Food service in the ALF | VA

As many operators of ALFs are aware, the culinary program can be the bane of your existence. Food quality or the 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 Virginia Department of Social Services, will keep you in the clear for any potential issues with state surveyors:

22VAC40-73-580. Foodservice and nutrition.

1. When any portion of an assisted living facility is subject to inspection by the Virginia Department of Health, the facility shall be in compliance with those regulations, as evidenced by an initial and subsequent annual report from the Virginia Department of Health. The report shall be retained at the facility for a period of at least two years.
2. All meals shall be served in the dining area as designated by the facility, except that:
3. If the facility, through its policies and procedures, offers routine or regular room service, residents shall be given the option of having meals in the dining area or in their rooms, provided that:
4. There is a written agreement to this effect, signed and dated by both the resident and the licensee or administrator and filed in the resident’s record.
5. If a resident’s individualized service plan, physical examination report, mental health status report, or any other document indicates that the resident has a psychiatric condition that contributes to self-isolation, a qualified mental health professional shall make a determination in writing whether the resident should have the option of having meals in his room. If the determination is made that the resident should not have this option, then the resident shall have his meals in the dining area.
6. Under special circumstances, such as temporary illness, temporary incapacity, temporary agitation of a resident with cognitive impairment, or occasional, infrequent requests due to a resident’s personal preference, meals may be served in a resident’s room.
7. When meals are served in a resident’s room, a sturdy table must be used.
8. Personnel shall be available to help any resident who may need assistance in reaching the dining room or when eating.
9. A minimum of 45 minutes shall be allowed for each resident to complete a meal. If a resident has been assessed on the UAI as dependent in eating/feeding, his individualized service plan shall indicate an approximate amount of time needed for meals to ensure needs are met.
10. Facilities shall develop and implement a policy to monitor each resident for:
11. Warning signs of changes in physical or mental status related to nutrition; and
12. Compliance with any needs determined by the resident’s individualized service plan or prescribed by a physician or other prescriber, nutritionist, or health care professional.
13. Facilities shall implement interventions as soon as a nutritional problem is suspected. These interventions shall include the following:
14. Weighing residents at least monthly to determine whether the resident has significant weight loss (i.e., 5.0% weight loss in one month, 7.5% in three months, or 10% in six months); and
15. Notifying the attending physician if a significant weight loss is identified in any resident who is not on a physician-approved weight reduction program and obtaining, documenting, and following the physician’s instructions regarding nutritional care.
16. Residents with independent living status who have kitchens equipped with stove, refrigerator, and sink within their individual apartments may have the option of obtaining meals from the facility or from another source. If meals are obtained from another source, the facility must ensure the availability of meals when the resident is sick or temporarily unable to prepare meals for himself.

22VAC40-73-590. A number of meals and availability of snacks.

1. At least three well-balanced meals, served at regular intervals, shall be provided daily to each resident unless contraindicated as documented by the attending physician in the resident’s record or as provided for in 22VAC40-73-580 G.
2. Snacks shall be made available at all times for all residents or in accordance with their physician’s or other prescriber’s orders.
3. Appropriate adjustments in the provision of snacks to a resident shall be made when orders from the resident’s physician or another prescriber in the resident’s record limit the receipt or type of snacks.
4. Vending machines shall not be used as the only source for snacks.

22VAC40-73-600. The time interval between meals.

1. The time between the scheduled evening meal and scheduled breakfast the following morning shall not exceed 15 hours.
2. There shall be at least four hours between scheduled breakfast and lunch and at least four hours between scheduled lunch and supper.
3. When multiple seatings are required due to limited dining space, the schedule shall ensure that these time intervals are met for all residents. Schedules shall be made available to residents, legal representatives, staff, volunteers, and any other persons responsible for assisting residents in the dining process.

22VAC40-73-610. Menus for meals and snacks.

