Food Safety Policy

Food Safety Policy 2017-2020 0

Policy Title: Executive Summary: Policy for Food Safety The Food Safety Policy details the precautions required within the Trust for handling, storage and distribution of food safely. Details of the food that is permitted to be brought into the Trust by visitors, under what conditions and circumstances. The policy covers all aspects of the patient food delivery from the kitchen to the wards, to ensure safety remains a priority. This document will assist the staff within the Trust in meeting its responsibilities with regards to the NHS Litigation Authority (NHSLA) Risk Management and all current Food Safety Legislation. Supersedes: ECT000805.IC20090601 - Food Hygiene Guidelines V1 (Food Safety Policy) Description of Updated from Guidelines to a Policy Amendment(s): Updated Legislation Additional section clarifying HACCP Additional information on fund raising food provision within the Trust This policy will impact on: Health and Safety of patients, staff and visitors Financial Implications: Litigation could be from minor to major impact for the Trust, if current legislation is not followed, which in turn impacts on the Food Safety Law or Health and Safety Laws and causes food poisoning or injury Policy Area: Trust Wide Document ECT002868 Reference: Version Number: 0.2 Effective Date: September 2017 Issued By: Director of Nursing Quality & Performance Review Date: September 2020 Author: Head of Facilities Soft FM & Facilities Soft FM Monitor Impact Assessment Date: August 2017 APPROVAL RECORD Committees / Group Date Consultation: Dietitians Patient Meals Group (Sub Group) Clinical Nutrition Steering Group Infection & Prevention Control Group Performance & Quality Care Standards September 2017 September 2017 September 2017 September 2017 September 2017 Forum Approved and Ratified: Head of Facilities (Soft FM) September 2017 Received for information Approved and Ratified: Director of Corporate Affairs and Governance September 2017 1

Table of Contents 1. Introduction Page 4 2. Purpose Page 5 3. Responsibility Page 5 4. Personal Hygiene Page 5 5. General Ward Kitchens Page 6 6. Visitors Page 6 7. Notices Page 7 8. Ward Kitchen Fridges Page 7 9. Patient Meals Page 8 10. HACCP Page 8 11. Rehabilitation Kitchens Page 9 12. Guidelines for Patient Catering Organised by Ward Staff Page 9 13. Guidelines for Staff Catering for Functions/Entertainment Page 11 14. Monitoring Compliance with this Document Page 12 15. Legislation, Guidelines and Reference Page 12 2

Appendices Appendix 1 Appendix 2 Appendix 3 Appendix 4 Appendix 5 Appendix 6 Appendix 7 Appendix 8 Appendix 9 10 Point Code for Food Handlers The Use of Microwave Ovens in Hospital Fridge Notice Ward kitchen Fridge Temperature Record Hospital Ward Kitchen Checklist Hazard Analysis Critical Control Points (HACCP) Recording Form Patients Food Disclaimer Form How Supplements Should be stored and Used Guidelines for Visitors Wishing to Bring Food into Hospital For Patients 3

1. Introduction Health & Social Care Act updated in 2015, The Code of Practice for the Prevention and Controls of Healthcare Associated Infections requires all Trusts to have Food Safety Policies and Guidance 2008. All staff involved in the storage, preparation, transportation and serving of food need training in food catering practices to the level required to minimise the transmission of gastro-intestinal infections to patients, the general public, and staff of the East Cheshire NHS Trust. The very young or elderly, pregnant or nursing mothers and those who are already ill in hospital are particularly vulnerable to the effects of food poisoning and procedures must be put in place for its prevention in ward kitchens etc. within the East Cheshire NHS Trust. Recent guidelines which are recommendations from the Department of Health have been taken into consideration when drawing up these procedures: Food Safety & Hygiene (England) Regulations 2013 Guidance on Temperature Control Legislation in the UK Regulations (EC) 852/2004 EC 852/853 Food Hygiene (England) Regulations 2006 HACCP (Hazard Analysis of Critical Control Points) Article 5 of Reg. (EC) No 852/2004 COSHH (Control of Substances Hazardous to Health) Regulations May 2017 Health & Safety at Work Act 1974 Food is at risk in all areas where it is stored, prepared, transported and served. Good food hygiene conditions are necessary: 1. To minimise / reduce the risk of food poisoning. 2. To assure the public that food is free from spoilage and is prepared and served in clean surroundings by properly trained staff. 3. To ensure that the food is palatable and nutritious as well as safe. 4. To ensure that hot food served is kept above 63 C and cold food below 5 C 5. To ensure that patient food delivered to the wards is served immediately before the food cools. Most outbreaks of food poisoning are caused by bacteria that are given ideal conditions to grow. The ideal conditions are: Significant Time. Warmth. Food. Moisture. Correct ph. Oxygen. The risk of an outbreak of food poisoning occurring will be minimised if all staff involved in food handling follow the correct procedures and policies. All staff are responsible for their own good standards of practice and must be aware of the role they have in ensuring that food is safe.. Responsibility rests with all staff providing food for others to ensure that the food is safe to eat. Any breaches of the Food Safety Act may result in prosecution. Penalties can result in fines from 5,000 per offence or a prison sentence from 6 months for serious breach of the regulations. These guidelines are intended for ward staff, nursing, domestic and other staff using ward kitchens. 4

