Part 5: Why you need a menu management system
What was the objective of the audit?
The audit objective was to assess whether the Ministry of Long-Term Care, in conjunction with long-term-care homes and public health units, has effective systems and procedures in place to ensure that:
- food and nutrition services are delivered to residents in long-term-care homes in accordance with relevant legislation, regulations and policies;
- resources are appropriately managed to provide safe and nutritious meals to long term-care home residents; and
- results on the efficiency and effectiveness of food and nutrition services provided to long term-care home residents are measured and publicly reported.
They visited 62 of the province’s 626 homes across 60 municipalities, with the majority of our work conducted at 59 homes. We conducted detailed audit procedures in five homes in Mississauga, Oshawa, Ottawa, Thunder Bay and Toronto. We selected these homes to visit based on a variety of factors such as geography, amount of funding provided, governance type of the home and number of residents. At these five homes, we conducted the following work:
- interviewed senior management, residents and family councils;
- interviewed and shadowed staff including registered dietitians, registered nurses and registered practical nurses (nurses), personal support workers, chefs and food service workers;
- observed inventory control at the home’s kitchen, dining services and snack services;
- reviewed client files, homes’ policies, records of gastroenteritis infections and outbreaks, inspection reports prepared by the Ministry and public health, complaints, resident council minutes, surveys and other relevant documents related to food and nutrition; and
- obtained and analyzed relevant data.
They also conducted unannounced visits at another 54 homes to observe meal service at either breakfast, lunch, or dinner, with some visits conducted on the weekend or on a statutory holiday when staffing level may differ from the regular workday.
At another two homes, they observed dining and kitchen operations and interviewed senior management as well as selected food and nutrition services staff to better understand their perspectives on food and nutrition services for home residents and their day-to-day work.
Regarding the design and application of nutrition policy, they met with and reviewed documents prepared by Dietitians of Canada and its Ontario Long Term Care Action Group (Dietitians of Canada), a professional association representing dietitians at the local, provincial/territorial and national levels. As well, they met with Ontario Society of Nutrition Management. They spoke with the Office of Nutrition Policy and Promotion in Health Canada to understand the federal government’s efforts to support healthy eating. They also engaged an independent registered dietitian to provide advice on information on best practices and evaluate a sample of menus used in homes to determine whether they meet regulatory requirements.