1. Food preferences of residents shall be considered when menus are planned.
2. Menus for meals and snacks for the current week shall be dated and posted in an area conspicuous to residents.
3. Any menu substitutions or additions shall be recorded on the posted menu.
4. A record shall be kept of the menus served for two years.
5. Minimum daily menu.
6. Unless otherwise ordered in writing by the resident’s physician or another prescriber, the daily menu, including snacks, for each resident shall meet the current guidelines of the U.S. Department of Agriculture’s food guidance system or the dietary allowances of the Food and Nutritional Board of the National Academy of Sciences, taking into consideration the age, sex, and activity of the resident.
7. Other foods may be added.
8. Second servings and snacks shall be available at no additional charge.
9. At least one meal each day shall include a hot main dish.
10. When a diet is prescribed for a resident by his physician or another prescriber, it shall be prepared and served according to the physician’s or other prescriber’s orders.
11. A copy of a diet manual containing acceptable practices and standards for nutrition shall be kept current and readily available to personnel responsible for food preparation.
12. The facility shall make drinking water readily available to all residents. Direct care staff shall know which residents need help getting water or other fluids and drinking from a cup or glass. Direct care staff shall encourage and assist residents who do not have medical conditions with a physician or other prescriber ordered fluid restrictions to drink water or other beverages frequently.

22VAC40-73-620. Oversight of special diets.

54. There shall be oversight at least every six months of special diets by a dietitian or nutritionist for each resident who has such a diet. Special diets may also be referred to using terms such as medical nutrition therapy or diet therapy. The dietitian or nutritionist must meet the requirements of § 54.1-2731 of the Code of Virginia.
55. The oversight specified in subsection A of this section shall be on-site and include the following:
56. A review of the physician’s or other prescriber’s order and the preparation and delivery of the special diet.
57. An evaluation of the adequacy of the resident’s special diet and the resident’s acceptance of the diet.
58. Certification that the requirements of this subsection were met, including the date of the oversight and identification of the residents for whom the oversight was provided. The administrator shall be advised of the findings of the oversight and any recommendations. All of the requirements of this subdivision shall be (i) in writing, (ii) signed and dated by the dietitian or nutritionist, (iii) provided to the administrator within 10 days of the completion of the oversight, and (iv) maintained in the files at the facility for at least two years, with any specific recommendations regarding a particular resident also maintained in the resident’s record.
59. Upon receipt of recommendations noted in subdivision 3 of this subsection, the administrator, dietitian, or nutritionist shall report them to the resident’s physician. Documentation of the report shall be maintained in the resident’s record.
60. Action taken in response to the recommendations noted in subdivision 3 of this subsection shall be documented in the resident’s record.

Top Takeaways:

• Weighing residents at least monthly to determine whether the resident has significant weight loss (i.e., 5.0% weight loss in one month, 7.5% in three months, or 10% in six months); and

2. Notifying the attending physician if a significant weight loss is identified in any resident who is not on a physician-approved weight reduction program and obtaining, documenting, and following the physician’s instructions regarding nutritional care.

While this may fall more so under the care team’s responsibility the dietary team plays a key role in identifying if residents are not coming to the dining room or eating the appropriate amount of food. The care team must have a system in place to ensure they are getting monthly weights for residents and recognizing any trends in weight change.

• The time between the scheduled evening meal and scheduled breakfast the following morning shall not exceed 15 hours.

1. There shall be at least four hours between scheduled breakfast and lunch and at least four hours between scheduled lunch and supper.

You must follow the stipulation regarding meals being 4 hours apart and no more than 15 hours between meals (Dinner to the following day’s breakfast). Having snacks and freshwater readily available is also required by DOSS.

 

• There shall be oversight at least every six months of special diets by a dietitian or nutritionist for each resident who has such a diet. Special diets may also be referred to using terms such as medical nutrition therapy or diet therapy. The dietitian or nutritionist must meet the requirements of § 54.1-2731 of the Code of Virginia.

Due to the unique nutritional needs of residents in a senior living community, it is imperative that a dietician or nutritionist review all special diet orders to ensure they are meeting the criteria to remain on that diet.

Pro Tip:

1. Ask your residents what they would like to see on the menu. This will drastically improve the satisfaction of your food service program if residents are giving input into their food choices.
2. Ensure your dietary team is well versed in sanitation, cross-contamination, and general food handling procedures. Rest assured they will be quizzed by the survey team and/or the Virginia DOH.