2. Purpose 2. Purpose The Trust accepts its responsibility with regard to food safety. Therefore the aims of this policy are: To provide direction in respect of food safety and hygiene practices through the Trust sites, and to provide the basis from which Trust staff can ensure that all legislative requirements are met in order to protect the health and safety of all personnel involved in cooking, serving, handling and consumption of food within the premises of the Trust. To ensure that all staff involved in the food chain are trained to an appropriate level and accept responsibility for providing a high quality and safe service. 3.0 Responsibilities 3. Responsibility Chief Executive has overall responsibility for ensuring that the Trust has appropriate policies in place and this responsibility may be delegated to an appropriate deputy. Director of Finance as the nominated Lead Director has the delegated management responsibility for the implementation and delivery of this policy. Head of Facilities (Soft FM) has day to day responsibility for ensuring that legislation is being followed at all times and will ensure that processes and plans are in place to monitor compliance with this policy. Executive Directors and Heads of Services are responsible for the ratification, implementation and monitoring of this policy All staff, including staff not employed by ECNHST, locums, contractors, agency and volunteers have a responsibility to comply with the requirements of this policy. 4. Personal Hygiene Staff must ensure cleaning and disinfection of the workplace is carried out before food preparation. A separate wash hand basin must be available with the provision of liquid soap, hot and cold water, single use disposable nailbrush and disposable paper towel for the drying of hands. All staff MUST adhere to the following: 1. Report any symptoms of ill health e.g. rashes, diarrhoea, vomiting, upper respiratory tract and septic infections to their Managers, with details to the Occupational Health Department for guidance. 2. Cover all wounds with a coloured waterproof dressing whilst on duty. 3. Keep jewellery to the minimum i.e. a plain wedding band. Finger nails must be kept short and clean. Nail varnish or acrylic/false nails are not acceptable. 4. Long and shoulder length hair must be tied back off the face. 5. Receive training in a good hand cleansing technique (see the Trust, Infection Prevention and Control Hand Hygiene Policy). Hands must always be washed before commencing work in ward kitchens and before serving food and drinks. 6. Clean food service equipment must be used for the service of food. 7. All staff or volunteers serving patients meals must wear clean green plastic aprons. 8. Do not smoke or consume food and drink in ward kitchens. There are designated areas for staff breaks. The Trust operates a no smoking policy on site. 9. Do not cough or sneeze over food. 10. Do not sit on work surfaces. 5

5. General Ward Kitchens Procedures Ward kitchens are to be used by authorised staff only. Patients and visitors MUST NOT use these kitchens for either the preparation of food or drink. General Ward Kitchen Hygiene 1. Keep hands off food as far as possible. All staff must use clean serving utensils to prevent cross contamination. 2. Ensure that any spillage of food is cleaned up immediately with a green disposable cloth and disposed of after use. 3. Ensure that all food is labelled and placed immediately in the fridge on arrival to the ward, if it is to be used later. 4. Ensure that all food is covered, labelled and stored correctly. 5. Ensure that food is used within the 'Use by' dates and used in strict rotation. Do not overstock. 6. All opened food items e.g. tea bags, sugar, bread etc. must be stored in washable, lidded containers when not being used. 7. Personal belongings must not be stored in ward kitchens. 8. Use the foot pedal when opening bins and avoid touching the lid with hands. 9. Keep plants and pets out of kitchens. 10. Ensure that all work surfaces/window sills are free from clutter. 11. Do not line drawers or shelves with paper. 12. Do not wash hands at the kitchen sink. Use the dedicated wash hand basin provided. 13. Do not use the wash hand basin for any other purpose than washing hands. 14. Only use a disposable nail brush if absolutely necessary. Nail brushes must be single use only disposed of after use. 15. Report any signs of pest infestations immediately to the Facilities Help Desk ext. 1616. 16. Ensure dishwashers reach the required wash temperature of 60 C and rinse cycle temperature of 80-82 C. 17. Any hand washing of pots must be done in very hot soapy water (appropriate colour coded gloves must be worn) rinsed with hot as you can bare water, care must be taken to avoid scalding. Air dry or thoroughly dry with disposable centre feed paper roll. Cotton tea towels must not be used (except in rehabilitation situations. (See section 11). 18. Ward Kitchen Check List (Appendix 5) must be filled in by all wards at the end of every month and sent to Facilities Soft FM via, post, fax or email. (Details in Appendix 5). The evidence and monitoring of the services provided can be used to improve the cleaning, storing, temperature reporting and repairs required etc. 19. To ensure our water is cold and of the best quality for our patients, and to comply with ECT Water Quality Control & Potable Water Policy, we advise to always run the taps before filling cold water jugs. Ice Making Machines: Ice making machines are for Clinical use only, ice from these machines must not be ingested. 6. Visitors Visitors must not be allowed entry into ward kitchens or the use of any facilities. Visitors should check with the ward sister to see if the patient is permitted food and must only bring in food that is permitted in the leaflet 10412 Guidelines for Visitors Wishing to Bring Food into Hospital for Patients (This leaflet can be found in pdf form at the back of the policy and also can be found in Appendix 9). Patients who choose not to follow dietary advice or trust guidelines in leaflet 10412 may be at risk of food poisoning or reactions to food items, which staff may not be aware of. Therefore it would be advisable for the patient, relative or visitor to sign a Disclaimer Form. The Disclaimer Form and Ward Procedure can be found in (Appendix 7). 6

