Food - ALF Boss

WAC 388-78A-2300 Food and nutrition services. (1) The assisted living facility must:

(a) Provide a minimum of three meals a day:

At regular intervals;
With no more than fourteen hours between the evening meal and breakfast, unless the assisted living facility provides a nutritious snack after the evening meal and before breakfast.
Provide sufficient time and staff support for residents to consume meals;
Ensure all menus:
Are written at least one week in advance and delivered to residents’ rooms or posted where residents can see them, except as specified in (f) of this subsection;
Indicate the date, day of week, month and year;
Include all food and snacks served that contribute to nu-tritional requirements;
Are kept at least six months;
Provide a variety of foods; and
Are not repeated for at least three weeks, except that breakfast menus in assisted living facilities that provide a variety of daily choices of hot and cold foods are not required to have a minimum three-week cycle.
Prepare food on-site, or provide food through a contract with a food service establishment located in the vicinity that meets the requirements of chapter 246-215 WAC Food service;
Serve nourishing, palatable and attractively served meals ad-justed for:
Age, gender and activities, unless medically contraindicated; and
Individual preferences to the extent reasonably possible.
Substitute foods of equal nutrient value, when changes in the current day’s menu are necessary, and record changes on the original menu;
Make available and give residents alternate choices in en-trees for midday and evening meals that are of comparable quality and nutritional value. The assisted living facility is not required to post alternate choices in entrees on the menu one week in advance, but must record on the menus the alternate choices in entrees that are served;
Develop, make known to residents, and implement a process for residents to express their views and comment on the food services; and
Maintain a dining area or areas approved by the department with a seating capacity for fifty percent or more of the residents per meal setting, or ten square feet times the licensed resident bed capacity, whichever is greater.

(2) The assisted living facility must plan in writing, prepare on-site or provide through a contract with a food service establishment located in the vicinity that meets the requirements of chapter 246-215 WAC, and serve to each resident as ordered:

(a) Prescribed general low sodium, general diabetic, and mechanical soft food diets according to a diet manual. The assisted living facility must ensure the diet manual is:

Available to and used by staff persons responsible for food preparation;
Approved by a dietitian; and
Reviewed and updated as necessary or at least every five years.

(b) Prescribed nutrient concentrates and supplements when prescribed in writing by a health care practitioner.

(3) The assisted living facility may provide to a resident at his or her request and as agreed upon in the resident’s negotiated service agreement, nonprescribed:

(a) Modified or therapeutic diets; (b) Nutritional concentrates or supplements.

[Statutory Authority: Chapter 18.20 RCW. WSR 13-13-063, § 388-78A-2300, filed 6/18/13, effective 7/19/13; WSR 10-03-066, § 388-78A-2300, filed 1/15/10, effective 2/15/10. Statutory Authority: RCW 18.20.090. WSR 06-01-047, § 388-78A-2300, filed 12/15/05, effective 1/15/06. Statutory Authority: RCW 18.20.090 (2004 c 142 § 19) and chapter 18.20 RCW. WSR 04-16-065, § 388-78A-2300, filed 7/30/04, effective 9/1/04.]

WAC 388-78A-2305 Food sanitation. The assisted living facility must:

Manage food, and maintain any on-site food service facilities in compliance with chapter 246-215 WAC, Food service;
Ensure employees working as food service workers obtain a food worker card according to chapter 246-217 WAC; and
Ensure a resident obtains a food worker card according to chapter 246-217 WAC whenever:
The resident is routinely or regularly involved in the prepa-ration of food to be served to other residents;
The resident is paid for helping to prepare food; or
The resident is preparing food to be served to other resi-dents as part of an employment-training program.

[Statutory Authority: Chapter 18.20 RCW. WSR 13-13-063, § 388-78A-2305, filed 6/18/13, effective 7/19/13. Statutory Authority: RCW 18.20.090. WSR 06-01-047, § 388-78A-2305, filed 12/15/05, effective 1/15/06.]

