeting needs are met, as well as prevention of waste having a negative environmental impact.

Another source of waste stems from packaging and other disposable goods, such as utensils. Use of disposable paper and plastic dining ware creates waste and deters from the attractive appearance of the tray as a whole. A proposed change in overall meal service would be to utilize more china ware and less Styrofoam cups, paper pates, etc.

These dining tools make meals more enjoyable overall, as they ease consumption of food (solid mugs/glasses are more stable than tippy Styrofoam cups) and improve the overall presentation of meals.

b) After analyzing the current 8-week cycle menu, a multitude of findings present themselves. The current menu lacks a meat-free/vegetarian alternative 5 out of 7 days, on average. Additionally, the current menu is extremely high in fat, primarily of the saturated type, which is of high concern for the elderly population in particular. The justification for the current menu is outdated and does not follow the dietary guidelines at this time. The menu in place at Baptist at this time was originally designed to maximize nutrient intake, incorporating mostly high-fat and high-calorie food items in order to get adequate nutrition into older adults who find it difficult to eat adequate amounts of food. However, this nutritional approach does not apply to the population of the facility as a whole and fails to meet the total well-being and health goals of a medical practice. A set menu should be designed to be a basic outline of meals that meet majority of dietary needs and is flexible to adjustment based on individualized needs, likes, and dislikes, honoring preferences to provide satisfaction. Additional diets should be available to meet particular health conditions and food preferences. The menu designed for this project addresses these needs and meets the most current evidence-based dietary guidelines for the population at Baptist Health.

2. The current nutrition/dietary guidelines followed by the facility and which the menu refers to are open to interpretation, as there are not strict confines and requirements outlined. The general description in the out-dated facility dietary guidelines states that reference to the 2010 Dietary Guidelines is to be made and the menu is to be ultimately determined by the Registered Dietitian(s) who are responsible to oversee whether the foods/meals provided meet the nutritional needs of residents. The guidelines used at Baptist state that the focus is on “promoting health and reducing risk for major chronic diseases.” Additionally, they take into account “concerns for good health to include diet-related health problems of overweight and obesity, hypertension, abnormal blood lipids, diabetes, renal disease, coronary heart disease, gastrointestinal disorders, certain types of cancer, and osteoporosis.” They advise selection of a nutritious diet include consumption of a variety of foods within and among the basic food groups while staying within energy needs. Emphasis on increasing daily intake of fruits and vegetables, whole grains, and nonfat or low-fat milk and milk products is made as well. The Guidelines advises wise selection for healthy fats for good health and preparing/selecting foods with little salt.

Closer analysis of the nutrient content of the current menu reflects over-provision of energy and fat on a daily basis (though there is a slight range in nutrient content). A nutrient analysis of the current menu reflects that meals served at Baptist Health on a regular diet provide 2250-2700cal, 95-135g fat, 3,000-5,060mg Na. Saturated fat and fiber content of the current menu is not tracked. Additionally, the tracking system used to analyze nutrient content of the foods on the menu is unknown. Food items are listed on hand-written documentation and the source is not cited. Through further analysis of listed foods, it appears many items listed are comprised of underestimated amounts of calories, fat, etc. (The diet techs and RD agree foods are usually underestimated). Additionally, the recipes which the menu is based off of are frequently not followed by majority of the

chefs at the facility (as reported by management and staff in the dietary services). As a result, nutrient content of meals provided to the residents is extremely variable.

The Food Guide from which the menu is based off of for this facility outlines each of the main food groups as they pertain to menu design and dietary intake. The grain group is to be included in menu design and the diet supplied should include a variety of grains, with the goal of at least half of the servings per day being whole grains. For the vegetable group, colorful varieties of vegetables should be offered through the menu, especially dark green and orange. Vegetables rich in vitamins, minerals, and fiber are usually lacking in the typical American diet and should be emphasized in the diet supplied through the rotational menu. In order to increase fiber, the Food Guide suggests serving raw vegetables often when chewing permits. If vegetables are not a popular item, the Food Guide offers possible alternative, which include soups containing significant amounts of vegetables and the liquids in which the vegetables were cooked. It continues, suggesting that vegetables can be pureed to make a “cream soup” and shredded or minced vegetables may be added to gelatin salads, casseroles, and meat loaf.