7. Notices All kitchens must display the following notices: 10 Point Code for Food Handlers (Appendix 1) No Smoking Use of Microwave Ovens in Hospital (if applicable) (Appendix 2) Fridge notice indicating correct use (to be sited on the fridge door) (Appendix 3) Fridge temperature recording chart (to be sited on or near fridge) provided and recorded by the Service Provider. (Appendix 4) 8. Ward Kitchen Fridges 1. It is the responsibility of the Ward Manager, Senior Sister and Housekeeper to ensure the safety of the patients by completing the ward fridge temperature recording sheets. All fridges must have a thermometer inside the cabinet, provided by the ward, to monitor the internal air temperature, which must be checked by the domestic and recorded twice daily, and to be within 1-5 C. If the temperature is not within these limits and is raised to above 8 C, report immediately to the ward staff and Facilities Help Desk ext. 1616. Do not record temperatures from the digital display external thermometer. Units producing their own meals e.g. cluster houses, rehabilitation - fridge temperatures to be taken and recorded three times per day. 2. Fridges must not be over filled to allow air circulation, and should only stock patient food which is date labelled and in a sealed container. 3. Fridges must be regularly defrosted and kept clean, any spillage must be cleaned up immediately. 4. Jugs of milk must always have lids on, and if stored in the fridge must be used up and not refilled to prevent contamination. No additional milk should be added to an existing jug of milk and once used must be washed thoroughly before filling for the next beverage round. 5. Any food kept over from the previous day and out of date food must be discarded each morning by the domestic informing the Housekeeper and Senior Sister first. 6. Staff food must only be stored in staff fridges in a sealed, clean container and labelled with a name and date. Patient s food brought in from home should be similarly contained, see leaflet 10412 Guidelines for Visitors Wishing to Bring Food into Hospital for Patients (Appendix 9) 7. Fridges must not be overfilled with food. Air circulation within the unit is most important to maintain the correct temperature. 8. Any damage to seals which prevents the fridge door from closing properly must be reported immediately to Facilities Help Desk ext. 1616. 9. No clinical items or medicines must be stored in kitchen fridges. 10. Most dietary supplements need to be labelled and refrigerated once opened, and must be used within 24 hours or used within 4 hours once opened if kept at room temperature. See (Appendix 8) for storage and detailed use of individual supplements. 7

9. Patient Meals 1. The service of all meals must be a continuous process carried out by an adequate number of staff. Hot food must be served hot and cold food cold. Where food temperatures can be monitored, hot food must be above 63 C and cold food should be 5 C or below. 2. Staff serving the meals must wash hands using liquid soap and water prior to serving meals and wear a green plastic apron. 3. Not all food trolleys are heated; those which are must be plugged in immediately on arrival at the ward to maintain temperature. 4. Meals travelling to the wards on ambient (un-heated) trolleys must be served immediately on arrival at the ward, so that the correct temperatures are maintained. The Environmental Health Officer has stated that all meals must be served to patients within 20 to 25 minutes of arrival on the ward. 5. Hazard Analysis of Critical Control Points (HACCP) Meal service times must be recorded on ward HACCP form at the start of service to the patients, and on completion of the last patients meal served. This is recommended by our local Environmental Health Officer. Six months of recordings are to be kept visual at ward level for the Environmental Health Officer to inspect during a visit (see Appendix 6). 6. Food must always be handled using serving tongs and spoons, etc. 7. Meals must not be kept warm or reheated in microwave oven, if a patient is not on the ward at meal time. The Catering Department should be contacted and an alternative meal will be provided. ('Use of Microwaves in Hospitals' Appendix 2). 8. Snack Boxes and hot meals are available for patients who have missed a meal, been admitted after an evening meal or are still hungry. These can be obtained by contacting the Help Desk on ext. 1999 and filling in the relevant information. 9. Used meal trays and equivalent that have not been returned to the Catering Department must be placed in the small, covered tray trolleys for later collection. 10. No patient s food trays, especially Red Trays, should be removed from the patient s bedside until the nurse responsible has given permission to the domestic. This ensures patients food or hydration charts are filled in accurately where applicable. 11. Patients should be given approximately seven hot drinks per day, served by the domestic and the nursing staff as and when required. There should be fresh water available and replenished throughout the day, and where patient s fluid intake is recorded a Red Mug can be used. 12. During drinks rounds biscuits should be offered and fresh fruit made available should there be any left from the evening snack. 10. HACCP (Hazard Analysis of Critical Control Points) All food operations and processes must be examined within the trust, and processes put in place with regards to purchase, storage, handling, preparation, cooking, service and transport, to ensure that at each stage the food is being treated in a safe and hygienic way. HACCP Potential to cause harm to the consumer ANALYSIS OF THE RISK The chance that a given hazard will occur CRITICAL CONTROL POINTS A point, step or procedure to which control can be applied and food safety Hazard can be prevented, eliminated or reduced to an acceptable level 8