Intermittent Nursing Services and Resident-Arranged Services

WAC 388-78A-2310 Intermittent nursing services. (1) Intermittent nursing services are an optional service that the assisted living facility may provide.

(2) The assisted living facility may choose to provide any of the following intermittent nursing services through appropriately licensed and credentialed staff; however, the facility may or may not need to provide additional intermittent nursing services to comply with the reasonable accommodation requirements in federal or state law:

(a) Medication administration; (b) Administration of health treatments;

Diabetic management;
Nonroutine ostomy care;
Tube feeding; and(f) Nurse delegation consistent with chapter 18.79 RCW.
The assisted living facility must clarify on the disclosure form any limitations, additional services, or conditions that may apply under this section.
In providing intermittent nursing services, the assisted liv-ing facility must observe the resident for changes in overall functioning and respond appropriately when there are observable or reported changes in the resident’s physical, mental or emotional functioning.
The assisted living facility may provide intermittent nursing services to the extent permitted by RCW 18.20.160.

[Statutory Authority: Chapter 18.20 RCW. WSR 13-13-063, § 388-78A-2310, filed 6/18/13, effective 7/19/13. Statutory Authority: RCW 18.20.090 (2004 c 142 § 19) and chapter 18.20 RCW. WSR 04-16-065, § 388-78A-2310, filed 7/30/04, effective 9/1/04.]

WAC 388-78A-2320 Intermittent nursing services systems. (1) When an assisted living facility provides intermittent nursing services to any resident, either directly or indirectly, the assisted living facility must:

Develop and implement systems that support and promote the safe practice of nursing for each resident; and
Ensure the requirements of chapters 18.79 RCW and 246-840 WAC are met.

(2) The assisted living facility providing nursing services, either directly or indirectly, must ensure that the nursing services systems include:

Nursing services supervision;
Nurse delegation, if provided;
Initial and on-going assessments of the nursing needs of each resident;
Development of, and necessary amendments to, the nursing com-ponent of the negotiated service agreement for each resident;
Implementation of the nursing component of each resident’s negotiated service agreement; and
Availability of the supervisor, in person, by pager, or by telephone, to respond to residents’ needs on the assisted living facility premises as necessary.

(3) The assisted living facility must ensure that all nursing services, including nursing supervision, assessments, and delegation, are provided in accordance with applicable statutes and rules, including, but not limited to:

Chapter 18.79 RCW, Nursing care;
Chapter 18.88A RCW, Nursing assistants;
Chapter 246-840 WAC, Practical and registered nursing;
Chapter 246-841 WAC, Nursing assistants; and(e) Chapter 246-888 WAC, Medication assistance.

[Statutory Authority: Chapter 18.20 RCW. WSR 13-13-063, § 388-78A-2320, filed 6/18/13, effective 7/19/13. Statutory Authority: RCW 18.20.090 (2004 c 142 § 19) and chapter 18.20 RCW. WSR 04-16-065, § 388-78A-2320, filed 7/30/04, effective 9/1/04.]

WAC 388-78A-2330 Tube feeding. (1) Tube feeding services are an optional service that an assisted living facility may provide.

(2) The assisted living facility must provide intermittent nursing services to develop and implement the nursing component of the negotiated service agreement, administer feedings and necessary medications, and provide routine care of the tube insertion site whenever any resident requiring tube feeding is not able to:

(a) Independently and safely manage:

(i) Maintenance of the tube insertion site; (ii) Necessary medication administration through the tube; and

(iii) Feeding administration through the tube.

(b) Arrange for an outside resource to provide:

Maintenance of the tube insertion site;
Necessary medication administration through the tube; and(iii) Feeding administration through the tube.

(3) The assisted living facility is not required to provide nursing services to a resident simply because the resident requires tube feeding if the resident can either independently manage or arrange for an outside resource to perform the tasks specified in subsection (2)(a) and (b) of this section.

