Clinical Skills Approach

He’s new to social care. He’s good at his job and is always smiling.

She’s proud to be very good at her job

He’s experienced and has high standards

She’s keen, enthusiastic and ambitious and has a responsible job.

Anna is preparing food in the kitchen, but her hair is not tied back securely. This means one or more hairs could escape and fall into the food. Also, she needs to change her chef’s whites. The ones she’s wearing are covered in old food splashes which could be a source of contamination.

Dan has just come back after his lunch break to welcome some visitors. He washed his hands, but failed to notice that he got some of his lunch on his sleeve. Apart from being unhygienic, the food stain looks very unprofessional.

Orla knows that she shouldn’t be eating or drinking at her desk, but she’s brought a sandwich back to her computer for lunch. She should either eat the sandwich immediately or cover it up until she’s ready for it. It’s beginning to go stale and is attracting insects which can carry disease.

Marek has not thoroughly checked the cutlery before putting it out. A dirty fork is very likely to put people off their food – and if not detected, might make someone ill.

Gastrointestinal illnesses (food poisoning) are usually caused by bacteria, including:

Salmonella
Staphylococcus
Clostridium
Shigella
Campylobacter
Escherichia coli (E. coli)

These bacteria can be spread via faeces, hands, soil, and animals such as insects and pets.

The image below is a picture of the E. coli bacterium.

Although some viruses can cause food poisoning, the most common viruses passed along through food contamination are cold and influenza (flu) viruses.
Viruses can be spread by hand, or by coughs and sneezes.
The image below is a picture of the flu virus.

Earlier, Marek handled some discarded peanuts. He then didn’t wash his hands before serving in the dining area. Some dust from the peanuts was still on his hands, and it got into someone’s food. This person was allergic to nuts and had a severe reaction.

Orla was feeling unwell this morning, but she had a lot to do so she took some aspirin and came into work anyway. She quickly washed her hands before serving sandwiches in a meeting. Even so, it turned out that Orla had influenza and two of the visitors caught the illness too.

While Dan was arranging some fresh flowers in reception, some pollen got onto his sleeve. Some of the pollen fell into a cup of coffee that he served to a visitor. The visitor was very upset and demanded to see the manager.

Earlier Anna was making sandwiches. She was very careful to keep different foodstuffs separate, but the utensils she was using for each kind of food were not kept separate. Later, a lady who was very pregnant ate one of the sandwiches. She became ill with food poisoning. The source of the germ was traced to a box of soft cheese in the kitchen, even though the woman had not ordered cheese.

A basin must be available that is purely for washing hands and is used for no other purpose, so as to prevent cross-contamination.

The handwashing basin may be available in a bathroom or toilet, if not in the kitchen.

Hot tap

Plenty of warm water should be available. This makes it easier to wash your hands for longer, and therefore more thoroughly.

You need plenty of soap. The soap should be in a dispenser to help avoid cross-contamination, and must be non-scented.

A mechanical hand dryer or disposable paper towels should be available so as to avoid cross-contamination.

You can find out more about handwashing in the Resources section of this learning.

Marek hasn’t noticed his dandruff and he is still serving in the dining area. Would you want to be served by someone whose dandruff is probably on your food?

Orla has noticed that she has developed a few itchy spots here and there, but she thinks it’s nothing serious so doesn’t report it, even though she’s scratching a lot. It turns out that she has chicken pox. The virus from the scratching spreads rapidly, and several employees and visitors become ill. ?

Anna has a cold sore, which is caused by a herpes virus and is very infectious. She should certainly not be working around food, and should have reported it as soon as it appeared. ?

Dan has a small wart on his finger. He hasn’t really noticed it. Unfortunately the wart is caused by an infectious virus, and the virus is picked up by the hands of visitors whom he greets. ?

Dan often serves coffee to visitors. Every time he makes a fresh cup, he uses a hand sanitiser first to make sure his hands are really clean. Whenever there’s a coffee spill, Dan clears it up immediately – and he has learned the value of wearing his non-slip shoes while he does it!

Marek needs to clean the surfaces in the kitchen and dining area regularly. The anti-bacterial spray he uses for this is quite strong, so he wears gloves to protect his hands.

Orla is helping to lay out a cold buffet for some visitors. She’s wearing a new pair of disposable gloves so that her hands don’t touch the food directly. When she’s finished, she’ll throw away the gloves immediately. If she needs to set out more food, she’ll put on a fresh pair.

Anna puts on clean chef’s whites every day. They show up any food stains and protect her from food splashes. If her uniform does become stained during her shift, she puts on a new one straightaway to avoid the possibility of cross-contamination.

Your kitchen will have a heavy duty dishwasher that is used for cleaning the plates, dishes and cutlery that are used to serve and eat food. It may also be used to clean equipment such as food warmers. The dishwasher is very good at washing things thoroughly. It also washes at a high temperature, which cleans more effectively.