The Environmental Health Officer (EHO) has established that all HACCP has been provided for processes within the kitchen to the wards and that they are fully compliant with Due Diligence. In order for the Trust to complete the HACCP chain to the patient, it was requested that the tray system with heated billets has only 20 25 minutes to maintain the heat, before the food cools, quality is affected and bacteria could grow. Therefore it was requested that we provide monthly HACCP forms on all the wards providing the times that the first patient is served to the last patient served, which should not go beyond the 25 minutes. This process completes the HACCP chain. The recordings are monitored and held for the EHO visit (Appendix 6). Non-compliance with a request from the EHO would mean that the Trust Due Diligent failure would lead to the trust not having all the documentation required and could lead to a fine and litigation. 11. Rehabilitation Kitchens The same rules and regulations must be adhered to as stated, except that cotton tea towels may be used but must be sent for laundering after each patient use. Patients/residents/clients must be supervised by staff who have received the necessary training in food hygiene. Fresh food must be bought, cooked and served on the same day. Any raw meat stored in a fridge must be covered and placed on a shelf below the ready-to-eat foods. The food prepared must only be eaten by the patient/resident/client group involved in the rehabilitation session. Food poisoning can be very unpleasant and a life threatening condition, especially to vulnerable patients. Staff are responsible in helping to prevent it by having good standards of practice when dealing with food and when using ward kitchens. 12. Guidelines for Patient catering organised by Ward Staff (Excluding rehabilitation or agreed self-catering wards) It is appreciated that on occasions staff may wish to cater for patients on their wards. This policy applies to food supplied to patients/residents/clients that is not prepared or supplied by the Trust's Service Providers or relatives (see leaflet 10412 - 'Guidelines for Visitors Wishing to Bring Food into Hospital for Patients'). Patients are vulnerable to food poisoning pathogens, therefore as a responsible Trust we need to ensure the hygiene standards of all food consumed by our patients. East Cheshire NHS Trust is responsible for providing for the health and welfare of its patients and everything possible is done to ensure that food provided for patients is stored, prepared and served in hygienic conditions. In East Cheshire NHS Trust we are aware of the conditions that food is stored, prepared and served under, and stringent hygiene checks are made. However, the Trust has no means of monitoring the hygienic state of food brought in by other agencies e.g. Private Contractors, Visitors or Staff. 9

A nominated member of staff, who is fully aware of the food hygiene regulations should be consulted and be responsible for ensuring hygiene standards are maintained as far as is reasonably possible during production of the food. It is recommended by Law that anyone handling food must be trained to the level of catering provided. Therefore all staff serving meals to patients must be trained and updated every 3 years at MDGH. Staff working at CWMH are required to follow the Food Safety course every 2 years because they serve open food to patients from a counter hostess service. The course for Food Safety is available on elearning and takes approximately 20 minutes to complete. HACCP Instruction Training - ½ hour session on the HACCP principals can be arranged at ward level via Facilities Soft FM ext. 1334. It is not intended that these guidelines should prevent patient enjoyment, but they will ensure that food provided for their enjoyment is stored, prepared and served in hygienic conditions. 12.1 Hot Food Under no circumstances must hot food (see paragraph referring to Takeaways) or food requiring reheating, be brought in to hospital to be served to patients. Please request that any relative / friend bringing food into a patient in hospital which is not on the permitted list signs a disclaimer form (Appendix 7) should they still insist on having the food. Takeaway Food: Should not be brought in for patients. If purchased for agreed care homes the food must be consumed immediately and under no circumstances be kept warm or reheated. 12.2 Cold Food Raw foods requiring cooking, including fresh eggs, must not be brought in to hospital. 12.3 Commercially Prepared Foods i.e. Tinned goods, prepared sweet products (cheesecakes, trifles, yoghurts, etc), cooked meats (vacuum packed) and ready-made dishes. These food items, by the nature of the way they are produced and the strict hygiene controls placed upon manufacturers, ensure that they are safe to use. However, these products must be stored as recommended on the packaging, chilled in transit in a cool bag or box, and used the same day. The day of consumption must be within the manufacturers recommended 'Use by' date. Therapeutic Diets If a patient needs a special diet as part of their treatment, it is important that food brought is checked and meets the requirement. Soft cheeses, pates and eggs of any kind must not be brought in and given to patients. This follows recommendations from the Department of Health concerning vulnerable groups and problems associated with Listeria and Salmonella eg. Pregnant women, immuno compromised patients. List of high risk food is in Leaflet Guidelines for visitors wishing to bring food into hospital for patients. (Appendix 9) 12.4 Home-made dishes/sandwiches It is recommended that any home-made dishes, certainly meats, cream, custard, fish, chicken, milk-based sauces, sausage rolls, vol-au-vents, chicken drumsticks, sandwiches and trifles are not brought in for patients. 12.5 Kosher, Caribbean and Halal meals Selections of meals are always available for certain religious beliefs. The catering manager or dedicated chef is available to discuss the menu with patients on request, should there be any problems with the choices. If you have any queries, please contact: 10

