Section 134.64. Dietetic services.

 

(1)   Services. Facilities shall provide or contract for dietetic services which meet the requirements of this section. Services shall include:

(a) Planning menus that provide nutritionally adequate diets to all residents;

(b) Initiating food orders;

(c) Establishing and enforcing food specifications;

(d) Storing and handling food;

(e) Preparing and serving food;

(f) Maintaining safe and sanitary conditions;

(g) Orienting, training and supervising staff; and

(h) Controlling food costs.

(2)   Staff.

(a) Numbers. A facility shall have enough capable staff to meet the food and nutrition needs of the residents. In small facilities the residents shall be encouraged to participate, under proper supervision, in planning, preparing and serving the food.

(b) Supervision. Dietetic services shall be supervised by a full-time supervisor, except that an FDD with fewer than 50 residents may employ a part-time supervisor.

(c) Qualifications. The dietetic services supervisor shall be either:

1. A dietitian; or

2. Shall receive necessary consultation from a dietition, and shall either:

a. Hold an associate degree as a dietetic technician; or

b. Have completed a course of study in food service supervision at a vocational, technical and adult education school, or an equivalent school or program, or presently be enrolled in a course of study in food service supervision.

(3)   Staff health and personal hygiene. Food service staff and other staff who prepare and serve food shall be in good health and practice hygienic food-handling techniques.

(4)   Menus.

(a) General diets.

1. Menus shall be planned and written at least 2 weeks in advance of their use, shall be different for the same days of each week and shall be adjusted for seasonal availability of foods.

2. The facility shall provide nourishing, well-balanced meals that are, to the extent medically possible, in accordance with the recommended dietary allowances of the food and nutrition board of the national research council, national academy of sciences, adjusted for age, sex, activity level and disability. See Appendix A of this chapter.

3. The facility shall make a reasonable adjustment to accommodate each resident's preferences, habits, customs, appetite and physical condition.

4. Food may not be denied to a resident in order to punish the resident unless the denial is a part of an approved, documented behavior management program under s. DHS 134.60 (6) , and then only if a nutritionally adequate diet is maintained.

5. A variety of foods, including protein foods, fruits, vegetables, dairy products, breads and cereals, shall be provided.

(b) Modified diets.

1. A modified diet may be served only on order of the resident's physician and shall be consistent with that order. A dietitian shall participate in decisions about modified and special diets. A record of the order shall be kept on file.

2. The modified diet shall be reviewed by the physician and the dietitian on a regularly scheduled basis and adjusted as needed. Modifications may include changes in the type and texture of food.

(5)   Meal service.

(a) Schedule. The facility shall serve at least 3 meals daily at regular times comparable to normal meal times in the community. No more than 14 hours may elapse between a substantial evening meal and breakfast the following day, and not less than 10 hours may elapse between breakfast and the evening meal of the same day.

(b) Table service. All meals shall be served in dining rooms unless otherwise required by a physician or by decision of the resident's interdisciplinary team. The facility shall provide table service in dining rooms for all residents who can and want to eat at a table, including residents in wheelchairs.

(c) Developmental needs of residents. Dining areas shall be equipped with tables, chairs, eating utensils and dishes to meet the developmental needs of each resident.

(d) Self-help. There shall be adequate staff and supervision in dining rooms and resident rooms to direct self-help eating procedures and to ensure that each resident receives sufficient and appropriate foods to meet the resident's needs.

(e) Re-service. Food served but uneaten shall be discarded unless it is served in the manufacturer's package which remains unopened and is maintained at a safe temperature.

(f) Temperature. Food shall be served at proper temperatures but not more than 50ºF. (10ºC.) for cold foods and not less than 120ºF. (49ºC.) for hot foods.

(g) Snacks. If not prohibited by the resident's diet or condition, snacks shall be routinely offered to each resident between the evening meal and bedtime. Between-meal snacks shall be planned in advance and shall be consistent with daily nutritional needs.

(6)   Food supplies, preparation and cooking.

(a) Food supplies. Food shall be obtained from sources that comply with all laws relating to food and food labeling.

(b) Preparation and cooking. Food shall be cleaned, prepared and cooked using methods that conserve nutritive value, flavor and appearance and prevent food contamination. Food shall be cut, chopped or ground as required for individual residents.

(7)   Sanitation.

(a) Equipment, utensils and environment.

1. All equipment, appliances and utensils used in preparation or serving food shall be maintained in a functional, sanitary and safe condition. New and replacement equipment shall meet criteria, if any, established by the national sanitation foundation.

2. The floors, walls and ceilings of all rooms in which food or drink is stored, prepared or served, or in which utensils are washed or stored, shall be kept clean and in good repair.

3. All furnishings, table linens, drapes and furniture in rooms in which food is stored, prepared or served, or in which utensils are washed or stored, shall be in good condition and maintained in a clean and sanitary condition.

(b) Storage and handling of food.

1. Food shall be stored, prepared, distributed and served under sanitary conditions that prevent contamination.

2. All potentially hazardous food that requires refrigeration to prevent spoilage shall, except when being prepared or served, be kept in a refrigerator which shall have a temperature maintained at or below 40 ° F. (4 ° C.).

(c) Animals. Animals shall be kept out of areas of the facility where food is prepared, served or stored or where utensils are washed or stored.

(8)   Dishwashing. Whether washed by hand or by mechanical means, all dishes, plates, cups, glasses, pots, pans and utensils shall be cleaned in accordance with accepted procedures, which shall include separate steps for pre-washing, washing, rinsing and sanitizing by means of hot water or chemicals or a combination approved by the department.

Cr. Register, June, 1988, No. 390 , eff. 7-1-88; CR 04-053 : r. (6) (c) and (7) (a) 4. Register October 2004 No. 586 , eff. 11-1-04.

Note

For standards on safe and sanitary conditions, see s. DHS 190.09 . Microsoft Windows NT 6.1.7601 Service Pack 1 See s. DHS 134.47 (5) (c) 6. for required documentation of consultation from a dietitian. Microsoft Windows NT 6.1.7601 Service Pack 1 For inservice training requirements, see s. DHS 134.45 . Microsoft Windows NT 6.1.7601 Service Pack 1 For more information about nutritional needs of residents, write the Division of Quality Assurance, P.O. Box 2969, Madison, WI 53701-2969. Microsoft Windows NT 6.1.7601 Service Pack 1 Copies of the National Sanitation Foundation's "Listing of Food Service Equipment" are kept on file and may be consulted in the Department's Division of Quality Assurance and the Legislative Reference Bureau. Microsoft Windows NT 6.1.7601 Service Pack 1 See ch. DHS 145 for the requirements for reporting incidents of suspected disease transmitted by food. Microsoft Windows NT 6.1.7601 Service Pack 1 For more detailed information on safe and proper methods of dishwashing, see s. DHS 190.10 . Microsoft Windows NT 6.1.7601 Service Pack 1