PURPOSE: This rule establishes the minimum standards for providing nutrition services for the elderly with federal or state funds.

PUBLISHER'S NOTE: The publication of the full text of the material that the adopting agency has incorporated by reference in this rule would be unduly cumbersome or expensive. Therefore, the full text of that material will be made available to any interested person at both the Office of the Secretary of State and the office of the adopting agency, pursuant to section 536.031.4, RSMo. Such material will be provided at the cost established by state law.

1. (1) A unit of nutrition service is one (1) meal—

   1. (A) Served to a service recipient in a center for congregate nutrition services; or
   2. (B) Delivered to a homebound service recipient’s home for home-delivered nutrition services.
2. (2) Nutrition service providers shall provide services and meet all requirements set forth in 13 CSR 15-7.010.

3. (3) Staffing and Training.

   1. (A) There shall be an administrator who shall be responsible the operation of the senior center and the service. The administrator, or a person designated by the administrator, shall be present in the senior center at all times the senior center is open.
   2. (B) There shall be an adequate number of staff (paid or volunteer) who are qualified to perform assigned functions in order to implement the activities and services of the senior center.

   3. (C) Training Requirements.

      1. 1. Administrator—six (6) hours’ orienta-

tion plus twelve (12) hours’ supervised onthe-job training and an additional four (4) hours’ in-service training per quarter or sixteen (16) hours annually.

1. 2. Cook—four (4) hours’ orientation

plus six (6) hours’ supervised on-the-job training and additional two (2) hours’ in-service training per quarter or eight (8) hours annually.

1. 3. Cook helper—two (2) hours’ orienta-

tion plus four (4) hours’ supervised on-thejob training and an additional one (1) hour inservice training per quarter or four (4) hours annually. (4) Recordkeeping. The following additional records shall be maintained by nutrition service providers:

1. (A) Daily record of signatures of nutrition service recipients.

   1. 1. The nutrition provider shall maintain

the congregate service sign-in sheet in a convenient location to assure that each service recipient signs for each meal.

1. 2. The nutrition provider shall assure

that home-delivered s are signed for daily by the service recipient.

1. 3. If the service recipient cannot or will

not sign his/her name, the recipient’s representative or another individual designated by the senior center administrator shall sign the service receipt’s name as well as his/her name. Service recipient records shall document why the recipient will not or cannot sign;

1. (B) Meal count or reports, including total United States Department of Agriculture (USDA)-eligible meals, USDA-eligible meals served to low-income elderly minority persons, meals served to handicapped persons eighteen to fifty-nine (18–59) and meals ineligible guests and staff;
2. (C) Perpetual and physical inventory records for all foods; and
3. (D) Food Cost Records.

1. (5) Nutrition Education.

   1. (A) Each senior center shall provide nutrition education programs to service recipients at least quarterly. Programs and literature shall be planned approved by a qualified dietitian or nutritionist.
   2. (B) Each home-delivered meals provider shall provide nutrition education materials to homebound recipients on a quarterly basis.

2. (6) Equipment Requirements.

   1. (A) Whether the senior center is catered or has an on-site food preparation kitchen, adequate equipment shall be available to keep refrigerated foods below forty-five degrees Fahrenheit (45°F), heated foods above one hundred forty degrees Fahrenheit (140°F) and frozen foods at or below zero degrees Fahrenheit (0°F).

   2. (B) Specific equipment required for all centers serving meals is as follows:

      1. 1. A home-style or commercial range;
      2. 2. A home-style or commercial refriger-

ator;

1. 3. A handwashing sink;
2. 4. A three (3)-vat sink or other accept-

able method for dishwashing;

1. 5. A hot table if the senior center serves

a total of thirty (30) meals more per day (if the senior center serves fewer thirty (30) meals per day, the meals can be served direct- 13 CSR 15-7

ly from the insulated carriers, provided meal service begins immediately after the food arrives);

1. 6. A cold table or another acceptable

method of keeping cold food at the proper temperature during food service; and

1. 7. Additional equip as needed and

required by the area agency.

1. (C) Additional equipment required for onsite food preparation senior centers is as follows:

   1. 1. A range with an automatic range-

hood extinguishing system, preferably commercial;

1. 2. Adequate number of refrigerators and

freezers, preferably commercial;

1. 3. A three (3)-vat sink; and
2. 4. Other equipment as determined by the

area agency (ice machine, mixer, dishwasher and the like).