Catering Contract Manager, ext. 1631 Trust Facilities Soft FM, ext. 1334 Infection Prevention & Control Team ext. 1597 The Catering Department can provide food for staff organised functions in hygienic conditions and competitive prices. For further information, please contact: Retail Catering Manager, ext. 1632 or 1631. 13. Guidelines for Staff Catering for Functions/Entertainment This falls into three categories: 13.1 Individual Staff / Ward / Departmental / Office Parties Catered For By Individual Contributions of Food. (The Trust will not take any responsibility for any food brought on site for consumption in this section) It is recommended that the following codes of practice are used in these circumstances: Keep food chilled for transportation, especially if the journey is longer than 20 minutes. Food must be kept refrigerated or in a cool box until service time. Food must be kept covered. Any remaining food must be disposed of and not kept for consumption later. Separate food for night staff should be kept chilled and covered for them. Food should be kept on display for a minimal period and certainly for no longer than one and a half hours. Any meat items e.g. chicken must be well cooked. Serving implements are used to handle food. 13.2 Individual members of staff organising food for a function for staff groups, using an outside Contractor. In these circumstances the nominated individual would be responsible for ensuring the hygiene standards are maintained during production of the food. Therefore this member of staff should be fully aware of the food hygiene regulations and be prepared to make a visit to the venue and inspect the premises they are going to use to ascertain their food hygiene standards. The Trust Facilities Soft FM Catering Monitor will audit premises if requested. 13.3 Charity Catering Events within the Hospital. When an event has not been organised by the registered catering department the responsibility lies with the organiser to ensure that there are some basic ground rules for everyone to follow, particularly in respect of a one off charity event. Occasional events are deemed not to have continuity and therefore do not require catering registration. On this basis simple checks need to be applied in terms of safeguarding the integrity of foods, their hygiene control, preparation, handling storage, food tongs, transportation and temperature control management to the event, maintaining food covering during sales period. 13.4 Making Sure Food is Safe to Sell If you want to provide or sell food at an event, here are some basic questions you need to be able to answer: Are the food preparation, serving facilities and equipment clean and in good repair? Has food been prepared where it does not become contaminated by e.g. pests, waste, domestic birds, dog or cat hairs etc.? 11

Are the washing facilities adequate and used throughout preparation to prevent cross contamination? Some people have allergies; is there someone who can answer questions about the origin of food and its ingredients e.g. nuts, onions, gluten free, etc. Transfer all food in closed sealed containers (temperature controlled where required). Keep all food covered, use tongs for transferring to bags or plate once sold. Due to the high RISK of food poisoning from certain foods, if the temperature cannot be maintained below 5 C it is recommended not to sell High Risk Foods e.g. Fresh Cream Cakes, Cheesecake, Quiche etc. (for food safety reasons these items must be temperature controlled). Food Labelling Food sold for a charity event or community organisations have to follow best practice when they are not registered as a food premises. Voluntary food labelling will be helpful to prospective buyers; particularly if the food contains any ingredients of a common allergen that buyers may need to be aware of further information can be found: The Food Standards Agency, Local Government Association Top Tips and www.food.gov.uk/businessindustry/carerers/food-hygiene/charity-community-groups/#.u5mvlprdvim For further advice contact the Facilities Soft FM Catering Monitor. 14. Monitoring Compliance with the Document An annual review will be undertaken by Facilities Soft FM to ensure the continued effectiveness of the policy: Monitoring: Compliance of staff completing Food Safety Training. Compliance with HACCP on the wards Contracted Food Hygiene Audits The policy will be renewed on a three yearly basis by the Facilities Department. 15. Legislation, Guidelines and Reference Food Safety & Hygiene (England) Regulations 2013 Guidance on Temperature Control Legislation in the UK Regulations (EC) 852/2004 E.C 852/853 Food Hygiene (England) Regulations 2006 HACCP (Hazard Analysis of Critical Control Points) Article 5 of Regs. (EC) No 852/2004 COSHH (Control of Substances Hazardous to Health) Health & Social Care Act updated 2015 Health & Safety at Work Act 1074 Trust - ECT2518 Water Quality Control & Potable Water Policy 2015 Trust CNSG004 Protected Mealtime Policy Trust CNSG005 Red Tray Policy Further information can be found: Food Standards Agency, Local Government Association Top Tips www.food.gov.uk/business-industry/carerers/food-hygiene/charity-communitygroups/#.u5mvlprdvim Pdf Leaflet 10412 - Guidelines for Visitors Wishing to Bring Food into Hospital for Patients. 12

Appendix 1 10 POINT CODE FOR FOOD HANDLERS. 1. Always wash your hands before touching food, between different actions/processes and always after using the toilet. 2. Tell your supervisor or manager at once of any skin, nose throat or bowel trouble to prevent contamination. 3. Cover cuts and sores with a coloured waterproof dressing. 4. Wear clean clothing and when serving patients food, a green protective apron must be worn. A plain wedding band is permitted, but no other jewellery. 5. Remember that smoking in a food room is illegal and dangerous. Never cough or sneeze over food. 6. Keep kitchen equipment and utensils used clean. All food surfaces should be cleaned as you work to prevent contamination. 7. Keep all food covered and either cold or piping hot. Separate raw and cooked food. 8. Keep your hands off food as far as possible by using utensils e.g. spoons, tongs etc. 9. Always use the foot pedal to dispose of waste and keep the lid on the dustbin when not in use. 10. Do not break the law. Tell your supervisor if you cannot follow the rules. ALWAYS REMEMBER FOOD POISONING CAN KILL 13