[Statutory Authority: Chapter 18.20 RCW. WSR 13-13-063, § 388-78A-2330, filed 6/18/13, effective 7/19/13. Statutory Authority: RCW 18.20.090 (2004 c 142 § 19) and chapter 18.20 RCW. WSR 04-16-065, § 388-78A-2330, filed 7/30/04, effective 9/1/04.]

WAC 388-78A-2340 Resident-arranged services. (1) The assisted living facility must allow a resident to arrange to receive on-site care and services from:

A practitioner, licensed under Title 18 RCW regulating health care professions; and
A home health, hospice, or home care agency licensed under chapter 70.127 RCW.
The assisted living facility may permit the resident or the resident’s legal representative, if any, to independently arrange for other persons to provide on-site care and services to the resident.
The assisted living facility is not required to supervise the activities of a person providing care or services to a resident when the resident or resident’s representative has independently arranged for or contracted with the person.
The assisted living facility may establish policies and pro-cedures that describe reasonable limitations, conditions, or requirements that must be met prior to an outside service provider being allowed on-site.
When the resident or the resident’s representative, if any, independently arranges for outside services under subsection (1) of this section, the assisted living facility’s duty of care, and any negligence that may be attributed thereto, shall be limited to: The responsibilities described under subsection (3) of this section; observation of the resident for changes in overall functioning, consistent with RCW 18.20.280; notification to the person or persons identified in RCW 70.129.030 when there are observed changes in the resident’s overall functioning or condition; and appropriately responding to obtain needed assistance when there are observable or reported changes in the resident’s physical or mental functioning.

[Statutory Authority: Chapter 18.20 RCW. WSR 13-13-063, § 388-78A-2340, filed 6/18/13, effective 7/19/13. Statutory Authority: RCW 18.20.090 (2004 c 142 § 19) and chapter 18.20 RCW. WSR 04-16-065,

388-78A-2340, filed 7/30/04, effective 9/1/04.]

WAC 388-78A-2350 Coordination of health care services. (1) The assisted living facility must coordinate services with external health care providers to meet the residents’ needs, consistent with the resident’s negotiated service agreement.

The assisted living facility must develop, implement and in-form residents of the assisted living facility’s policies regarding how the assisted living facility interacts with external health care providers, including:
The conditions under which health care information regarding a resident will be shared with external health care providers, consistent with chapter 70.02 RCW; and
How residents’ rights to privacy will be protected, including provisions for residents to authorize the release of health care information.
The assisted living facility may disclose health care infor-mation about a resident to external health care providers without the resident’s authorization if the conditions in RCW 70.02.050 are met.
If the conditions in RCW 70.02.050 are not met, the assisted living facility must request, but may not require, a resident to authorize the assisted living facility and the external health care provider to share the resident’s health care information when:
The assisted living facility becomes aware that a resident is receiving health care services from a source other than the assisted living facility; and
The resident has not previously authorized the assisted liv-ing facility to release health care information to an external health care provider.
When a resident authorizes the release of health care infor-mation or resident authorization is not required under RCW 70.02.050, the assisted living facility must contact the external health care provider and coordinate services.
When authorizations to release health care information are not obtained, or when an external health care provider is unresponsive to the assisted living facility’s efforts to coordinate services, the assisted living facility must:
Document the assisted living facility’s actions to coordinate services;
Provide notice to the resident of the risks of not allowing the assisted living facility to coordinate care with the external provider; and
Address known associated risks in the resident’s negotiated service agreement.
When coordinating care or services, the assisted living fa-cility must:
Integrate relevant information from the external provider in-to the resident’s preadmission assessment and reassessment, and when appropriate, negotiated service agreement; and
Respond appropriately when there are observable or reported changes in the resident’s physical, mental, or emotional functioning.

[Statutory Authority: Chapter 18.20 RCW. WSR 13-13-063, § 388-78A-2350, filed 6/18/13, effective 7/19/13. Statutory Authority: RCW 18.20.090 (2004 c 142 § 19) and chapter 18.20 RCW. WSR 04-16-065,

388-78A-2350, filed 7/30/04, effective 9/1/04.]