13.1 GENERAL STANDARDS The facility shall provide meals that are nutritious; attractive; well balanced; in conformity with practitioner orders and resident choice and served at the appropriate temperature in order to enhance residents' health and well being. It shall also offer nourishing snacks.
13.2 ORGANIZATION The facility shall have an organized food service that is appropriately planned, equipped and staffed to prepare and serve meals. The facility shall offer at least three meals daily at regular times comparable to normal mealtimes in the community or in accordance with resident needs, preferences, requests and plan of care. The facility shall make available suitable, nourishing alternative meals and snacks for residents who want to eat at non-traditional times or outside of scheduled meal service times and in accordance with the resident plan of care.
13.3 PERSONNEL The administrator shall designate a Registered Dietitian who meets standards established by the Commission on Dietetic Registration to be responsible for the dietary services.
A) If not a Registered Dietitian, the designee shall receive regularly scheduled consultation for dietary services oversight from a Registered Dietitian and have applicable qualifications that meet at least one of the criteria listed below. 1) A Bachelor's degree with a major study in food, nutrition, dietetics, or hotel and/or restaurant management,2) An Associate's degree with a major in dietetic technology, food management, culinary arts or hotel and/or restaurant management,3) Eligible to take the exam for certifying dietary managers or culinary certification from a national credentialed organization,4) A graduate of a state approved course of 90 hours for food service management and two years food service management experience,5) Military education and training equivalent to subsection (2) or (4), or6) A combination of training and experience deemed appropriate by the nursing home administrator to meet the expectations for providing comprehensive dietary services oversight.B) The number of trained food service personnel shall be sufficient to provide food service to the residents in the facility over a period of 12 hours or more per day.13.4 POLICIES The facility shall have written policies and procedures approved by the governing body for dietary practices.
13.5 ORDERS All diets and nourishments shall be provided and served as ordered by the attending practitioner.
13.6 NUTRITIONAL ASSESSMENT AND PROGRESS NOTES The dietary supervisor or consultant shall participate in resident assessment and care planning required in sections 7.16, 7.20, and 7.21 of this chapter.
A) The supervisor or consultant shall write progress notes on each resident at six-month intervals, at a minimum.B) The facility shall reasonably accommodate individual resident preferences in meals by offering appropriate and nutritionally adequate substitutes.13.7 DIET MANUAL The facility shall maintain a current diet manual conveniently available to the dietary and nursing staffs. For purposes of this section, current means initially published or revised within five years.
13.8 MENUS A) Menus shall meet the nutritional needs of residents in accordance with the Dietary Reference Intakes: The Essential Guide to Nutrient Requirements, National Academy of Sciences, Institute of Medicine, Food and Nutrition Board (2006), which is incorporated by reference consistent with section 1.3 of this chapter.B) Menus shall be written, approved by a Register Dietitian and planned at least one week in advance, with consideration given to residents' personal tastes, desires and cultural patterns. Menus shall be posted in the kitchen area and retained by the facility for at least four weeks after the menu is used. If menus are changed, all changes shall be posted as served.C) A standard meal planning guide shall be used primarily for menu planning and food purchasing. It is not intended to meet the nutritional needs of all residents. This guide shall be adjusted to consider individual differences since residents may have different nutritional needs based upon age, size, gender, physical activity and state of health.1) There are many meal planning guides from reputable sources such as the American Diabetes Association, Academy of Nutrition and Dietetics or U.S. Department of Agriculture that are available and appropriate for use when adjusted to meet each resident's needs. Recipes appropriate to the menus and needs of the facility shall be available to the cooks.13.9 SPACE The facility shall provide adequate space to accommodate fixed and movable equipment and employee functions; receive, store, refrigerate and prepare food; assemble trays; store carts and clean dishes, pots, and pans.
13.10 REFRIGERATOR SAFETY Effective June 1, 2016, walk-in refrigerators and freezers shall have inside lighting and inside lock releases. In facilities where the walk-in refrigerators or freezers do not have an inside lock release, there shall be an alarm system that is clearly audible throughout the food preparation and storage areas of the facility and that may be readily activated by staff members from within the walk-in refrigerators or freezers.
13.11 EQUIPMENT The facility shall provide equipment of sufficient amount and adequate type for efficient and timely preparation of meals.
13.12 STORAGE OF DISHES AND GLASSES Clean glasses, cups and other dishes shall not be stored in such a manner as to entrap moisture.
13.13 RESIDENTS IN ISOLATION Disposable dishes and utensils are acceptable for use with residents in isolation.
13.14 NAIL POLISH AND FALSE NAILS Unless wearing intact gloves in good repair, staff involved in preparing and serving food shall not wear nail polish or false nails.
13.15 DINING AND RECREATIONAL FACILITIES Dining and recreation areas shall be readily accessible to all residents and shall not be in a hallway or lane of traffic in or out of the facility. Such space shall be sufficient to accommodate activities conducted there, consistent with resident comfort and safety. The dining and recreation areas may be separate or combined.