(1) General.
(a) Direction and Supervision. The services of a Dietitian shall be provided to any resident of an assisted
living facility who requires a therapeutic diet. Congregate assisted living facilities shall be under the direction and
supervision of a full or part-time professionally qualified dietitian or a consulting dietitian that is licensed in the
State of Alabama. Responsibility for the supervision of dietary services shall be delegated to a responsible
employee who is a graduate of a Dietary Managers course or has completed an approved course that includes basic
sanitation. The facility shall provide meals, fluids, and snacks to the residents that meet the Dietary References
Intakes from the basic food groups. The meals shall be of the quality and quantity necessary to meet the residents’
needs, and must be in accordance with the recommended dietary allowances of the Food and Nutrition Board of the
National Research Council, National Academy of Sciences.
(2) Food Handling Procedures.
(a) Dish and Utensils Washing, Disinfection, and Storage.
1. Wash water shall be changed with sufficient frequency to avoid gross contamination, and final rinse
water shall be kept clean and clear.
2. Hand washed repeated service and multiservice utensils and dishes, after washing and rinsing, shall be sanitized by either of the following methods:
(i) Utensils and dishes shall be completely immersed for a period of not less than 30 seconds in water
that is at least 171 degrees Fahrenheit (pouring scalding water over utensils and dishes does not meet this
requirement); or
(ii) A cold water sanitizer. A sanitizing solution shall be used in accordance with manufacturer’s
instructions. Utensils and dishes shall be completely immersed for a period of not less than 10 seconds in a
clean solution containing not less than 50 ppm, and not more than 200 ppm, of available chlorine bleach, or 30 seconds in 12.5 ppm of iodine or the amount of time set by the manufacturer in a 200 ppm quaternary ammonium solution. Water temperature must be at least 75 degrees Fahrenheit. Water temperatures and chemical concentrations shall be monitored and documented prior to dishwashing. A record of each test shall be maintained for at least three months.
3. Dishes and utensils shall be allowed to airdry.
4. After washing, rinsing, sanitizing, and airdrying, all repeated use service ware (utensils and dishes)
shall be stored in a clean, dry place that is protected from pests, dust, splash, and other contaminants. Utensils
shall be handled in such a way as to prevent contamination from hands and clothing.
5. The results from the use of dishwashing machines shall be equivalent to those obtained from the
method outlined above, as documented in material provided from the manufacturer and kept on file at the facility.
(b) Ice. Crushed or chipped ice shall be protected from splash, drip, and hand contamination during
storage and service. The ice scoop may be stored in the ice bin in a manner to prevent ice from coming into contact
with the handle, or it may be stored in an airtight container outside the ice bin.
(c) Protection of Food from Contamination.
1. Food and food ingredients shall be stored, handled, and served so as to be protected from pests, dust,
rodents, droplet infection, unsanitary handling, overhead leakage, sewage back flow, and any other contamination.
Sugar, syrup, and condiment receptacles shall be provided with lids and shall be kept covered when not in use.
2. Medications, biologicals, poisons, detergents, and cleaning supplies shall not be kept in the
refrigerator or in other areas used for storage of food.
3. Food shall not be stored on the floor. All food and food ingredients stored on shelving must be placed
on shelving that is at least six inches above the floor.
4. Refrigerators shall maintain a maximum temperature of 41 degrees Fahrenheit. Freezers shall be
maintained at a maximum temperature of 0 degrees Fahrenheit. Thermometers shall remain in refrigerators and
freezers at all times.
5. All leftover foods shall be labeled and dated with a “use by date”, so that it may be consumed or
discarded by that date, which is no more than 3 days from the date it was prepared.
6. All food products shall be used by the manufacturer’s indicated date or discarded.
7. Food shall be prepared either in the licensed facility or another location even when that
location is not part of the licensed facility. All food preparation areas used by the facility shall be subject to
the same inspections as though part of the licensed facility. The licensed facility is responsible to ensure
adequate equipment and measures are used to ensure that food is not contaminated in transport and that foods that
are transported are held and served at the appropriate temperatures at all times.
8. Hot food shall be maintained at a minimum of135 degrees Fahrenheit and cold foods at a maximum 41
degrees Fahrenheit.