1. (D) Insulated carriers for delivery of the food are required for senior centers receiving bulk prepared foods.

1. (7) Menu Planning Requirements.

   1. (A) Each meal served shall contain at least one-third (1/3) of the current recommended dietary allowances (RDA) as established by the Food and Nutrition Board of the National Academy of Sciences—National Research Council.
   2. (B) A twenty to twenty-eight (20–28)-day menu cycle shall be developed to be repeated for a three (3)-month period using the official menu form provided by the division. Suggestions from service recipients shall solicited regarding menu choices.
   3. (C) Standardized recipes shall be used to assure consistent quality and quantity.
   4. (D) Menus shall be reviewed and certified by a nutritionist or dietitian. This individual must meet the standards set forth in 13 CSR 15-4.240(12). Copies of all certified menus shall be submitted to the area agency and shall be maintained for at least one (1) year.
   5. (E) Menu substitutions shall be made in accordance with the established procedures of the area agency.
   6. (F) Menus shall conform to the meal patterns and principles of menu planning provided by the division.

2. (8) Special menu requirements are as follows:

   1. (A) Special menus shall be provided to meet the particular dietary needs arising from the health requirements, religious requirements or ethnic backgrounds of service recipients, where appropriate;

   2. (B) At a minimum, minor modifications shall be made to the regular mens follows:

      1. 1. For a diabetic diet, a baked, broiled

or boiled meat entree, fresh or unsweetened canned fruits for dessert, two percent (2%) milk and vegetables with no fat seasonings shall be provided;

1. 2. For a four gram (4 gm) sodium diet,

salt shall be red to one-half (1/2) the amount indicated in baked goods recipes, no salt or high sodium condiments added in cooked foods and a low sodium entree choice offered if a high sodium entree is on the regular menu, low sodium vegetable choice offered if a high sodium vegetable is the regular menu (for example, sauerkraut);

1. 3. For a low-fat/cholesterol diet, a

baked, broiled or boiled meat entree (except that no liver, no cheese containing more than five grams (5 gm) fat per ounce, and no egg yolks shall be served as entrees), skimmed milk, polyunsaturated margarine in cooking and for table use (up to one (1) teaspoon) and a low-fats desert shall be provided; and

1. 4. All other food s may be as listed on

the regular menu;

1. (C) Special meals provided for health requirements shall be planned, prepared and served under the supervision/consultation of a dietitian. Copies of all certified menus shall be maintained on file by the area agency for at least one (1) year;
2. (D) The persons responsible for the service of special diets shall be trained to make appropriate substitutions based on food values;
3. (E) Diet counseling, if provided, shall be conducted by a dietitian, according to the individual’s diet prescription which shall be obtained from the service recipient’s physician;
4. (F) A diet prescription shall be obtained for persons receiving home-delivered special meals. The prescription shall be kept current and shall be reviewed at least annually with the service recipient’s physician;
5. (G) Individuals with a strict dietary regimen shall be referred to the medical profession management of dietary needs; and
6. (H) The current Missouri Diet Manual shall be used as a reference in developing special diets.

1. (9) Requirements for handling prepared foods are as follows:

   1. (A) A sample portion of each potentially hazardous food item served shall be refrigerated and kept at least seventy-two (72) hours. It shall available for analysis by the Department of Health if a food-borne illness is suspected;
   2. (B) Potentially hazardous food which has been held at one hundred forty degrees Fahrenheit (140°F) or higher over four (4) hours or between forty-five degrees and one hundred forty degrees Fahrenheit (45°F–140°F) for two (2) hours and any prepared food that has lost its quality shall not be served and shall be destroyed;
   3. (C) Foods that are usually considered safe to store, such as fruits, vegetables, cake, breads, cookies, ice cream and fruit pies, may be retained for use while quality remains acceptable;
   4. (D) The proper equipment shall be used to maintain hot foods at or above one hundred forty degrees Fahrenheit (140°F) and cold foods at or below forty-five degrees Fahrenheit (45°F) while serving. Hot and cold food temperatures shall be checked immediately prior to service and recorded at least twice a week. Records must be kept for six (6) months at the center;
   5. (E) When cooling, food shall be placed no more than two inches (2") deep in a container, covered and immediately placed in the refrigerator or freezer so it will cool to fortyfive degrees Fahrenheit (45°F) or below as rapidly as possible. Once food is cooled to forty-five degrees Fahrenheit (45°F) or below, it may be stored in a container more than two inches (2") deep;