For the fruit group, the Food Guide advises that fresh, frozen, canned or dried fruit be selected over juice when possible. It adds that prune juice, while it’s a popular breakfast item, is not a good source of vitamin C unless it is vitamin C-fortified, thus the menu should include another rich source of vitamin C. As advised by the Food Guide, extra portions of potassium-rich fruits should be included daily for those individuals receiving potassium-wasting diuretics. It states that bananas and orange juice are high in potassium, accepted by most individuals and permitted on most diets.

As for the milk group, which includes yogurt and cheese, the Food Guide states milk may be consumed as a beverage or in foods and low-fat or fat-free milk, yogurt and other milk products should be encouraged. (This guideline is not adhered to per the current rotational menu.) To increase calcium and protein intake, the Food Guide recommends using non-fat dry milk in cooking. When fluid milk is refused, the Food Guide advises alternatives include cream soups and casserole made with milk and/or cheese, and milk-based puddings. It goes on to state that non-fat dry milk may be added to hot cereals and other dishes before cooking. Other recommendations include offering calcium-fortified fruit juices, offering lactose-free milk for residents who are lactose intolerant, and that the calcium needs of lactose intolerant individuals be closely monitored. Additional calcium and vitamin D supplementation is recommended for individuals with these special cases. Calcium and vitamin D-fortified soy or almond milk can contribute to calcium intake but the Food Guide also states almond and rice milk lack the protein of milk and soy milk.

The meat and beans group includes poultry, fish, dry beans, eggs, and nuts and the Food Guide recommends protein sources be of the lean variety. Fish and poultry are to be emphasized, as they are lower in fat and cooking methods should most often include baking, broiling, braising, or grilling. The menu should provide a wide variety of protein sources.

Fats, oils, sugar and salt (the last group outlined in the Food Guide) are to be used sparingly and the nutrition facts label is to be referenced, in order to keep saturated fats, trans-fats and sodium low. (The facility currently uses trans fats through cooking/preparation methods, which is against Morrison policy. This method is to be eradicated immediately.) The use of mono and poly unsaturated oils (such as olive,

canola and safflower oils) is preferred and advised. Use of hydrogenated fats is to be limited and ingredient lists should be read closely when ordering and using products. Foods and beverages low in added sugars are to be selected for menu inclusion, as added sugars contribute calories with no nutrients. The Food Guide concludes with the statement “Number of servings from each group depends upon individual nutritional needs,” thus reaffirming that the Registered Dietitian should be overseeing that the meals provided to each resident meet their estimated nutritional needs.

A liberalized geriatric diet is emphasized in the Dietary Guidelines for Baptist’s facility. This approach is evidence-based and aims to increase overall quality of life, as less restrictive diets enhance nutritional status and thus QOL of older adults residing in health care communities. Additionally, research on this age group proves that a well balanced is a key factor in maintaining good health. Nutritional status is a complex issue, as food is not nutritional unless it is consumed, thus liberalization of a geriatric diet can promote both quality of life and quality of care.

The Dietary Guidelines lists some frequently prescribed specialized diets such as No Added Salt and Sodium-restricted, as well as consistency modifications that can be ordered. These diet specifications can be individualized by the Registered Dietitian, in conjunction with coordination of care, including recommendations from the physician and the speech pathologist.

Lastly, the Dietary Guidelines gives usual portion sizes for food group items. It also lists modifications for smaller and larger portions which may be included for individualized diet orders. The Dietary Guidelines state that a Regular Diet should provide approximately 1600-1800 calories and 50-65 grams high quality protein, adding that adequate complex carbohydrates and fiber should be included, and only moderate amounts of fats, sugar, and sodium should be supplied.

3. The proposed one-week menu for this project offers a wide array of foods that provide a variety of flavors, textures, and presentation, to be aesthetically pleasing and prevent palate boredom. Additionally, it incorporates more fresh foods rather than frozen or prepared foods. Along with more scratch cooking, ingredients used in the recipes for this one-week menu are low-fat (especially low in saturated fat), low-sodium, high-fiber, and high in vitamins and minerals. Considering the Food Guide and Dietary Guidelines outlined above, the one-week menu is nutritionally adequate and meets the nutritional needs of its residents while in line with the overall health goals of the facility and its clientele.