The pots and pans that are used for cooking are often too large to go into a dishwasher. They may also need special attention to scrub away cooked-on food.

A double sink is used to clean this kind of equipment. The pots are cleaned in one sink, using a strong liquid cleaner and very hot water that is changed often. You need to be sure that the amount of cleaner you add is appropriate for the quantity of water you’re using – if in doubt, check the label.

The equipment is then rinsed in the other sink in very hot water fresh from the tap. The equipment is closely inspected to make sure it’s thoroughly clean before it is laid aside for draining and drying. Some utensils may be left to drain and dry naturally in the air, avoiding the need for a tea towel.

A large shallow sink is used to wash food such as fruit and root vegetables, to remove any traces of pesticide or soil. Cold running water alone is used for this, along with a scrubbing brush if needed. The scrubbing brush should be regularly sanitised by running it through the dishwasher or a washing machine.

The preparation of raw meat must be kept totally separate from all other food preparation, including cooked meat. The utensils and equipment used to prepare raw meat must also be kept separate, and must be washed separately. Red chopping boards are used for meat, while a brown board is used for vegetables and a green board is used for salad.

Clean fresh kitchen cloths should be used to wash and to dry raw meat preparation equipment, and these cloths should themselves be washed very frequently.

Marek is wiping down surfaces in the dining area with a cleaner that is getting the job done very thoroughly and very quickly. Unfortunately he hasn’t noticed the sign on the bottle that says this cleaning agent is corrosive. Marek burns his hands as well as the counter, and a customer who touches the surface soon after is also affected.

Although Anna knows that vegetables should be washed using only cold running water, she is using soap because she wants to get these carrots extra clean. Later, when the carrots are served to eat, customers complain that they have a really horrible flavour.

Orla gave her desk a quick wipe down with some spray cleaner, but forgot to wash her hands afterwards. She opens a packet of her favourite crisps for a snack and can’t work out where the horrible taste is coming from.

Dan has used a descaler to clean the coffee machine. He’s followed all the instructions except the one at the end that tells him to rinse through the coffee machine at least twice. This means that the coffee machine still contains traces of descaler, and any coffee made with it also contains descaler.

Used to wash food equipment
Used to dry food equipment
A clean drying cloth can be used to wipe remaining water from items coming out of the dishwasher

Used to wipe down food preparation areas
A separate supply of cleaning cloths may be used to wipe down tables in the dining area
Cleaning cloths might be used with a cleaning or sanitising agent

Used to clean floors only – they might be used with a strong cleaning agent
If a mop and bucket is used to wash the floor, a clean floor cloth might be used to dry it off
Used by employees in the dining area when serving
These are usually special cloths of a higher quality

You may also find that you use a lot of disposable paper towels to wipe up small spills hygienically

Orla has gone to fetch more cereal for breakfast, but there are holes in the bottom of the sack. The small droppings are a sign that mice have probably done the damage, so she reports it immediately.

Dan has found some spilled sugar where visitors were having coffee. It’s a warm day and it hasn’t taken long for some wasps to appear. Dan clears up the sugar immediately, but there still seem to be some wasps around. He reports this and a large wasps’ nest is discovered near the front entrance.

Marek finds a very bold sparrow in the dining area. He discovers that it’s flown in through an open window, looking for crumbs. He reports it because the sparrow could be bringing with it pests such as fleas.

Anna has gone out to the waste bins behind the kitchen. One of them has been tipped over, spilling its contents over the ground, which is itself a big attraction for more pests. Anna reports it immediately so that the mess can be cleared up. It turns out there’s a family of foxes in the area, so the enclosure where the bins are kept is made extra secure.

Objects that could cause injury.

Examples:

Broken glass
Sticking plaster
Jewellery
Staples
Fingernail
False nail

Poisons that occur naturally or are accidentally added when preparing food.

Examples:

Cleaning fluid
Pesticide

Germs/other microorganisms.

Examples:

Parasites
Bacteria
Viruses

Any food that can trigger an allergic reaction in a person who has the allergy.

Examples:

Peanuts
Strawberries
Shellfish

To prevent physical contamination:

Wash fruit and vegetables thoroughly and carefully
Look closely at food you prepare
Keep your food preparation area clean and free from things that could fall into food
Ensure you are following your company’s policy on the wearing of jewellery
Tie hair back off your face
Keep fingernails short and clean
Never wear false nails

To prevent chemical contamination:

Wash fruit and vegetables thoroughly and carefully
Store all chemicals securely away from food, food storage and food preparation areas
Label all chemicals clearly
Use only approved food containers to store food
Make sure food is protected when you leave the kitchen(ALL APPEAR UPON INTERACTION)

To prevent biological contamination:

Ensure food is stored securely at a low temperature
Wash your hands frequently, and always after using the toilet
Use gloves or utensils when handling ready-to-eat food such as cakes, bread, buffet food
Never work with food when you feel ill or are showing signs of illness
Wash and dry all food preparation equipment very thoroughly

To prevent contamination with food allergens:

Ensure all food containing nuts or other potential allergens is clearly labelled
Prevent potential allergens or food containing potential allergens coming into contact with other foo

As we’ve already seen in this course, it’s important to identify and use separate work areas, surfaces and equipment for:

∙Raw food that needs to be cooked before it is eaten

∙Food that is ready to eat

Handwashing

∙Handwashing should be carried out using a recognised technique, such as the one we saw in Section 3 of this course.