   6. (F) When transporting prepared foods, the following procedures shall be used:

      1. 1. Hot food shall be delivered within

three and one-half (3 1/2) hours following end preparation time. This limit includes the time required for packaging foods by the caterer, transporting to the centers, holding time at the center, packaging meals for homedelivered meal recipients and transporting meals to the home; and

1. 2. Hot foods delivered to the center shall

be at a minimum temperature of one hundred forty degree Fahrenheit (140°F) and cold foods shall be at a maximum temperature of forty-five degree Fahrenheit (45°F). A daily record of the delivery time and temperature of the food when received shall kept at each center. Records must be kept for six months at the center;

1. (G) Meal service shall be scheduled so that food is available for at least thirty (30) minutes after serving begins;
2. (H) Appropriate serving utensils shall be used for food portion cool;
3. (I) Appropriate food containers and utensils blind or otherwise handicapped service recipients shall be available for use upon request;
4. (J) Service recipients should be discouraged from taking potentially hazardous foods from the center. It is recommended that centers include information about food safety in nutrition education; and
5. (K) Leftover foods shall not be given old to another organization, employee, volunteer or service recipient to take from the center.

1. (10) Food Storage Requirements for All Foods, Including USD Commodities.

   1. (A) Cleaning supplies and clearly lab pesticides shall be stored in separate locations m food products;
   2. (B) Food products shall be stored at least six inches (6") above the floor;
   3. (C) Dry food storage shall be well-ventilated, away from direct sunlight and maintained between fifty degrees Fahrenheit and seventy degrees Fahrenheit (50°F–70°F)(D);
   4. (D) All refrigerated foods shall be maintained at below forty-five degrees Fahrenheit (45°F);
   5. (E) Frozen foods shall be maintained at or below zero degree Fahrenheit (0°F);
   6. (F) Inventory of all foods shall be depleted on a first-in/first basis;
   7. (G) Adequate transportation for all foods shall be provided as required; and
   8. (H) Thermometers shall be kept in each refrigerator and freezer and temperatures shall be checked and recorded daily. Records must be kept for six (6) month at the centers.

2. (11) Health and Sanitation Requirements.

   1. (A) Personnel with symptoms of communicable disease or open or infected wounds shall not be permitted to handle food.
   2. (B) All food handlers shall use effective hair restraints. Effective restraints are devices which both cover and hold hair, such as hair s, caps, hats and bandannas. Hair spray is not an acceptable hair restraint.
   3. (C) Equipment and work areas shall routinely be cleaned and sanitized according to a posted written schedule.
   4. (D) Disposables shale discarded by a locally approved sanitary method.
   5. (E) If a garbage disposal is not used, waste shall kept in leak-proof containers w close fitting lids and disposed of daily. Waste containers shall be cleaned daily.
   6. (F) Dishes and utensils washed in water temperatures of less than one hundred fifty degrees Fahrenheit (150°) and rinsed at less than one hundred eighty degree Fahrenheit (180°F) shall be chemically sanitized. When single-tank, stationary-rack and door-type machine using chemicals for sanitizing are used, the wash water shall not be less than one hundred twenty degrees Fahrenheit (120°F) and rinse water not less than seventy-five degrees Fahrenheit (75°F). If the dishwashing machine uses hot water for sanitizing, the wash water shall be at least one hundred fifty degrees Fahrenheit (150°F) and the final rinse at least one hundred-eighty degrees Fahrenheit (180°F). A test kit or other device that accurately measures the parts per million concentration of the solutions shall be provided and used.
   7. (G) All dishes and utensils shall be air dried.
   8. (H) Disposable towels and soap shall be available at the handwashing sink in the kitchen.
   9. (I) A handwashing sign shall be posted in the rest room.
   10. (J) Methods of insect and rodent control shall be used on a regularly scheduled basis.
   11. (K) A product thermometer must be available and used to check internal food temperatures required.

3. (12) USDA Commodity Foods or Foods Phased With USDA Cash.