Appendix 2 THE USE OF MICROWAVE OVENS IN HOSPITALS. In hospitals, the use of microwave ovens is very limited. Staff must ensure that: 1. Food sent to the wards from the Catering Department at specified meal times must be consumed as soon as possible after arrival on the ward and certainly within 30 minutes. 2. All food not consumed at the meal time must be disposed of and never kept for reuse and must never to be re-heated in a microwave or by any other means. If a patient is absent from at ward a meal time or may require a meal at a later date (e.g. on the Paediatric Unit) the Catering Department must be contacted (within their working hours) and a meal will be provided for that patient. This may be a cook-chill meal which must be microwaved for a specific length of time (plus 2 minutes standing time when the food will continue to cook). Remember food must be kept hot or be kept cold, or not kept at all. Cleaning and Maintenance of Microwave Ovens: (It is not the responsibility of the Contract Cleaners to clean the ward microwaves) 1. Any spillages in the microwave oven must be cleaned immediately after use and not allowed to dry.. 2. Staff are responsible for the cleaning of the microwaves as they are not used for patient s meals. 3. The microwave ovens must be regularly monitored for leakage. This notice should be displayed by the microwave oven. 14

Appendix 3 Please label any food left in this fridge with PATIENT S NAME AND DATE. Any food not labelled or considered out of date will be thrown away. Stock rotation is essential. Record the temperature daily to ensure the fridge is between O C 5 C. Ring Estates on 1616 when the temperature is too high 15

Appendix 4 WARD KITCHEN FRIDGE TEMPERATURE RECORD MONTH. WARD.. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 AM PM COMMENTS Please record the internal thermometer temperature twice per day. Example of the type provided by the contractor and will require the same information, including outcomes. The recordings must be between 0 C-5 C. If the temperature remains above 5 C for over an hour, please ring the Estates Help Desk on ext.1616 16

Appendix 5 HOSPITAL WARD KITCHEN CHECKLIST Hospital Ward 1 REFRIGERATOR a) Patient s food must be stored in the fridge labelled with name & date (this must be disposed of after 24 hrs). Only permitted food accepted, stored in a plastic box. Staff food must not be stored in patient s fridges. b) Clean inside & out and free from food debris 17 Month of Inspection Inspected By Yes No Action Taken Action by Ward Staff c) Undamaged inside and out Estates Door seal clean and undamaged d) and closes correctly to maintain temperature. Estates e) Ensure all fridges have the blue information label as stated in the Food Safety Policy. Estates f) Defrosted regularly each month. g) Working between 3 C 5 C Report fault immediately Estates h) Please ensure you have a separate thermometer inside the fridge by Law to take the readings twice daily. Ward Staff i) Are temperatures recorded twice daily on the fridge chart by the domestic Ward Staff j) Are the milk bottles clean and at a temperature of below 5 C Milk in a Estates jug must be stored with a lid on, in the fridge. k) Is food within its use by date? Ward Staff l) Is there evidence of clinical items being stored in the fridge. 2 FREEZERS Ward Staff a) Working between -18 C 22 C Estates b) Clean and defrost monthly inside & out and ensure weekly seals are not Ward Staff damaged. 3 PATIENT MEALS / BEVERAGE TROLLEY a) Surfaces clean & free from stains, spillages & food debris. b) Internal shelves clean and free from food. c) Working efficiently. If not report to the Contract Catering Manager. Catering

d) Drainpipe free from lime scale. e) Wheels are cleaned and steam Estates cleaned monthly or when required. f) Biscuits are provided by the wards Ward Staff and offered at mid-morning/afternoon s rounds. g) Milk in a jug with a lid, and sugar is dispensed from the trolley dispenser to prevent cross contamination. Ward staff 4 STORAGE CUPBOARDS AND SHELVES a) Work surfaces clean and in good order? b) Cupboards & drawers cleaned weekly, no lining paper, free from Ward Staff food debris and inappropriate items? c) Are tops of all cupboards clear and clean? d) Has stock been rotated on the ward? Ward Staff e) All open food stored in clean plastic lidded containers (including tea, coffee and sugar)etc. j) Are condiments, sauces and food containers labelled, stock rotated, clean and kept in the fridge when applicable? 5 SINKS AND DRAINS a) Sinks, drainage boards and work surfaces are clean and free from food debris? b) Paper towels dispensed from the centre feed are only used for drying (no linen tea towels or hand towels). c) Are all green cleaning cloths and scouring pads disposed of at the end of the day? 6 DISHWASHER a) Is the above clean inside & out and free from lime scale? b) Working efficiently. Report faults immediately to the service contractor. Ward Staff Ward Staff Ward Staff Ward Staff Contractor Help Desk 7 GENERAL a) Floor is clean, dust free (particular in corners and under sink units) b) Floor is in good state of repair? Estates c) Walls are clean, dust free, no food debris (behind sinks, work surfaces and fridges)? d) Walls are in good state of repair with Estates no cracks or tape marks? e) Light food storage tray trolleys are clean including wheels and underside of shelves? f) Hot food has been disposed of immediately after service? Ward staff 18