Based on feedback of the Food Service Director at Baptist Health (and the preceptor for this project), the proposed one-week menu would be feasible for production, given the facilities capacity. All recipes utilized in menu development, which were obtained through the USDA website and other suggested government health/nutrition resources, could be followed by the cooks present and all products used as ingredients could be purchased through food distributors the facility currently conducts business. While preparation time could potentially increase slightly due to the nature of scratch cooking, the improved efficiency of offering fewer “always available” and “alternates” which are currently provided, would aid in the adjustment of time management. Other considerations identified by the Food Service Director include tray feasibility and the utensils available at the facility at this time. This point relates to

overall aesthetics of the meal and providing a menu that allows for appealing plate presentation. The increased variety of colors and textures included in the proposed one-week menu would greatly aid in plate presentation, as well as increasing overall meal satisfaction and, ideally, meal consumption. This menu offers great variety of foods, carefully avoiding repetition of foods, flavors, combinations, or ethnic origin (such as Italian entrees offered two days in a row). This variety includes taking into consideration all daily meals cross-referenced across a weekly span, including alternates.

The Food Service Director also made note of the importance of wording of entrees and other foods listed on the menu. Foods should be listed and described in a way that easily explains to the clientele (whether they be a resident, staff, family or visiting friends) what is being offered that meal. Menu verbiage should also make the food sound attractive.

Overall, the one-week proposed menu fits within the nutritional framework outlined in the Diet Manual more effectively than the current cycle menu. The considerations of the satisfaction survey were taken into account in the design as well.

MONDAY TUESDAY WEDNESDAY

THURSDAY

FRIDAY SATURDAY

SUNDAY

Low-fat cottage cheese with peaches & pears

Bran muffin

Egg & vegetable quiche with fruit cup

Cranberry-orange muffin

Yogurt parfait with low-fat granola and peaches

Oatmeal with dried fruit

Turkey sausage

Apple-cinnamon baked French toast with fruit topping

Mixed berries

Egg sandwich on w.w. English muffin with cheese

Pears

Raisin bran or cheerios with banana

Hard-boiled egg

Turkey Meatloaf with Mashed Potatoes and Peas

Alt: Teriyaki Salmon

D: frozen yogurt

*Jambalaya/ Chicken Gumbo

Alt: Chicken BBQ

WW RollGreen Beans

D: King’s Cake

Beef Stir-Fry with w.w. Lomein

Alt: veggie burger

D: Strawberry Shortcake cup with angel food cake pieces

Pork Loin with Ratatouille and Baked Beans

Alt: Stuffed Portobello Mushroom

D: Lemon Sorbet

Baked Chicken with w.w. Pasta and red sauce

Broccoli

Alt: Crab Cake on w.w. bun

D: Fruit bar

Steak Sandwich on w.w. roll with peppers and onions

Alt: Lemon-Baked Haddock with peas & carrots

D: Vanilla ice cream

Turkey Dinner with Sweet Potato and Green Beans

Alt: Veg-etarian Zuc-chini lasagna

D: cran-apple crisp

Mushroom-Barley Soup with Glazed Carrots

Baked Chicken Tenders

Alt: Butternut Squash Soup with Zucchini Tenders

D: Oatmeal-Raisin cookie

Grilled Cheese and Tomato Soup with Tossed Salad

Alt: Turkey Panini

D: Brown Rice Pudding

Chicken Salad with Lemony Veggies

Mediterr-anean Quinoa Salad

Alt: Pot Roast

D: Mousse a la Banana

W.W. Pizza with Tossed Salad and Fruit Parfait

Alt: Eggplant Parm

D: Low-fat Brownie

Tuna-Noodle casserole with Sautéed Spinach

Alt: Egg Salad Sandwich

D: Sweet Potato Custard

3-Bean Veggie Chili

New Potato Salad

Alt: Stuffed Pepper

D: Pumpkin Spice Blonde

Split Pea Soup (with ham)

Pesto-baked Polenta

Alt: Veggie-feta Fritata

D: Berry Fro-Yo

Alt= alternate entrée option D= dessertW.W. = whole wheat*= Theme Meal

4. The theme meal created for Baptist Health Nursing and Rehab Center is in celebration of Mardi Gras, held on March 4th. The main entrée served is jambalaya with a side of okra. The alternate offered is a chicken gumbo to be served with a wheat roll. The dessert to be served is a yellow cake with rainbow glaze. These foods are culturally recognized as traditional Mardi Gras foods. This theme meal chosen fits the setting and needs of this facility, as they have observed this holiday in the past and residents, as well as staff, really enjoyed the festive occasion. Baptist Health has not participated in celebrating Mardi Gras for a few years and thus we predict this theme meal will be well received.

