Section 11-94.2-40 - Dietary services(a) The food and nutritional needs of the residents shall be met through a nourishing, well-balanced diet in accordance with the recommended dietary allowances of the Food and Nutrition Board of the National Research Council, and shall be adjusted for age, sex, activity, and disability. (1) At least three meals shall be served daily at regular times with not more than a fourteen hour span between a substantial evening meal and breakfast on the following day;(2) Between meals nourishment that is consistent with the resident's needs shall be offered routinely and shall include a regular schedule of hydration to meet each resident's needs;(3) Appropriate substitution of foods shall be promptly offered to all residents as necessary;(4) Food shall be served in a form consistent with the needs of the resident and the resident's ability to consume it;(5) Food shall be served with appropriate utensils;(6) Residents needing special equipment, implements, or utensils to assist them when eating shall have the items provided by the facility; and(7) There shall be a sufficient number of competent personnel to fulfill the food and nutrition needs of residents. Paid feeding attendants shall be trained as per the facility's state-approved training protocol.(b) All diets prepared for residents shall be:(1) Prescribed by the resident's physician, physician assistant, or APRN with a record of the diet as ordered kept on file;(2) Planned, prepared, and served by qualified personnel according to diet prescription. The current Hawaii Dietetic Association Manual or The Manual of Clinical Dietetics of the American Dietetic Association or both shall be readily available to all medical, nursing, and food service personnel;(3) All diets shall appropriately meet the nutrient, texture, and fluid needs of each resident; and(4) Therapeutic or special diets shall be planned by a dietitian and served accordingly as prescribed by the resident's physician, physician assistant, or APRN. (c) A nutritional assessment and care plan shall be recorded in each resident's medical record and integrated into the overall comprehensive assessment and overall plan of care coordinated/integrated with all disciplines. The nutritional assessment and care plan shall be reviewed on a regular basis and adjusted as needed.(d) The food service shall be directed by a dietary manager. If the food service is directed by a dietary manager who is not a dietitian, there shall be frequent and regularly scheduled consultation with, and in-service education by, a dietitian. Consultation and in-service education shall be appropriate to the needs of the dietary personnel and residents of the facility, and this shall be documented. In-service education specific to the needs of the dietary staff shall be provided at least on a semi-annual basis.(e) A facility may provide for food service by contract with an outside supplier. The method of transport, storage, preparation, and serving of food, as well as the method of providing prompt, appropriate substitution of foods in therapeutic or special diets shall be approved by the dietitian or dietary manager prior to the implementation of the contract.(f) The facility shall have a food service plan documented and available for department review that shall include but not be limited to the following: (1) Menus shall be written at least one week in advance;(2) Menus shall provide a sufficient variety of foods served in adequate amounts at each meal, and be adjusted for seasonal changes along with resident preference;(3) A different menu shall be followed for each day of the week. If a cycle menu is used, the cycle shall cover a minimum of four weeks;(4) All menus shall be filed and maintained with any recorded changes for at least three months; and(5) Menus shall be in place for at least three to five days of meal service in case of a natural or external disaster. A plan for meal service in the event of an internal disaster such as interruption of power or water supply shall also be in place and available for departmental review.Haw. Code R. § 11-94.2-40
[Eff 9/16/2022] (Auth: HRS §§ 321-9, 321-11) (Imp: HRS §§ 321-9, 321-11)