Nutrition Site Assessment Fy 2012 2013 2014 2015

NUTRITION SITE ASSESSMENT FY 2013

Program Name:______Site:______Hours:______Days Open:____-_____ Site Manager: ______

Facility Director:______Support Staff:______Facility Director Title:______

Marketing

A. How do community residents find out about the program? i.e. attach sample newsletter (a) ______Is the website up-to-date and easy to maneuver? ______Reservations required? Yes/No If yes, list number ______

Parking accessible/available? Yes/No Signage in the lobby/entrance? Yes/No

Does the front of the building display information about dinning hours? Yes/No

Is the exterior/interior well maintained? Yes/No Days transportation available______

Facility/lobby staff knowledgeable about the senior nutrition program? Yes/No

Facility sponsored programs available before or after dining (list) ______

Dining area easily identified? Yes/No Program staff easy to identify? Yes/No

Congregate poster display? Yes/No At what age are you considered a guest?______

Membership required? (Attach) (b) Yes/No

Are the program staff, customers and volunteers knowledgeable of the AAA 1-B? Yes/No

Are they knowledgeable of the aging network services? Yes/No

Operations

B. Dining room clean and inviting? Yes/No C. Are lunch reservations recorded? (c) Yes/No Donations recorded $______(Attach receipt) (d) Donation method: ______(describe) Avg.$______of the suggested donations received. Sign-in sheets (Attach) (e). Participant intake files/forms (Attach) (f) Percentage/Number of customers new to the program? YTD______%/______Volunteers/staff assist customers? ______Assistive devices______Amenities dining program promotes or provides______

List posting(s) in kitchen/dining area______

Frequency menu posted?(Circle) Daily Weekly Monthly (Attach) (g)

Menu corresponds to meal served? Yes/No Nutrition education literature(Attach) (h)

Meals served today: Congregate __ /___ Guest _____HDM Meals__ /___ Total:______

1st 2nd 1st 2nd

Is there representation of customers on your advisory council? Yes/No

Are survey questions reviewed with council members and action taken? Yes/No

Does the Center have capacity for increased guest counts? Yes/No

Would you recommend the program to your family and friends? Yes/No

Food Service Operations Food license Date:______List: Certified Manager: ______Date: ______

Open issues health report compliance? ______Are your health inspection reports and recommendations reviewed with staff? (Attach Current) (i)

______

Source of food preparation? ______

Time of food delivery: ______Temps______(j)

Meal serving time:(Begin/End)______/______Temps______- (k)

Style of food service? (Serving styles)______

Comment Cards available ? Yes/No (Attach Sample) (l)

Suggestions discussed? Yes/No Date of last Customer Survey?______Equipment used to maintain temperatures (list)______

______

Today’s Menu Serving Comments Temps Entrée 41°/135° Fruit/Vegetables 41°/135° Fruit/Vegetables 41°/135° Bread or Equivalent 41°/135° Fat/Condiments 41°/135° Milk: Skim, ½%, Low Fat 1%, 2%, Whole 41°/135° Optional Menu Items 41°/135° Quality of the food (i.e. appearance and taste)

Meals uniform in portion? Yes/No Is there enough food? Yes/No

Are there leftovers? Yes/No What was done with leftovers?______

Is food labeled and dated? Yes/No Safety Training/Fire Drill documented? Yes/No

Training Topics?______

Employee safety items available? ______

How long is the time from food production to service? From:______To:______

Recipes tested and standardized? Yes/No (m) Temp Logs posted? Yes/No (n)

Nutritional Analysis available? Yes/No (o)

Name of Nutritional Analysis/Source______

Summary/Comments

Marketing: Operations:

Food Service/Safety: Attach Additional Forms, New Policies. Additional Comments :

______Name of Person Completing Form Date

Standard Operating Policy and Procedure

Senior Nutrition Dining Program Assessment

9-21-2011

Policy: A program site assessment is to be completed for all Senior Nutrition Dining Program locations on an annual basis and maintained by nutrition contractors for review.

Procedure: Contractors are requested to provide written documentation quarterly to the Area Agency on Aging 1-B for each senior dining program and summarize key performance indicators.

Description

A. Complete top portion of the Senior Nutrition Dining Program Assessment form with site specific information in advance.

B. Visit the programs website. Determine ease of use and AAA1-B program related information. C. Arrange to tour facility with site director or designated contact person. D. Utilize assessment form to obtain all required information and summarize the results:

Written Summary:

1. Document new programs/activities being planned, staff changes, updates to site agreement. 2. Review food handling and storage compliance with health department guidelines. 3. Observe general cleanliness, organization, traffic flow and sanitation. 4. Note amenities that promote a positive dining experience. 5. Identify areas requiring follow-up action during your assessment. 6. Summarize action items, follow-up timelines and responsibility. 7. Attach items identified where applicable: (a) Newsletter (b) Membership form (c) Reservation Sheet (d) Donation Receipt (e) Sign-in Sheet (f) NAPIS Form (g) Menu(s) (h) Nutrition Education handout/Schedule (i) Health Inspection/Follow-Up (j) Temperature Records (k) Temperature Records (l) Comment Card/Customer Survey (m) Recipes (n) Temperature Logs (o) Nutrient Analysis Information