Planning for the theme meal required coordinating decorations with the head of the activities and recreations. Activities and Recreations already possessed décor for the occasion, including bead necklaces for residents/staff, masks, wands, balloons, posters, noise-makers, etc. They volunteer to decorate resident dining rooms the evening prior to Mardi Gras. In order to prepare the population of Baptist Health for the festive event, advertisement included flyers, emails and word-of-mouth initiated from the dietary and food service staff. Fliers included a colorful graphic with details of the celebration, including the date, the food items offered, and a description of each dish. Fliers were hung on the Thursday prior to the Tuesday event.

Additionally, brainstorming and recipe negotiating with the executive chef was conducted to settle on the precise components, amounts, and preparation methods of foods for the meal. Careful consideration was made regarding all food allergies, as some

residents presented with seafood allergies and red dye allergies. Adjustments made for the residents included separate preparation of the shrimp used in the jambalaya (to be mixed in as the entrée was served on tray line) and a piece of King Cake with plain glaze in place of the rainbow colored glaze (for the one resident with a red dye allergy). The theme meal was produced facility-wide with the adjustment of the meal provided to staff in the café being an out-of-pocket self-pay expense.

5. Nutrient Analysis:a) Analysis of one-week menu in comparison to current menu in place:

More fruits and vegetables included to supply more vitamins, minerals, and fiber in the diet

Lower sodium Lower fat and saturated fat All recipes used for menu development obtained through Government Nutrition

Education resources available to the public All daily totals of macronutrients supplied through the one-week menu are within

the guidelines for recommended daily intake for older Americans

b) Specific nutrient analysis of theme meal:Jambalaya (1c)

Gumbo (1c)

Okra (1/2 c buttered)

Roll Cake TOTAL

Calories 391 106 45 98 240 880Protein 17.5 7.8 1.4 2 1 29.7Carbohydrate 31 16 4.8 21 32 104.8Sugar 6 2.8 0.8 3.1 31 43.7Total fat 19 5.6 5.8 2 11 43.4Saturated fat 10 2 3.6 1 2.4 19Sodium 445 511 56 151 171 1334Fiber 3.4 2.8 1.4 3 1 11.6

c) Compare to meal being replaced:Roast Beef with Mashed Potato, Gravy and Buttered Green Beans

Roast Beef (3oz)

Mashed Potato (1c)

Gravy (1/3c)

Buttered Green Beans

White Bread with Butter

Lemon Pound Cake

TOTAL

Calories 238 214 60 47 210 310 769Protein 21 4 1 2 1 1 29Carbohydrate 0 35 5.5 7 20 41 67.5Sugar 0 1.2 0.5 3 4 38 46.7Total Fat 7 6 5 1 12 14 45Saturated Fat 5 2 3 0.5 7 9 26.5Sodium 390 680 650 300 160 190 2370Fiber 0 3.1 0 2 1 1 7.1

6. A few factors allowed for a cost savings with this project. The Activities and Recreations Department provided use of decoration materials that the facility had previously purchased, sparing purchase of new materials for creating a celebratory environment. The theme meal required purchase of some expensive ingredients such as shrimp, while utilizing some cost-effective and inexpensive items, such as okra, brown rice and box cake mix.

7. Marketing materials: fliers, memos, decorations

Flier delivered to each unit and posted in facility:

Tuesday March 4 th

Main entrée: jambalaya with okra and a wheat rollA traditional dish of rice, shrimp, chicken sausage, and ham with Creole seasoning and vegetables. A side of steamed okra and a wheat roll make this meal deliciously satisfying!

Alternate: chicken gumboA flavorful tomato-based stew made with chicken, sausage, rice, and veggies, including okra, carrots, and onions

Dessert: King CakeFestive yellow cake with delicious sugar glazed topping in the traditional Mardi Gras colors of purple, green, and gold

**A tasty celebration!**

8. Budget, equipment order, and recipe cost for Jambalaya, chicken gumbo, okra and Kings Cake; cost analysis (based on estimated 90 servings for residents and staff café, plus dessert for entire house)Food/Ingredient Specification Market

Unit SizeQuantity Needed

Market Unit Cost

Total Cost (price per amount used)

Brown rice Brown, long grain

25# bag 3 gallons (1/2 bag)