g) Extractor fans are free from dust and Estates grease? h) Extractor fans working efficiently? Estates i) 10 Point Code of Kitchen and Microwave Instruction posters are displayed? j) Notices are laminated, attached with blue tack or double sided tape? h) Patients hand wipes are available at all meal times. i) Greens aprons are available and worn by staff when handling food and drinks. j) Wash hand basin and taps are clean? k) Paper towel holders replenished and clean? l) Liquid soap replenished and clean inside, outside and underside? m) Foot operated lidded waste bin available & clean inside and out? 8 TOASTERS (Never use unattended) (Always un-plug when cleaning) Ward staff Ward staff Ward staff Ward staff Ward Staff a) Unplug when not in use. Ward staff b) Working efficiently? Estates c) Clean and free from crumbs? Ward Staff d) Gluten Free Patients. Are you Ward Staff providing bags for the toaster? To prevent contamination. 9 MICROWAVE OVENS (Industrial type only) a) Clean inside and out? Ward staff b) No damage to lead or plug? Estates 10 HACCP (Hazard Analysis of Critical Control Points) a) Have you filled in your HACCP form at both lunch & supper? b) Are the fridge temperatures being recorded by the twice daily? c) File consisting of six months of Ward Cleaning Checklists for evidence. HACCP recording sheets, retained on the ward; checks will be undertaken by Monitoring and EHO. Ward staff Ward staff check. Ward Staff 19

REMEMBER THE RESPONSIBILITY MAY BE YOURS... all levels of Management that may have either a direct or indirect responsibility for food services and hereby statutory obligations. (Management of Food Services and Food Hygiene in the NHS) Food Safety & Hygiene (England) Regulations 2016 EC 852/853 Control of Substances Hazardous to Health Regulations (COSHH) 2017 The Food Safety Act 1999 / 2006 HACCP (Hazard Analysis of Critical Control Point) Article 5 of Regs (EC) No 852 / 2017 Food Safety (Temperature Control / Regulations 1995 (EC) Regulations 852/ 2013 Health &Social Act update 2015 The Codes of Practice for Prevention & Controls of Healthcare Associated Infections 2008 Health & Safety at Work Act 1974 Food Allergen & Labelling under the EU Food Information for Consumers 1162/2011 PENALTIES CAN LEAD TO UNLIMITED FINES UP TO 2 YEARS IMPRISONMENT These penalties can be imposed on the responsible employee, his or her superiors for not conforming to HACCP recording requested by The Local Environmental Health Officer (EHO) General Inspection Comments:- Signature Job Title Date This form must be completed at the end of the month and forwarded to Facilities (Soft FM) by the beginning of each month QUICK TELEPHONE NUMBERS 1616 1661 / 1660 3386 / 1334 1630/1631 1597 Facilities Help Desk Services Monitoring Catering Department Infection Prevention & Control If following contact with the service provider your problems have not been resolved or they are frequently reoccurring, please contact Facilities (Soft FM) on extension 1334 or 3386 who will be pleased to offer any assistance or advice you may require Further copies of this form may be obtained from the Print Room Ref CPY 1224 2017-20 20

Appendix 6 HACCP Meal Distribution Recording Form Before serving the food & drinks wash hands, put on a green apron, ensure that bedside table is clear & ready to take the patient s food tray and offer wipes to patients. This form must be retained at ward level for 6 months for inspection by EHO / Monitoring Office. Ward: Month: Score Date Lunch Supper Monitoring / Comments Start Time End Time Start Time End Time For use by staff and the Monitoring Office 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 CPY 186 10/17 21

Appendix 7 Patients Food Disclaimer Form On Behalf of the Service Provider:.. Patient Name: Patients NHS No: Ward: Date:. Name of member of staff attending patient:.. Designation: The Catering Department provides meals to patients that have been stored, cooked and served following strict Food Safety Laws. Please tick in the box which applies:- I understand that during my stay in hospital I have chosen on this occasion to have food brought in, and have chosen not to have a meal from the main menu, or further suggestions which could have been be provided by the Catering Department. The food provided from an outside source may be contaminated, and may not have been transported at a safe temperature, which may increase the chances of a RISK with this food. I therefore sign this disclaimer. Or I have chosen to have meals from the main menu rather than the special diet/menu which has been advised. In the case of gluten free diets for coeliac disease it cannot be guaranteed that food from the main menu is gluten free. Name of Patient or Relative:.. Date:. Signature:.. A copy of this disclaimer form been placed into the patient s notes, and also sent to the Catering Department: YES / NO (Please indicate) 22

Ward Procedure for Patients who Refuse Special Diets or Food Provided, to be Logged on a Disclaimer Form A. For those patients already referred to the dietitian:- If the patient refuses to eat the special meals provided e.g. Gluten-free, lactose-free, low potassium, very low fat, low residue, restricted diets due to allergy/intolerance. 1. Clearly document the situation in the patient s nursing notes and/or medical notes. 2. Ward staff to contact the dietitian who will review the patient (Monday-Friday), explain the need for the diet and the consequences of non-compliance. 3. The dietitian will document the discussion and the outcome in the patient s medical notes and dietetic notes. 4. If the patient still refuses to comply with the special diet they should sign a disclaimer. A copy of the disclaimer should be included in: a. Medical notes b. Dietetic notes c. Catering department file 5. The patient may then choose from the standard menu and the catering department will send what is ordered and the patient will be removed from the dietitian s menu list and may be discharged from the service. B. For those patients who are NOT already known to the dietitian:- 1. Clearly document the situation in the nursing and/or medical notes. 2. Consider whether a referral to the dietitian may be helpful in aiding compliance. 3. If appropriate, refer to the dietitian then follow steps for patients already referred to the dietitian. 4. If still not referred to the dietitian, ask the patient to sign a disclaimer. A copy should be included in: a. Medical notes b. Catering department file C. For those patients who will just not eat the food provided:- 1. Clearly document the situation in the nursing and/ or medical notes & Disclaimer Form 2. Ask all parties to sign the form as requested. A copy should be included for evidence if required due to a Food Poisoning Outbreak with that patient:- a. Medical notes b. Catering department file (This will form part of our Due Diligence defence of our HACCP Systems) 23