∙You should never use anti-bacterial gels as a substitute for thorough handwashing.

These items must:

∙Meet officially recognised standards, and

∙Be used as instructed by the manufacturer

Roast chicken and other poultry should be cooked to a minimum of 74°C at the thickest part of the meat. You can test this core temperature by using a food thermometer. The length of cooking time depends on the size of the roast.

Unless the customer requests pink or rare meat, beef, lamb and pork should be cooked to a minimum of 62°C (75°C in Ireland) at the thickest part of the meat. You can test this core temperature by using a food thermometer. The length of cooking time depends on the size of the roast.

Regardless of how they are cooked, eggs should be cooked to a minimum temperature of 62°C (65°C in Ireland) for at least two minutes and until whites and yolks are firm. If you use a probe to test the inside of the egg, ensure you clean it thoroughly afterwards

Fish and/or shellfish should be cooked to a minimum internal temperature of 62°C or until flesh is opaque or easily separated. The length of cooking time depends on the size of the fish.

A refrigerator should have a maximum temperature of 4°C (5°C in Ireland). It is used to store food that needs to be kept cold but not frozen, such as milk, cooked meat, and yoghurt.

A freezer should be kept at a temperature of -18°C or colder. It is used to store food that must be kept frozen until it is needed, such as raw meat, ice cream, and fish.

Storage shelves away from the main cooking area may be used to store food that is safe to keep at room temperature, such as foods that are dried, tinned or vacuum-packed.

Bulky or heavy food containers might be stored on pallets on the floor away from the main cooking area. All food stored this way will go through a thorough cleaning and cooking process. Examples include sacks of potatoes or other vegetables, or very large unopened tins.

Dan is unpacking mini chocolate bars for a big meeting. Today’s date is 24th June, but the ‘Best before’ date on the box of chocolate bars is two weeks earlier. Dan needs firstly to make sure this chocolate is not available to anybody, and then to report the problem.

Marek has fetched some fresh fruit to serve to customers, but one of the oranges looks as though it’s going bad. As the orange is touching the other fruit in the bowl, all the fruit could be contaminated. Marek needs to throw out all the fruit, thoroughly wash the bowl and the surrounding area, and then get some replacement fruit from the kitchen. While he’s there, he should tell the head chef about the problem.

Orla is passing the breakfast serving area when she notices a couple of serving spoons lying between a large bowl of cornflakes and a large bowl of muesli. The bowl of muesli is clearly labelled to show that it contains nuts, but the serving spoons are not similarly labelled, and are touching each other. Orla realises that this could cause a problem in someone with a nut allergy, so she immediately removes the spoons and ensures that the cornflakes are thrown away. She reports the incident to her manager.

In the kitchen, someone has left some meat to defrost by the sink that is used for washing vegetables. Even though the meat is still wrapped in plastic, there’s a risk it could become contaminated by the soil and dirt that is washed away from items like potatoes and carrots. Anna is right to be concerned, and reports the problem to the head chef immediately.

Employers have to maintain health and safety within the workplace extending to non-employees and members of the public too

The employer must provide adequate personnel, training, equipment and facilities for First Aid if anyone becomes injured or ill.

Management of the Health and Safety at work Regulations 1999

Risk assessments on Health and Safety must be carried out.

∙Police

∙Fire

∙Rescue Ambulance

∙Coastguard

∙Mountain rescue

∙Cave Rescue

The number to dial for the emergency ambulance service is 999 / 112.

Care Certificate

Bullying and Harassment – Biography:

Conflict Resolution

Dementia Care

Privacy and Dignity

Duty of Care

Emergency First Aid Awareness

Epilepsy Awareness

Fire safety

Food Safety Level 2

GDPR Awareness

Health and Safety Awareness

Infection Prevention and Control – Advance

Infection Prevention and Control – Intermediate

Information Governance Awareness Caldicott Principles

Lone Working

Manual Handling of Inanimate Objects

Medication Advanced

Medication Awareness

Mental Capacity and Deprivation of Liberty

Moving and Handling of People

Risk Assessment

RIDDOR Awareness

Safeguarding Adult Awareness