   1. (A) The nutrition provider shall—

      1. 1. Accept and use USDA commodity

foods or foods purchased with USDA cash that are made available; and

1. 2. Provide adequate transportation for

USDA foods as required.

1. (13) Nutrition service providers shall—

   1. (A) Provide outreach services;
   2. (B) Coordinate activities with the Missouri Division of Family Services to facilitate participation of eligible persons in the Food Stamp Program and assist service recipients in taking advantage of the benefits available to them under the Food Stamp Program. All centers shall be authorized to accept food stamps; and
   3. (C) Comply with the requirements of the area agency regarding eligibility of individuals to receive nutrition services (see 13 CSR 15-0(7)–(9)).

2. (14) Senior Centers.

   1. (A) Senior center shall be visible within the community and located as close as possible and, where feasible and appropriate, within walking distance to the majority of the elderly persons.

   2. (B) Physical Plant Requirements.

      1. 1. Senior centers shall have a minimum

of fifteen (15) square feet per service recipient to assure adequate space for programs and activities. Food preparation, office and storage areas are not included in this mum.

1. 2. Adequate storage space shall be avail-

able as well as adequate space for hang and storing coats, wraps and packages.

1. 3. Senior centers shall be clean and have

an attractive appearance. Walls, ceilings, floors and furniture in a center shall be of smooth, easily cleanable materials. Maintenance shall be performed daily to assure the center is clean, neat and safe. 4.Adequate lavatory facilities shall be available. The number of rest rooms shall be adequate for the size the facility and number of persons served with at least one (1) barrier-free restroom each for men and women.

1. (C) Each senior center shall provide—

   1. 1. Services to older persons at least five

1. (5) days per week with sufficient hours to meet community needs. If open less than six

2. (6) hours per day, the division shall be informed of the hours of operation and the reason(s) fewer hours are justified;

   1. 2. Hot or other appropriate meals at

least once a day, five (5) or more days a week;

1. 3. At a minimum, an average of fifty

1. (50) meals a day;

   1. 4. A variety of supportive services;
   2. 5. An information area with a bulletin

board, display rack or other method of posting information which is easily accessible and well-lighted. Notices should be attractive, easy to read and placed within eye level; 6 An easy-to-read posted monthly activities calendar in area which is highly visible and accessible to service recipients; and

1. 7. A posted attractive, easy-to-read,

weekly menu in a conspicuous location the dining room on Friday of the week prior to service. The certified menu on the official menu form shall be posted in the kitchen.

1. (15) Home-delivered meals service providers shall—

   1. (A) Assess the need for home-delivered meals among the elderly within the community they serve;
   2. (B) Provide identification other than the meal container which is easily recognizable through a door or window for the person delivering the meals to the service recipient’s home when the deliverer is not personally known to the recipient;

   3. (C) Assess and document individual’s eligibility to receive home-delivered meals prior to initiation of the service and reassess the need for continuing the services at least each six (6) months after that.

      1. 1. When referrals are received from the

division, the division’s assessment and reassessment of the service recipient will be sufficient documentation of eligibility. The service recipient’s assessment card shall document that referral was received from the division and an assessment made by the division established eligibility for the homedelivered meal.

1. 2. In emergency situations, home-deliv-

ered meals may be delivered for a maximum of five (5) days prior to the initial assessment of eligibility;

1. (D) Maintain a list in priority order of homebound persons requesting meals for which units of service are not available. Pri- 13 CSR 15-7

ority will be based on published criteria developed by the area agency;

1. (E) Use insulated carriers to assure that foods delivered to home-delivered meal recipients are at the proper temperature, over one hundred forty degrees Fahrenheit (140°F) for hot food and under forty-five degrees Fahrenheit (45°F) for cold food. All equipment used in transporting foods shall have smooth cleanable surfaces, be cleaned and sanitized daily or be disposable;
2. (F) Deliver hot foods to the service recipient within three and one-half (3 1/2) hours following end preparation time;
3. (G) Make available home-delivered meals at least once a day, five (5) or more days a week; and
4. (H) Arrange for the availability of meals to service recipients in weather-related emergencies.