Appendix 8 How Supplements should be stored and used Unopened supplements should be stored in a cool (5 C-25 C) dry place. Some, e.g. Ensure Plus Milkshake and Ensure Plus Juce are more palatable if served chilled from the ward fridge. Always check best before date before using. Once opened the following guidelines should be followed: Label Required Once Opened Use Within Additional Information Calogen Date 14 days Calogen Extra Date 48 hours Must be stored in drugs fridge (<5 C) Enshake, Ensure Compact, Ensure Plus Crème, Ensure Plus Fibre, Ensure Plus Juce, Ensure Plus Milkshake, Ensure Two Cal, Meritene, Nepro, Nutilis Stage 1 and 2 Date and time 4 hours Can be stored for up to 24 hours if refrigerated immediately after opening Maxijul Powder, Duocal Date 1 month Store in cool dry place once opened Paediasure, Paediasure Plus, Paediasure Fibre, Paedisure Juce Date and time 4 hours Can be stored for up to 24 hours if refrigerated immediately after opening 24

Appendix 9 Patient Information Leaflet Guidelines for visitors wishing to bring food into hospital for patients Macclesfield District General Hospital www.eastcheshire.nhs.uk Leaflet Ref: 10412 Published: Review: 2020 Page 0

Appendix 9 Patient Information Leaflet Introduction Patients in hospital receive a well-balanced, nourishing diet. Meals are carefully prepared and cooked in the hospital s own kitchens to a very high standard. However, we recognise that patients may ask for food from home, or visitors might bring in gifts of snacks or fruit. Before bringing food or drink into hospital, please follow these simple guidelines. They will help to support patients on restricted diets and help us to maintain high standards of food hygiene. Foods not to bring The foods listed below must NOT be brought into the hospital because they may be contaminated with harmful bacteria: pâtés soft cheeses such as Brie and Camembert fresh cream items e.g. Cream Cakes, Trifle etc. eggs raw meat and fish ready prepared meals (freshly made or microwaveable meals) home-made or bought sandwiches. Foods you may bring Food and drinks listed below may be safely brought into hospital providing they are properly prepared and packaged: fresh fruit biscuits cakes without cream tinned fruits packaged savoury snacks sweets and chocolate fresh fruit juices squashes and cordials mineral water commercially prepared desserts e.g. yoghurts, fromage fraïs provided they are transported in a cool bag. favourite brands of tea. Leaflet Ref: 10412 Published: Review: 2020 Page 1

Appendix 9 Patient Information Leaflet Other information Always check with the nurse in charge or the patient s named nurse before taking food onto the ward. If food is not to be eaten straightaway, please give it to a nurse so that it may be properly stored until it is needed. Remember, there is only limited space available in the ward fridge. Please keep food quantities small. For food safety reasons, food and drink must be as fresh as possible. They must be stored in a clean sealed container, which is clearly labelled with contents, date, and the name of the person it is intended for. No food will be stored for more than 24 hours unless it is pre-packaged and within its sell-by date. Only bring cold or chilled food into the hospital and make sure it arrives fresh from the fridge, ideally in an insulated chilled container. Please do not bring any food that requires cooking or reheating. We provide food and menus for people with special cultural, religious and dietary needs. Patients should discuss their individual dietary needs with the senior nurse or dietitian, who will make sure the Catering Department, is kept fully informed. If you would like to know more about safe foods and food hygiene, please contact: Facilities Monitoring - Phone: 01625 661334 or Head of Nutrition and Dietetics - Phone: 01625 661126 or Catering Manager 01625 661631 or Facilities Manager - Phone: 01625 661626 or Senior Infection Control Nurse - Phone: 01625 661597 Leaflet Ref: 10412 Published: Review: 2020 Page 2

Appendix 9 Patient Information Leaflet Comments, compliments or complaints We welcome any suggestions you have about the quality of our care and our services. Contact us: Freephone: 0800 1613997 Phone: 01625 661449 Textphone: 01625 663723 Customer Care, Reception, Macclesfield District General Hospital, Victoria Road, SK10 3BL For large print, audio, Braille version or translation, contact East Cheshire NHS Trust operates a smoke-free policy (including e- cigarettes) For advice on stopping smoking please contact the KICKSTART Stop Smoking service on 01625 553 429. East Cheshire NHS Trust does not tolerate any form of discrimination, harassment, bullying or abuse and is committed to ensuring that patients, staff and the public are treated fairly, with dignity and respect. Leaflet Ref: 10412 Published: Review: 2020 Page 3