$13.10 $6.55

Sausage Low-sodium, pork and turkey, cooked

10# case 10# $25.14 per case

$25.14

Pulled chicken White and dark meat 60/40 mix, cooked and frozen natural

Patuxent Farms

10# $22.80 per 10#

$22.80

Olive oil Bellagio/Roseli 6 1gal per case

3 cups $89.90 per case

$1.87

Cilantro Fresh 1# case 5 cups $10.52 per case

$10.52

Diced tomatoes Fire-roasted 4 #10 cans $4.12 per #10

$16.50

Garlic Peeled #1 large 5# pack 36 cloves $10.32 per pack

$2.06

Green peppers Fresh, whole 25# case 12 $25.59 per case

$4.27

Red peppers Fresh, whole 11# bag, 40 each

12 $16.23 $6.21

Low-sodium chicken stock

Base, low-sodium chicken paste, shelf stable jar no MSG

6 per 1# case

6 gallon or 1 jar

$25.86 per case

$4.31

Paprika Smoked, Hungarian ground, Monarch brand

8oz pack 2 ½ cups $7.50 per pack

$15.00

Cumin Ground, 16oz pack 4T $8.50 per $2.12

Monarch brand packOregano Dried, ground,

Monarch brand11oz pack 8T $6.88 per

pack$3.44

Onion Spanish jumbo 10# bag 15 onions = ½ bag

$7.17 per bag

$3.58

Shrimp Raw, 41-50 wht peeled and de-tailed

4/2.5# packs per case

10# or 1 case

$81.53 per case

$81.53

Okra Frozen, chopped

Store bought (due to Exec Chef missed order)

10# $1.86 per lb bag

$18.60

Cake mix 5# boxes 3 boxes $10.17 per box

$30.51

Colored decorative sugar topping

Store bought 1 multicolored topping

$4.50 $4.50

Vanilla frosting 5# tub 11# case 1 tub $29.20 per case

$14.60

Rolls Assorted unsalted baked frozen

120/1.5 oz 2 $41.56 per case

$83.12

Cost Comparison per Serving:Total per meal, including jambalaya, chicken gumbo, roll, and cake = $3.42Cost for regular menu item scheduled for this meal (roast beef with mashed potato, vegetable, sides) = $3.15Loss per meal = $0.27

9. Planning schedule—itemized list of tasks with approximate completion timeGather and assess meal item countsPre-theme meal prep:Cooking

Jambalaya: prep ingredients on stove-top (30 mins), bake (1.5hr) Executive Chef

Gumbo: prep shrimp on grill and other ingredients (30 mins), add rice and allow stew to reduce (1hr)

Executive ChefPrep shrimp-free gumbo: 1.5 hr

Executive ChefRolls: pull from freezer and bake (30 mins)

1 Kitchen StaffOkra: pull from freezer and steam (30 mins) Executive ChefTexture modifications: portion according to count--purees and grounds (30 mins)

Executive Chef and 1 CookKing’s Cake: make, bake, frost, decorate, cut, plate, and cover—(2hr)

2 “salad” staff members Dish everything into tray line steam pans with corresponding serving size scoops:

15 mins 1-2 cooksMeal service: send food to staff café @11:10, start café service @11:15

Tray line from 11:15-12:45 6-7 kitchen staff, including 1-2 cooksMeal delivery from 11:35-12:55 2 kitchen staff

Clean-upStrip trays, wash tray items and clean carts, sweep and mop kitchen, clean out

ovens, wash all equipment and serving items: 1.5 hrs All Kitchen Staff

10. “Do” phaseNumber of call-downs: 8Plate waste: 55% consumed 25-50% of tray, 45% consumed 75-100% of tray for those who chose the theme meal

11. Conduct and evaluate a post theme meal customer satisfaction survey. Discuss findings: Evaluating the success of the theme meal incorporated assessment of food/plate waste, resident and staff satisfaction, the level off efficiency or increased workload on staff, and the overall reaction and coordination of staff in executing the theme meal.

