Food service and nutrition in the ALF
As many operators of residential care facilities are aware, the culinary program can be the bane of your existence. Food quality or they lack thereof is one of the most common complaints from residents and families. The dietary program is a difficult arena because you are balancing so many different things. There is the health code for restaurants, resident’s personal food preferences and the operational aspect of providing those meals. While the facility may not be considered a ‘4-star Michelin restaurant’ you can rest assured following the following regulations, provided by the Nevada Department of Health and Human Services, will keep you in the clear for any potential issues with state surveyors:
NAC 449.2175 Service of food; seating; menus; special diets; nutritional requirements; dietary consultants. (NRS 449.0302)
1. A residential facility shall have adequate facilities and equipment for the preparation, service and storage of food.
2. Tables and chairs must be of proper height and of sufficient number to provide seating for the number of residents authorized for the facility. They must be sturdy and have easily washable surfaces. Chairs must be constructed so that they do not overturn easily.
3. Menus must be in writing, planned a week in advance, dated, posted and kept on file for 90 days.
4. A resident who has been placed on a special diet by a physician or licensed dietitian must be provided a meal that complies with the diet. The administrator of the facility shall ensure that records of any modifications to the menu to accommodate for special diets prescribed by a physician or licensed dietitian are kept on file for at least 90 days.
5. Any substitution for an item on the menu must be documented and kept on file with the menu for at least 90 days after the substitution occurs. A substitution must be posted in a conspicuous place during the serving of the meal.
6. Each meal must provide a reasonable portion of the daily dietary allowances recommended by the Food and Nutrition Board of the Institute of Medicine of the National Academies.
7. Meals must be nutritious, served in an appropriate manner, suitable for the residents and prepared with regard for individual preferences and religious requirements. At least three meals a day must be served at regular intervals. The times at which meals will be served must be posted. Not more than 14 hours may elapse between the meal in the evening and breakfast the next day. Snacks must be made available between meals for the residents who are not prohibited by their physicians from eating between meals.
8. A resident must be served meals in his or her bedroom for not more than 14 consecutive days if the resident is temporarily unable to eat in the dining room because of an injury or illness. The facility may serve meals to other residents in their rooms upon request. If a meal is served to a resident in his or her room because the resident is unable to eat in the dining room, the facility shall maintain a record of the times and reasons for serving meals to the resident in his or her room.
9. A residential facility with more than 10 residents shall employ or otherwise obtain the services of a person to serve as a consultant for the planning and serving of meals who:
(a) Is a licensed dietitian; or
(b) Is a graduate from an accredited college with a major in food and nutrition and has 2 years of supervisory experience in a medical facility or facility for the dependent or has participated in a course of training for a supervisor of the service of food.
10. The person providing services pursuant to subsection 9 shall provide those services not less than once each calendar quarter. The administrator of the facility shall keep a written record of the consultations on file at the facility. The consultations must include:
(a) The development and review of weekly menus;
(b) Training for the employees who work in the kitchen;
(c) Advice regarding compliance with the nutritional program of the facility; and
(d) Any observations of the person providing the services regarding the preparation and service of meals in the facility to ensure that the facility is in compliance with the nutritional program of the facility.
NAC 449.217 Kitchens; storage of food; adequate supplies of food; permits; inspections. (NRS 449.0302)
1. The equipment in a kitchen of a residential facility and the size of the kitchen must be adequate for the number of residents in the facility. The kitchen and the equipment must be clean and must allow for the sanitary preparation of food. The equipment must be in good working condition.
2. Perishable foods must be refrigerated at a temperature of 40 degrees Fahrenheit or less. Frozen foods must be kept at a temperature of 0 degrees Fahrenheit or less.
3. Sufficient storage must be available for all food and equipment used for cooking and storing food. Food that is stored must be appropriately packaged.
4. The administrator of a residential facility shall ensure that there is at least a 2-day supply of fresh food and at least a 1-week supply of canned food in the facility at all times.
5. Pesticides and other toxic substances must not be stored in any area in which food, kitchen equipment, utensils or paper products are stored. Soaps, detergents, cleaning compounds and similar substances must not be stored in any area in which food is stored.
6. A residential facility with more than 10 residents shall:
(a) Comply with the standards prescribed in chapter 446 of NAC; and
(b) Obtain the necessary permits from the Division.
7. The equipment used for cooking and storing food and for washing dishes in a residential facility with more than 10 residents must be inspected and approved by the Division and the state and local fire safety authorities.
Top Takeaways:
- A resident who has been placed on a special diet by a physician or licensed dietitian must be provided a meal that complies with the diet. The administrator of the facility shall ensure that records of any modifications to the menu to accommodate for special diets prescribed by a physician or licensed dietitian are kept on file for at least 90 days.
The facility must take the varying needs of residents due to their medical and dietary needs. Having a culinary program that is flexible and accommodating is key to avoiding potential issues.
- A residential facility with more than 10 residents shall employ or otherwise obtain the services of a person to serve as a consultant for the planning and serving of meals who:
(a) Is a licensed dietitian; or
(b) Is a graduate from an accredited college with a major in food and nutrition and has 2 years of supervisory experience in a medical facility or facility for the dependent or has participated in a course of training for a supervisor of the service of food.
The facility must employ a supervisor responsible for the oversight of the culinary program- if the supervisor is not a dietician you must have a consultant contracted with the facility to perform services related to the operation of the program.