9. Frozen food items (raw and cooked) shall be thawed under refrigeration or under running water prior to
preparation. Frozen food may also be thawed as part of the cooking process when indicated by package directions. Raw meats shall be stored below and away from vegetables, fruits, and other foods to prevent contamination (meat
juices dripping on other foods).
10. Laundry shall not be brought through the food preparation or service area.
(d) Storage and Service of Milk and Ice Cream.
1. Milk and fluid milk products shall be served only from the original containers in which they were
received from the distributor. This shall not apply to cream for coffee, cereals, and milk for milk drinks which
may be dispensed from a readily cleanable container approved for such use.
2. Milk and fluid milk products shall be stored in such a manner that bottles or containers, from which the
milk or milk product is to be poured or drunk, will not become contaminated from drip or contact with foods. Milk
shall be maintained and stored at a maximum temperature of
41 degrees Fahrenheit and shall not be served at a temperature warmer than 45 degrees Fahrenheit unless
specifically requested to be served at a warmer temperature by a resident.
3. Contaminating substances shall not be stored with or over open containers of ice cream. Ice cream
dippers, spatulas, and other serving utensils shall be cleaned between uses.
(e) Kitchen Garbage and Trash Handling.
1. Kitchen garbage and trash shall be placed in suitable containers with tight-fitting lids and properly
stored pending removal. Kitchen garbage and trash shall not be allowed to accumulate in the kitchen and shall be
removed from the premises at frequent intervals.
2. After being emptied, all garbage cans and trash cans shall be washed and dried before reuse.
(f) Employees’ Cleanliness.
1. Employees engaged in the handling, preparation, and serving of food shall wear clean clothing
at all times. Employees shall wear hair restraints, for example, hairnets, headbands, caps, or other adequate means
to prevent contamination of food from hair. Employees whose duties include contact with residents shall change clothing or wear a clean covering over clothing before handling,
preparing, or serving food.
2. Employees handling food shall wash their hands thoroughly before starting work each day, immediately
after contact with any soiled matter, and before returning to work after each visit to the rest room.
3. Street clothing not worn by the employee shall be stored in lockers, dressing rooms, or closets
designated for staff use.
(g) Live Fowl or Animals. Live fowl or animals shall not be allowed in the food service area.
(h) Smoking and Spitting. Smoking, other use of tobacco products, and spitting within the food service area
shall be prohibited for all staff, residents, and visitors.
(i) Dining in Kitchen. Dining in the kitchen shall not be permitted in congregate assisted living
facilities.
(j) Paper for Food Wrapping. Only new paper, foil, or plastic wrap shall be used for wrapping of foods.
(k) Laundering of clothing shall not be permitted in food preparation or service areas.
(3) Dietary Service.
(a) Number of Meals. No fewer than three meals shall be provided each 24 hours. Food service shall be
provided in a resident’s room during temporary illness if necessary. The diet shall be well-balanced, palatable,
properly prepared, and sufficient in quantity and quality to meet the nutritional needs of the residents in
accordance with Dietary Reference Intakes of the Food and Nutrition Board of the National Research Council, National Academy of Sciences. The food must be adapted in type and preparation to the habits, preferences, and physical abilities of the residents.
(b) Timing of Meals. A time schedule for serving meals to residents and personnel shall be established.
Meals shall be served approximately five hours apart with no more than 14 hours between the evening meal and
breakfast. The time schedule of meals shall be posted with the menu. The facility shall make evening snacks available
after service of the evening meal. The facility shall provide fluids throughout the day and shall make between meal nourishment (snacks) available.
(c) Menu. The menu shall be planned and written at least 1 week in advance. The current week’s menu shall
be posted in the food service area and shall be kept on file for the following 2 weeks. For any resident with a
physician’s order for a therapeutic diet, the facility shall have a copy of the diet and the facility shall
document the adjustment of its menu to accommodate the resident’s needs.
(d) Alternate food selections or substitutes shall be made available to all residents.
(e) A facility shall not obtain food from charitable organizations. A facility shall not avoid serving a meal by sending or transporting residents to missions, soup kitchens, or other charitable facilities for meals.
(f) The amount of food on hand shall be sufficient to serve three meals per day to all residents
for 3 days. Non-perishable food and potable water shall be maintained in the facility in sufficient quantity to serve
three meals per day to all residents for 3 days.