Section 481.65.22. Nutrition.

There shall be policies and procedures written and implemented for dietary staffing.

        1.            The person responsible for planning menus and monitoring the kitchens in each facility shall have completed training, approved by the department, in sanitation and food preparation. (III)

        2.            In facilities licensed for over 15 beds, food service personnel shall be on duty during a 12-hour span extending from the preparation of breakfast through supper. (III)

        3.            There shall be written work schedules and time schedules covering each type of job in the food service department for facilities over 15 beds. These work and time schedules shall be posted or kept in a notebook which is available for use in the food service area. (III)

       65.22(1) Nutrition and menu planning. Residents shall be encouraged to the maximum extent possible to participate in meal planning, shopping, and in preparing and serving the meal and cleaning up. The facility shall be responsible for helping residents become knowledgeable of what constitutes a nutritionally adequate diet. (III)

        a.           Menus shall be planned and served to meet nutritional needs of residents in accordance with the physician’s diet orders which shall be renewed yearly. Menus shall be planned and served to include foods and amounts necessary to meet the recommended daily dietary allowances of the Food and Nutrition Board of the National Research Council, National Academy of Sciences. Other foods shall be included to meet energy requirements (calories) to add to the total nutrients and variety of meals. (II, III)

        b.           At least three meals or their equivalent shall be made available to each resident daily, consistent with those times normally existing in the community. (II, III)

       (1)             There shall be no more than a 14-hour span between the substantial evening meal and breakfast. (III)

       (2)             To the extent medically possible, bedtime nourishments, containing a protein source, shall be offered routinely to all residents. Special nourishments shall be available when ordered by the physician. (II, III)

        c.           Menus shall include a variety of foods prepared in various ways. The same menus shall not be repeated on the same day of the following week. (III)

        d.           If modified diets are ordered by the physician, the person responsible for writing the menus shall have completed department-approved training in simple therapeutic diets. A copy of a modified diet manual approved by the department and written within the past five years shall be available in the facility. (II, III)

        e.           Therapeutic diets shall be served accurately. (II, III)

        f.            Menus shall be written at least one week in advance. The current menu shall be located in an accessible place in the dietetic service department for easy use by persons purchasing, preparing, and serving food. (III)

        g.           Records of menus as served shall be filed and maintained for 30 days and shall be available for review by departmental personnel. When substitutions are necessary, they shall be of similar nutritive value and recorded on the menu or in a notebook. (III)

        h.           A file of tested recipes adjusted to the number of people to be fed in the facility shall be maintained. (III)

       65.22(2) Dietary storage, food preparation, service. In each stage, food shall be handled with maximum care for safety and good health.

        a.           The use of foods from salvaged, damaged, or unlabeled containers is prohibited. (II, III)

        b.           No perishable food shall be allowed to stand at room temperature any longer than is required to prepare and serve. (II, III)

        c.           Canning food is prohibited. The facility may freeze fruits, vegetables, and meats provided strict sanitary procedures are followed and in accordance with recommendations in the “Food Service Sanitation Manual,” revised 1976, U.S. Department of Health, Education, and Welfare, Public Health Service, U.S. Government Printing Office, Washington, D.C. (II)

        d.           Supplies of staple foods for a minimum of a one-week period and of perishable foods for a minimum of a three-day period shall be maintained on the premises. (III)

        e.           If family-style service is used, all leftover prepared food that has been on the table shall be safely handled. (III)

        f.            Poisonous compounds shall not be kept in food storage or preparation areas except for a sanitizing agent which shall be kept in a locked cabinet. (II, III)

       65.22(3) Sanitation in food preparation area. The facility shall develop and implement policies and procedures to address sanitation, meal preparation and service in accordance with recommendations in the “Food Service Sanitation Manual” reference in 65.22(2)“c,” which shall be used as the established, nationally recognized reference for establishing and determining satisfactory compliance with the department’s food service and sanitation rules. (III)

        a.           In facilities of 15 beds or fewer, residents may be allowed in the food preparation area in accordance with their IPP. (III)

        b.           In facilities licensed for over 15 beds, the kitchen shall not be used for serving meals to residents, food service personnel, or other staff. (III)

        c.           All appliances and work areas shall be kept clean and sanitary. (III)

        d.           There shall be written procedures established for cleaning all work and serving areas in facilities over 15 beds and a schedule of duties to be performed daily shall be posted in each food area. (III)

        e.           The food service area shall be located so it will not be used as a passageway by residents, guests, or nonfood service staff in facilities over 15 beds. (III)

        f.            Dirty linen shall not be carried through the food service area unless it is in sealed, leakproof containers. (III)

        g.           Mops, scrub pails, and other cleaning equipment used in the resident areas shall not be stored or used in the dietary area. (III)

       65.22(4) Hygiene of food service personnel. If food service employees are assigned duties outside the dietetic service, these duties shall not interfere with sanitation, safety, or time required for dietetic work assignments. (II, III)

        a.           Employees shall wear clean, washable uniforms that are not used for duties outside the food service area in facilities over 15 beds. (III)

        b.           Hair nets shall be worn by all food service personnel and residents who do work in the kitchen in facilities over 15 beds and effective hair restraints in facilities with fewer than 15 beds. (III)

        c.           People who handle food shall use correct hand-washing and food-handling techniques as identified in the “Food Service Sanitation Manual.” People who handle dirty dishes shall not handle clean dishes without washing their hands. (III)

This rule is intended to implement Iowa Code section 135C.14.