20 CAR § 410-1004 – Dietary services — Required facility dietary services

(a)
1. (1) As part of the basic charge, each assisted living facility must make available food for three (3) balanced meals, as specified in 20 CAR § 410-803(b)(1)(F), and make between-meal snacks available.
2. (2) Potable water and other drinking fluids shall be available at all times.
3. (3) Meals shall be served at approximately the same time each day.
4. (4) There shall be no more than five (5) hours between breakfast and lunch and no more than seven (7) hours between lunch and the evening meal.
5. (5)
  1. (A) Variations from these stated parameters may be permitted at the written request of the resident or his or her responsible party or as directed by the resident’s personal physician or advanced practice nurse in writing.
  2. (B) The facility shall retain documentation stating the reason for the variance.
(b) For those residents who wish to have meals served in their apartment or unit, the facility shall include this service as part of the service package, either for free, or for an additional fee basis, and indicate as such in the occupancy admission agreement.
(c)
1. (1) In the event that a resident is unable or unwilling to consume regular meals served to him or her for more than two (2) consecutive days, the facility shall immediately notify the resident’s personal physician or advanced practice nurse and take appropriate action to ensure the physician or advanced practice nurse’s instructions are implemented.
2. (2) If a resident chooses not to consume regular meals, it must be documented in the resident’s service plan portion of the occupancy admission agreement.
3. (3) In the event that the resident refuses to provide a written statement, the facility shall document the refusal as well as all contact with the resident’s personal physician or advanced practice nurse regarding the resident’s refusal to eat.
(d)
1. (1) A supply of food shall be maintained on the premises at all times.
2. (2) This shall include at least a twenty-four-hour supply of perishable food and a three-day supply of nonperishable food.
3. (3) The food supply shall come from a source approved by the Department of Health.
4. (4) Assisted living facilities attached to other licensed long-term care facilities may utilize the kitchen facilities of the attached long-term care facility, however, the assisted living facility shall ensure that the kitchen facilities so utilized are adequate to meet the needs of the residents of the assisted living facility.
(e) Dietary personnel/staff/employees shall wear clean clothing and hair coverings.
(f) Each facility shall comply with all applicable rules relating to food service for sanitation, safety, and health as set forth by state, county, and local health departments.
(g) Food service personnel/staff/employees shall ensure that all food is prepared, cooked, served, and stored in such a manner that protects against contamination and spoilage.
(h) The kitchen and dining area must be cleaned after each meal.
(i)
1. (1) An adequate supply of eating utensils, e.g., cups, saucers, plates, glasses, bowls, and flatware, will be maintained in the facility’s kitchen to meet the needs of the communal dining program.
2. (2) An adequate number of pots and pans shall be provided for preparing meals.
3. (3) Eating utensils shall be free of chips or cracks.
(j)
1. (1) Each assisted living facility shall have adequate refrigeration and storage space.
2. (2) An adequately sized storage room shall be provided with adequate shelving.
3. (3) The storage room shall be constructed to prevent the invasion of rodents, insects, sewage, water leakage, or any other contamination.
4. (4) The bottom shelf shall be of sufficient height from the floor to allow cleaning of the area underneath the bottom shelf.
(k)
1. (1) Refrigerator temperature shall be maintained at forty-one degrees Fahrenheit (41° F) or below, and freezer temperatures shall be maintained at zero degrees Fahrenheit (0° F) or below.
2. (2) Thermometers will be placed in each refrigerator and freezer.
(l)
1. (1) Raw meat and eggs shall be separated from cooked foods and other foods when refrigerated.
2. (2) Raw meat is to be stored in such a way that juices do not drip on other foods.
(m) Fresh whole eggs shall not be cracked more than two (2) hours before use.
(n) Hot foods should leave the kitchen or steam table above one hundred forty degrees Fahrenheit (140° F) and cold foods at or below forty-one degrees Fahrenheit (41° F).
(o)
1. (1) Containers of food shall not be stored on the floor of a walk-in refrigerator, freezer, or storage room.
2. (2) Containers shall be seamless with tight-fitting lids and shall be clearly labeled as to content.
(p)
1. (1) In facilities that have a residential-type kitchen, a five-pound ABC fire extinguisher is required in the kitchen.
2. (2) In facilities that have commercial kitchens with automatic extinguishers in the range hood, the portable five-pound fire extinguisher must be compatible with the chemicals used in the range hood extinguisher.
3. (3) The manufacturer recommendations shall be followed.
(q)
1. (1) Food scraps shall be placed in garbage cans with airtight fitting lids and bag liners.
2. (2) Garbage cans shall be emptied as necessary, but no less than daily.
(r) Leftover foods placed in the refrigerator shall be sealed, dated, and used or disposed of within forty-eight (48) hours.
(s) Personnel/staff/employees shall not use tobacco in any form while engaged in food preparation or service, nor while in areas used for equipment or utensil washing, or for food preparation.
(t)
1. (1) Menus shall be posted on a weekly basis.
2. (2) The facility shall retain a copy of the last month’s menus.
(u)
1. (1) Therapeutic diets shall be planned by a licensed dietician.
2. (2) The dietician should review any dietetic changes.
(v) Each assisted living facility shall make available a dietary manager who is certified as required by law or rule to prepare nutritionally balanced meal plans in consultation with staff and residents or their responsible parties.