SupremeCare Dietary Department Review - Score Card
FACILITY/City/State: ______DATE:______
Add a 1 next to the items in compliance and a 0 next to the ones not in compliance. Total the scores after every section. In the last section, add all section totals for the grand total. Any items with (0 ) are to be addressed in comment section
Menus and Tray Service
1. ______Menus and spreadsheets are posted at meal times, and appropriate foods/portions are prepared for all diets.
2. ______Food temperatures have been recorded/logged on menu or temperature log
3. ______Substitutions recorded . ____days with substitutions through the month
4. ______Substitutions of acceptable items
5. ______Food Temperatures are record on all food items (hot and cold).
6. ______Menus are posted in dining room and assessable to residents
7. ______Daily menus are posted in an assessable area for all residents
______TOTAL (MAXIMUM 7)
Comments:
Dry Food Storage
1. ______All foods are stored on their proper racks at least 6 inches off the floor and 18 inches away from the ceiling and sprinkler heads.
2. ______All open foods are kept in properly sealed containers with correct labels and dates. No foods are stored in plastic wrap.
3. ______There is enough food supply for emergencies including water. The disaster plan is followed and in compliance. At least quarterly (Jan/Apr/July/Oct perform physical count based on census.
4. ______There are no signs of pests or insect infestation.
5. ______Scoops are stored in bins and dented cans are stored in a separate area
6. ______Floors are clean, free of debris in isles and under shelving
7. ______Disposables are sealed and free from potential contamination
______TOTAL (MAXIMUM OF 7)
Comments:
Janitor's Closet and Dumpster
1. ______No chemicals are stored on floor and/or stored with food/food items.
2. ______Mops and brooms are hung/stored in designated areas
3. ______Clean mop-water is used for each use, and there is no standing/un-used water left in mop bucket.
4. ______All chemicals are correctly labeled.
5. ______Closet is clean and free of debris; as are the shelves, walls, and floors.
6. ______There is no musty odor present in the closet
7. ______All dumpsters are kept closed and free of debris and clutter.
8. ______Are all maintained to minimize any pest infestation
______TOTAL (MAXIMUM OF 7)
Comments:
Coolers/Refrigerators:
1. ______Temperatures are recorded/logged and within their normal ranges of 40 ̊ F or below. All thermometers are close to their doors and visible without searching. No temperatures have be skipped during the month of review. If missing documentation ___ of 31 days missing
2. ______All food is in proper containers and stored 6 inches off of floor. All raw food, including eggs, are in proper containers stored below cooked food.
3. ______Any raw or thawing foods are stored to prevent contamination of cooked or raw foods.
4. ______All foods are covered and stored securely, properly dated and labeled, and no expired dates present.
5. ______All foods stored in coolers/refrigerators are covered and stored securely, properly dated and labeled, and use by dates (UB) are visible and WNL of UB date
6. ______All outdated food has been thrown out per use by date, expiration date, or manufacturer's guidelines.
7. ______All refrigerators are clean on the inside as well as outside, with their floors, fans, shelves, walls, ceilings, and other hard-wares in appropriate condition.
8. ______All lights within the coolers/refrigerators are appropriately working and covered
9. ______All foods are stored to prevent contamination.
______TOTAL (MAXIMUM OF 9)
Comments:
Freezers:
1. ______Temperatures are recorded/logged and within their normal ranges or less than or equal to 0 ̊ F. Inside thermometers are close to their doors and visible.
2. ______All foods are properly stored in their correct containers six inches off the floor.
3. ______All foods are securely covered in containers with labels and dates.
4. ______All prepared frozen leftovers/foods stored in coolers/refrigerators are covered and stored securely, properly dated and labeled, and use by dates (UB) are visible and WNL of UB date
5. ______No ice has built up in any freezers.
6. ______No foods are wrapped in plastic wrap
7. ______All freezers are clean on the inside as well as the outside, with their floors, fans, shelves, walls, ceilings, and other hard-wares in appropriate condition.
8. ______All lights within the freezers are appropriately working and covered.
______TOTAL (MAXIMUM OF 8)
Comments:
Dish Room Area:
1. ______Water temperatures and ppm are tested and recorded/logged and are within manufacturer's normal range.
2. ______Solid/liquid chemicals have been dispensed properly.
3. ______Clean dishes, pots, and pans are not stored next to dirty/soiled dishes.
4. ______Hands are washed, clean, and properly sanitized before handling clean dishes and flatware to prevent contamination.
5. ______Aprons are before handling clean dishes and flatware to prevent contamination.
6. ______Dishes and flatware are free of food particles/debris, no cracks in dishes, and all dishes have been air dried.
7. ______Dishes, pots, and pans are stored inverted and placed to allow for air dry
8. ______All dishes, pots, and pans are free of grease and carbon build-up.
______TOTAL (MAXIMUM 8)
Comments:
Pot and Pan Sink Area:
1. ______Pot washing procedures are posted in designated area.
2. ______Water temperatures and ppm are tested and recorded/logged and are within manufacturer's normal range.
3. ______Solid/liquid chemicals have been dispensed properly.
4. ______Clean dishes, pots, and pans are not stored next to dirty/soiled dishes.
5. ______Hands are washed, clean, and properly sanitized before handling clean dishes and flatware to prevent contamination.
6. ______Aprons are before handling clean dishes and flatware to prevent contamination.
7. ______The sanitizer is being properly placed in the third sink, and there are no food particles or other contaminants in this section.