Resident satisfaction was high for the theme meal foods, however, due to miscommunication, the flow of the meal service was disrupted. This negatively impacted meal perceptions. Additionally, the workload of the staff was increased as the theme meal was late in preparation. This held up tray line and burdened dietary as well as nursing staff. Overall, the theme meal experience was positive and residents have been praising the meal since Mardi Gras has passed. Plate waste reflected the rolls had a hard exterior which was too difficult for residents to chew. Additionally, many did not prefer the okra vegetable side and much of it remained on meal trays after the conclusion of the meal. The coordination of both nursing staff and dietary staff could have been smoother. Confusion of nursing staff over the theme meal options and ordering was not brought to the attention of dietary staff until the day of, yet ample opportunity was given to answer questions ahead of time. Additionally, the executive chef could have communicated and coordinated with kitchen staff to aid in meal prep and ordering so that the meal was served on time and all necessary foods were included in ordering.

12. Summary/Individual reflection: Planning required the assistance of and coordination with the executive chef, dietary staff, nursing staff, food service director, the registered dietitian, and activities and recreation staff. Announcements were made to staff at the bi-weekly Department Head Meeting as well as morning report. A flier was distributed to nursing staff for circulation on all units as well as a memo being emailed to staff. The food ordering was conducted the week prior to the theme meal and the executive chef began prepping food for the theme meal the day before Mardi Gras.

Some challenges encountered include miscommunications with nursing staff in getting an accurate count for the two items being offered (jambalaya and chicken

gumbo), as well as the language used on meal selection tickets (some wrote out jambalaya, others “rice”, others didn’t specify which option the resident wanted). The nursing staff failed to turn in their counts at the date and time requested by dietary, adding strain on the chefs, as the quantities of foods were unknown even up until one hour prior to serving. These late changes and challenges were meant to be avoided through the repetitive informing of the theme meal being executed.

While decorations were accounted for and their distribution was intended for the evening staff prior to Mardi Gras, the Activities and Recreation director stated that stock of decorations ran short on the unit floors. Staff prioritized decorating the café and playing holiday themed music.

Another challenge was encountered through the food ordering for the theme meal, as it was conducted by both the theme meal designer and the executive chef. The ordering of specific ingredients, including the rolls and shrimp, was conducted by the theme meal creator. Quantities were calculated through collaboration with the food service director and the executive chef, while referencing the estimated meal count and analyzing the recipes selected. Some difficulties arose when okra, an ingredient in the chicken gumbo, was not ordered, a responsibility of the executive chef. This required alterations in food preparation as well as staff designation, as the rest of the recipe needed to start being made without the okra at hand and the shift manager needed to go food shopping for the ingredient.

Negotiations of the nutritional parameters of the meal were a challenge in planning the theme meal with the executive chef as well. Special diets were waved, as the meal was considered to be honoring a holiday, thus only texture modifications were made to adjust the meal to individual residents’ needs. Allergies were paid careful attention, making sure to avoid shellfish allergies and a red dye allergy (for the King’s Cake topping). All residents received the King’s Cake themed dessert served. The rolls selected and ordered to be served with the jambalaya appeared to be purely comprised of white bread, not the multi-grain/white/rye variety packs chosen. After questioning the selection of white rolls, it was discovered that the dietary staff pulled only white rolls from the mixed box of frozen par-boiled rolls. Miscommunication regarding serving size and which scoop size to use on tray line occurred, as well as confusion over how the gumbo was to be served. The preceptor decided the gumbo should be offered not as a main entrée but as a soup option to be included as an addition to one’s meal. Okra was served as the vegetable side for the theme meal.

The total count included 48 orders for jambalaya, 52 chicken gumbo, 12 ground jambalaya, 1 pureed jambalaya, 1 pureed chicken gumbo, 3 shellfish/shrimp allergies, and one red food coloring allergy from residents and spouses/guests. An estimated 20 portions of each, the gumbo and jambalaya, were counted and prepared for the staff café. This café allotment also provided a bit of a cushion for resident counts, in case additional meals were requested or missed.

Documentation of the theme meal was conducted throughout, as pictures were taken during meal production. Oversight and assistance in meal prep allowed the process of the theme meal production to be tracked. The recipes selected to be used served more as a rough guide in preparing foods, rather than being followed for specific measurements as intended. The executive chef stated after meal completion that he did not follow the recipes.

The meal was 15+ minutes late, causing upset staff in the café and delayed tray line, as the trays with requested the theme meal backed up the process, waiting for the completion of that dish. While observing tray line, it was detected that the dietary staff was unsure of what food items comprised the theme meal. Gumbo was being added to all meal tray tickets that said “jambalaya” and this clarification was made that only those that said “gumbo” got the soup.