Ariz. Admin. Code § 9-10-423

Current through Register Vol. 30, No. 24, June 14, 2024

Section R9-10-423 - Food Services

A. An administrator shall ensure that:

1. The nursing care institution has a license or permit as a food establishment under 9 A.A.C. 8, Article 1;

2. A copy of the nursing care institution's food establishment license or permit is maintained;

3. If a nursing care institution contracts with a food establishment, as established in 9 A.A.C. 8, Article 1, to prepare and deliver food to the nursing care institution:

a. A copy of the contracted food establishment's license or permit under 9 A.A.C. 8, Article 1 is maintained by the nursing care institution; and

b. The nursing care institution is able to store, refrigerate, and reheat food to meet the dietary needs of a resident;

4. A registered dietitian:

a. Reviews a food menu before the food menu is used to ensure that a resident's nutritional needs are being met,

b. Documents the review of a food menu, and

c. Is available for consultation regarding a resident's nutritional needs; and

5. If a registered dietitian is not employed full-time, an individual is designated as a director of food services who consults with a registered dietitian as often as necessary to ensure that the nutritional needs of a resident are met.

B. A registered dietitian or director of food services shall ensure that:

1. Food is prepared:

a. Using methods that conserve nutritional value, flavor, and appearance; and

b. In a form to meet the needs of a resident such as cut, chopped, ground, pureed, or thickened;

2. A food menu:

a. Is prepared at least one week in advance,

b. Includes the foods to be served on each day,

c. Is conspicuously posted at least one day before the first meal on the food menu will be served,

d. Includes any food substitution no later than the morning of the day of meal service with a food substitution, and

e. Is maintained for at least 60 calendar days after the last day included in the food menu;

3. Meals and snacks for each day are planned and served using the applicable guidelines in http://www.health.gov/dietaryguidelines/2010.asp;

4. A resident is provided:

a. A diet that meets the resident's nutritional needs as specified in the resident's comprehensive assessment and care plan;

b. Three meals a day with not more than 14 hours between the evening meal and breakfast except as provided in subsection (B)(4)(d);

c. The option to have a daily evening snack identified in subsection (B)(4)(d)(ii) or other snack; and

d. The option to extend the time span between the evening meal and breakfast from 14 hours to 16 hours if:

i. A resident group agrees; and

ii. The resident is offered an evening snack that includes meat, fish, eggs, cheese, or other protein, and a serving from either the fruit and vegetable food group or the bread and cereal food group;

5. A resident is provided with food substitutions of similar nutritional value if:

a. The resident refuses to eat the food served, or

b. The resident requests a substitution;

6. Recommendations and preferences are requested from a resident or the resident's representative for meal planning;

7. A resident requiring assistance to eat is provided with assistance that recognizes the resident's nutritional, physical, and social needs, including the use of adaptive eating equipment or utensils;

8. Tableware, utensils, equipment, and food-contact surfaces are clean and in good repair;

9. A resident eats meals in a dining area unless the resident chooses to eat in the resident's room or is confined to the resident's room for medical reasons documented in the resident's medical record; and

10. Water is available and accessible to residents.

C. If a nursing care institution has nutrition and feeding assistants, an administrator shall ensure that:

1. A nutrition and feeding assistant:

a. Is at least 16 years of age;

b. If applicable, complies with the fingerprint clearance card requirements in A.R.S. § 36-411;

c. Completes a nutrition and feeding assistant training course within 12 months before initially providing nutrition and feeding assistance;

d. Provides nutrition and feeding assistance where nursing personnel are present;

e. Immediately reports an emergency to a nurse or, if a nurse is not present in the common area, to nursing personnel; and

f. If the nutrition and feeding assistant observes a change in a resident's physical condition or behavior, reports the change to a nurse or, if a nurse is not present in the common area, to nursing personnel;

2. A resident is not eligible to receive nutrition and feeding assistance from a nutrition and feeding assistant if the resident:

a. Has difficulty swallowing,

b. Has had recurrent lung aspirations,

c. Requires enteral feedings,

d. Requires parenteral feedings, or

e. Has any other eating or drinking difficulty that may cause the resident's health or safety to be compromised if the resident receives nutrition and feeding assistance from a nutrition and feeding assistant;

3. Only an eligible resident receives nutrition and feeding assistance from a nutrition and feeding assistant;

4. A nurse determines if a resident is eligible to receive nutrition and feeding assistance from a nutrition and feeding assistant, based on:

a. The resident's comprehensive assessment,

b. The resident's care plan, and

c. An assessment conducted by the nurse when making the determination;

5. A method is implemented that identifies eligible residents that ensures only eligible residents receive nutrition and feeding assistance from a nutrition and feeding assistant;

6. When a nutrition and feeding assistant initially provides nutrition and feeding assistance and at least once every three months, a nurse observes the nutrition and feeding assistant while the nutrition and feeding assistant is providing nutrition and feeding assistance to ensure that the nutrition and feeding assistant is providing nutrition and feeding assistance appropriately;

7. A nurse documents the nurse's observations required in subsection (C)(6); and

8. A nutrition and feeding assistant is provided additional training:

a. According to policies and procedures, and

b. If a nurse identifies a need for additional training based on the nurse's observation in subsection (C)(6).

Ariz. Admin. Code § R9-10-423

Adopted effective January 28, 1980 (Supp. 80-1). Section repealed by final rulemaking at 8 A.A.R. 2785, effective October 1, 2002 (Supp. 02-2). New Section R9-10-423 made by exempt rulemaking at 19 A.A.R. 2015, effective October 1, 2013 (Supp. 13-2). Amended by exempt rulemaking at 20 A.A.R. 1409, effective 7/1/2014.