7.8.2.36                 NUTRITION:  The facility shall provide planned and nutritionally balanced meals from the basic food groups in accordance with the “recommended daily dietary allowance” of the American dietetic association, the food and nutrition board of the national research council, or the national academy of sciences.  Meals shall meet the nutritional needs of the residents in accordance with the “2005 USDA dietary guidelines for Americans.”  Vending machines shall not be considered a source of snacks.

  1.             Dietary services policies and procedures.  The facility will develop and implement written policies and procedures that are maintained on the premises and that govern the following requirements.

                                (1)           Meal service.  The facility shall:

                                                (a)           serve at least three (3) meals or their equivalent each day at regular times with no more than sixteen (16) hours between the evening meal and morning meal with snacks freely available;

                                                (b)           provide snacks of nourishing quality and post on the daily menu;

                                                (c)           develop menus enjoyed by the residents and served at normal intervals appropriate to the residents’ preferences;

                                                (d)           post the weekly menu, including snacks where residents and families are able to view it; posted menus shall be followed and any substitution shall be of equivalent nutritional value and recorded on the posted menu; identical menus shall not be used within a one (1) week cycle;

                                                (e)           have special menus or meal items following guidelines from the resident’s physician for residents who have medically prescribed special diets;

                                                (f)            serve all residents in a dining room except for residents with a temporary illness, or with documented specific personal preference to have meals in their room;

                                                (g)           allow sufficient time for meals to enable residents to eat at a leisurely pace and to socialize; and

                                                (h)           contact the resident’s PCP within forty-eight (48) hours if a resident consistently refuses to eat.

                                (2)           Staff in-service training.  The facility shall provide an in-service training program for staff that are involved in food preparation at orientation and at least annually and that includes:

                                                (a)           instruction in proper food storage;

                                                (b)           preparation and serving food;

                                                (c)           safety in food handling;

                                                (d)           appropriate personal hygiene; and

                                                (e)           infectious and communicable disease control.

  1.             Dietary records.  The facility shall maintain the following documentation onsite:

                                (1)           a systematic record of all menus and revisions, including snacks, for a minimum of thirty (30) calendar days;

                                (2)           a systematic record of therapeutic diets as prescribed by a PCP;

                                (3)           a copy of the most recent licensing inspection and for facilities with 10 or more residents, a copy of the New Mexico environment department inspection with notations made by the facility of action taken to comply with recommendations or citations; and

                                (4)           a daily log of the recorded temperatures for all facility refrigerators, freezers and steam tables maintained and available for inspection for thirty (30) calendar days.

  1.             Clean and sanitary conditions.  All practices shall be in accordance with the standards of the state environment department, pursuant to 7.6.2 NMAC.

                                (1)           Kitchen sanitation.

                                                (a)           Equipment and work areas shall be clean and in good repair.  Surfaces with which food or beverages come into contact shall be of smooth, impervious material free of open seams, not readily corrodible and easily accessible for cleaning.

                                                (b)           Utensils shall be stored in a clean, dry place protected from contamination.

                                                (c)           The walls, ceiling and floors of all rooms that food or drink is stored, prepared or served shall be kept clean and in good repair.

                                (2)           Washing and sanitizing kitchenware.

                                                (a)           All reusable tableware and kitchenware shall be cleaned in accordance with procedures that include separate steps for prewashing, washing, rinsing and sanitizing.

                                                (b)           Proper dishwashing procedures and techniques shall be utilized and understood by the dishwashing staff.

                                                (c)           Periodic monitoring of the operation of the detergent dispenser, washing, rinsing and sanitizing temperatures shall be performed and documented.

                                                (d)           When a dishwashing machine is utilized, the cleanliness of the machine, its jets and its thermostatic controls shall be monitored and documented by the facility.  A monthly log of the recorded temperature of the dishwasher shall be maintained in the facility and available for inspection.

                                (3)           Sinks for hand washing shall include hot and cold running water, hand-washing soap and disposable towels.

                                (4)           All garbage and kitchen refuse that is not disposed of through a garbage disposal unit shall be kept in watertight containers with close-fitting covers and disposed of daily in a safe and sanitary manner.

                                (5)           Cooks and food handlers shall wear clean outer garments and hair nets or caps and shall keep their hands clean at all times when engaged in handling food, drink, utensils or equipment in accordance with the local health authority.  Disposable gloves shall be used in accordance with the local health authority.

  1.             Food management.  The facility shall store, prepare, distribute and serve food under sanitary conditions and in accordance with the regulations governing food establishments of local health authority having jurisdiction, 7.6.2 NMAC.

                                (1)           The facility shall ensure that a minimum of a three (3) calendar day supply of perishables and a five (5) calendar day supply of non-perishables or canned foods is available for the residents.

                                (2)           The facility refrigerator and freezer shall have an accurate thermometer which reads within or not more than plus or minus three (3) degrees fahrenheit of the required temperature, located in the warmest section of the refrigerator and freezer and shall be accessible and easily read.

                                                (a)           The temperature of the refrigerator shall be thirty-five (35) – forty-one (41) degrees fahrenheit.

                                                (b)           Freezer temperatures shall be maintained at zero (0) degrees fahrenheit or below.

                                (3)           Refrigerators and freezers shall be kept clean and sanitary at all times. Food stored in refrigerators and freezers shall be covered, dated and labeled.  Unused leftover food shall be discarded after three (3) calendar days.

                                (4)           Steam tables, hot food tables, slow cookers, crock pots and other hot food holding devices shall not be used in heating or reheating food.  Hot food temperatures shall be checked periodically to insure that a minimum of one hundred forty (140) degrees fahrenheit is maintained.

                                (5)           Medication, biological specimens, poisons, detergents and cleaning supplies shall not be kept in the same storage areas used for storage of foods.  Medications shall not be stored in the refrigerator with food; an alternate refrigerator for medication shall be used pursuant to Subsection B of 7.6.2.8 NMAC.

                                (6)           Canned or preserved foods shall be procured from sources that process the food under regulated quality and sanitation controls. This does not preclude the use of local fresh produce.  The facility shall not use home-canned foods.

                                (7)           Dry or staple food items shall be stored at least six (6) inches off the floor in a ventilated room that is not subject to sewage, waste water back-flow or contamination by condensation, leakage, rodents or vermin.

                                (8)           The facility shall ensure the following:

                                                (a)           all perishable food is refrigerated and the temperature is maintained no higher than forty-one (41) degrees fahrenheit;

                                                (b)           the temperature for all hot foods is maintained at one hundred forty (140) degrees fahrenheit; and

                                                (c)           all displayed or transported food is protected from environmental contamination and maintained at proper temperatures in clean containers, cabinets or serving carts.

  1.             Milk.

                                (1)           Raw milk shall not be used.

                                (2)           Condensed, evaporated, or dried milk products that are nationally recognized may be employed as “additives” in cooked food preparation but shall not be substituted or served to residents in place of milk.

  1.             Collateral requirements.  Compliance with this rule does not relieve a facility from the responsibility of meeting more stringent municipal regulations, ordinances or other requirements of state or federal laws governing food service establishments.  Local health authority having jurisdiction means municipal, county, state or federal agency(s) that have laws and regulations governing food establishments, liquid waste disposal, treatment facilities and private wells.

[7.8.2.36 NMAC – Rp, 7.8.2.37 NMAC, 1/15/2010]

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