8. ______Dishes and flatware are free of food particles/debris, no cracks in dishes, and all dishes have been air dried.
9. ______Dishes, pots, and pans are stored inverted and placed to allow for air dry
10. ______All dishes, pots, and pans are free of grease and carbon build-up.
______TOTAL (MAXIMUM 10)
Comments:
Preparation Areas/Service:
1. ______Sanitizing buckets are stored/used properly with un-used dish towels placed in solution, and recorded ppm; no other items stored in container .
2. ______Sanitizing buckets are changed at least every shift and more often if water soiled
3. ______Tables, shelves, and bottoms/underneath tables are clean.
4. ______All utensils are clean, dry, and stored in proper areas.
5. ______All cutting boards are clean, sanitized, and stored in proper areas and without chips and cracks.
6. ______No wooden cutting boards are observed in the Food Service Department
7. ______All drawers and insides of cabinets/shelving are dry and clean.
8. ______Can opener is free of debris, food, and grime, and is cleaned after each use.
9. ______Food processor is free of debris, food, and grime, and blades are in clean/good condition. Food processor is stored in proper area.
10. ______No observation of Nesting Water observed
11. ______Hand sinks with adequate soap, paper towels and properly working trash cans
______TOTAL (MAXIMUM 11)
Comments:
Equipment
1. ______Slicer is clean and free of food/debris, and always covered when not in use.
2. ______Mixer and mixer table are clean, free of food/debris, and covered when not in use.
3. ______Food warmer and thermometer are clean and free of food debris.
4. ______Toaster is clean/sanitized and free of food/crumb/carbon build-up.
5. ______Oven and their racks are clean with no food/debris/carbon build-up.
6. ______Grills and range-tops are clean and free of grease and carbon build-up.
7. ______Grill grease catch bin is free of grease/ food/debris when not in use
8. ______Steamer is clean/sanitized and in good working condition.
9. ______Tilt skillet is clean/sanitized and in good working condition.
10. ______All fans are clean of debris and dust.
11. ______Ice machines have clean filters, free of mildew, and are clean on inside/outside(look up in ice maker for mildew)
12. ______Fryers are clean of food debris/grease. Fryers kept covered when not in use.
13. ______Plate lowerators/pellet warmers are clean, free of debris, and in good condition.
14. ______All food carts are thoroughly cleaned and sanitized after each meal/use.
15. ______Hoods and vents are free and clean of grease and food particles.
16. ______Is there any equipment requiring repair
______TOTAL (MAXIMUM 15)
Comments:
Beverage Area:
1. ______Coffee equipment and containers are clean, free of debris, and operational.
2. ______Tea brewers and dispensers are kept clean/sanitized.
3. ______Juice and beverage machines are kept clean/sanitized/good working condition.
4. ______All beverages are kept in clean storage containers and covered at all times.
5. ______The areas surrounding the beverage station are kept clean of debris and spills.
______TOTAL (MAXIMUM 5)
Comments:
Overall Area's
1. ______Serving line is clean, free of grease/debris including underneath, and in good working condition.
2. ______Floor is clean and free of grease, and no food debris/particles on floor.
3. ______Sanitizer buckets are available at all times to sanitize food surfaces.
4. ______Mats, walls, ceilings, light fixtures, doors, etc. are properly cleaned/good condition.
5. ______Fire doors are kept shut and properly functioning.
6. ______Staff are using proper hair restraints
7. ______No visible fake nails or polish,
8. ______Staff are in proper uniforms are worn and clean
9. ______Jewelry that is worn meets facility guidelines.
10. ______Trash cans, soap, towels, are kept in all hand washing stations.
11. ______Is policy for UB dates being properly used in throughout the food service department
12. ______Food is correctly handled with clean gloves and utensils by staff.
13. ______Items being thawed are kept in coolers; no food being thawed in sinks.
14. ______Is the microwave clean inside and out and cleaned after use
15. ______Trash cans and their lids are kept clean and covered when not in use. ______Cleaning schedule is kept posted and followed accordingly.
16. ______The ice cream storage area is kept clean and organized.
17. ______Are there any areas of concern unique to this operation
18. ______Restrooms are clean and have adequate soap and paper towels for food service staff
19. ______TOTAL (MAXIMUM (19)
Comments:
Expanded Dining
1. ______If fine dining, table clothes are clean and free of wrinkles and changed after every use.
2. ______Tables are not set between meals with flatware/cups/glasses unless dining area is closed to staff, residents and guests and table set up is free from risk of contamination
3. ______Juice and beverage machines are kept clean/sanitized/good working condition.
4. ______All beverages are kept in clean storage containers and covered at all times.
5. ______Are all residents served at a table before proceeding to serve other tables
6. ______Are residents served and provided dining to promote dignity
7. ______The areas surrounding the beverage station are kept clean of debris and spills.
8. ______TOTAL (MAXIMUM 8)
Comments:
Scoring Instructions:
Find the total score by adding together all of the totals from the previous sections. Take the grand total number and divide it by 114 which are the total available points, and then multiply by 100.
______divided by ____114___ = ______multiplied by 100 = ______%
Example: 95/114 = 0.833 * 100 = 87%
REGISTERED DIETITIAN:______
Was the Dietary Manager or Designee provided a copy of report__ yes ____no
Plan of Corrections/Notes:
Training Required
Monday, November 11, 2013 Page 1 of 7