AUTHORITY: section 660.050, RSMo 1994.* This rule was previously filed as 13 CSR 15- 6.155. Original rule filed Jan. 6, 1986, effective April 30, 1986. Amended: Filed Feb. 17, 1988, effective June 15, 1988. Amended: Filed June 3, 1991, effective Oct. 31, 1991. Amended: Filed Nov. 14, 1991, effective March 9, 1992. *Original authority 1984, amended 1988, 1992, 1993. Division Of Aging Menu Plan CHARTER: FROM ______________ THROUGH __________ ____________Area Agency on Aging ___________________Project Site MENU PATTERN MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY Date: Date: Date: Date: Date: MEAT OR ALTERNATE* 3 oz. cooked edible portion VEGETABLE AND/OR FRUIT 2 1/2-cup servings or 3 1/3-cup servings BREAD OR ALTERNATE* 1 serving BUTTER OR FORTIFIED MARGARINE 1 teaspoon DESSERT 1/2 cup MILK 1/2 pint BEVERAGE (OPTIONAL) No. Congregate Meals ___________ Prepared by: _________________________ Title: ___________________ Date:______________ No. Home-Delivered Meals _______ Certified by: _________________________ Title: ___________________ Date:______________ NOTE: A record of all substitutions made should be kept at each site. Any routine substitutions should be kept on file in the project office.

*For alternate see back of page. MEAT OR MEAT ALTERNATE 3 ounces cooked edible portion of meat, fish, poultry or luncheon meats. Alternates for 1 ounce of cooked meat: 1 egg 1 ounce cheddar cheese 1/4 cup cottage cheese 1/2 cup cooked dried beans or peas 2 tablespoons peanut butter Combinations of two or more foods to meet the standard of 3 ounces is acceptable. Examples: 1 ounce bologna and 1 ounce cheese in sandwich plus 1 deviled egg. Cheese enchiladas (1 ounce cheese and 1 cup refried beans) VEGETABLES AND FRUITS 2 or 3 kinds to total 1 cup serving. All vegetables, fruits and full strength vegetable and fruit juices. Rice, spaghetti, macaroni and noodles are not vegetables. Fruits served as dessert can be counted only as dessert. Fruit drinks and fruit ades are not 100% juice, so can be counted only as optional beverages. Vitamin A Rich Foods: include 2 good sources weekly. Vitamin C Rich Foods: include 3 good sources or 5 fair sources weekly. ENRICHED OR WHOLE GRAIN BREAD OR ALTERNATE 1 serving The following amounts are counted as 1 serving: 1 slice bread 1 biscuit, muffin, roll 1 square cornbread or hot bread 5 saltine crackers (enriched) 2 graham crackers 1 ounce ready-to-eat cereal 1/2 to 3/4 cup cooked cereal, cornmeal, grits, rice, spaghetti, macaroni, noodles 1 dumpling, pancake, waffle, yam, plantain, sweet potato 1 tortilla 13 CSR 15-7 BUTTER OR FORTIFIED MARGARINE 1 teaspoon This may be used on bread or in food preparation, including seasoning of vegetables. DESSERT 1/2 cup serving All fruits, full strength fruit juices and simple desserts such as puddings, gelatin desserts, ice cream, ice milk and sherbet. Cake, pie and cookies made with enriched or whole-grain flour are included. MILK 1 cup Fortified whole, skim, low-fat, flavored whole, buttermilk or equivalent. Equivalents: 1 ounce cheddar cheese = 3/4 cup milk 1/2 cup creamed cottage cheese = 1/3 cup milk 1/2 cup ice cream = 1/3 cup milk OPTIONAL BEVERAGES Coffee, tea, decaffeinated beverages, cambric tea, soft drinks and fruit flavored drinks may be used. No alcoholic beverages may be provided with nutrition project funds. GENERAL Some foods can fulfill requirements in more than one group but may not be counted twice. Examples: dried bean—either a vegetable or a meat alternate sweet potatoes—either a vitamin, a vegetable or a bread alternate IRON REQUIREMENT Each meal shall provide a minimum of 3 mg. iron. It is recommended that liver be served once a month. Menu Substitutions For Special Diets DATES _______________________ TO ____________________ Menu #: Menu #: Low Fat/ Low Fat/ Diabetic Low Na+ Chol Diabetic Low Na+ Chol Certified by: ______________________________________ Menu #: Menu #: Menu #: Low Fat/ Low Fat/ Low Fat/ Diabetic Low Na+ Chol Diabetic Low Na+ Chol Diabetic Low Na+ Chol