Current through Register 2024 Notice Reg. No. 52, December 27, 2024
(a) The dietetic service shall provide food of the
quality and quantity to meet the patient's need in accordance with physicians'
orders and, to the extent medically possible, to meet the "Dietary Reference
Intakes: The Essential Guide to Nutrient Requirements" (2006) by the National
Research Council of the National Academy of Sciences, Institute of Medicine, hereby
incorporated by reference, and the following:
(1)
Not less than three meals shall be served daily.
(2) Not more than 14 hours shall elapse between
the evening meal and breakfast of the following day.
(3) Nourishment or between meal feedings shall be
provided as required by the diet prescription and shall be offered to all patients
unless counter ordered by the physician.
(4) Patient food preferences shall be respected as
much as possible and substitutes shall be offered through use of a selective menu or
substitutes from appropriate food groups.
(5) Where desirable, table service should be
provided for all who can and wish to eat at a table. Tables of appropriate height
shall be provided for patients in wheelchairs.
(6) When food is provided by an outside commercial
food service, all applicable requirements herein set forth shall be met. The
hospital shall maintain adequate space, equipment and staple food supplies to
provide patient food service in emergencies.
(b) Written policies and procedures shall be
developed and maintained by the person responsible for the service in consultation
with other appropriate health professionals and administration. Policies shall be
approved by the governing body. Procedures shall be approved by the administration
and medical staff where such is appropriate.
(c) The responsibility and the accountability of
the dietetic service to the medical staff and hospital administration shall be
defined.
(d) A current diet manual
approved by the dietitian and the medical staff shall be used as the basis for diet
orders and for planning modified diets. Copies of the diet manual shall be available
at each nursing station and in the dietetic service area.
(e) Therapeutic diets shall be provided as
prescribed by the attending physician and shall be planned, prepared and served with
supervision and/or consultation from the dietitian. Persons responsible for
therapeutic diets shall have sufficient knowledge of food values to make appropriate
substitutions when necessary.
(f) A
current profile card shall be maintained for each patient indicating diet, likes,
dislikes and other pertinent information concerning the patient's dietary
needs.
(g) Menus.
(1) Menus for regular and routine modified diets
shall be written at least one week in advance, dated and posted in the kitchen at
least three days in advance.
(2) If any
meal served varies from the planned menu, the change shall be noted in writing on
the posted menu in the kitchen.
(3)
Menus shall provide a variety of foods in adequate amounts at each meal.
(4) Menus shall be planned with consideration for
cultural and religious background and the food habits of patients.
(5) A copy of the menu as served shall be kept on
file for at least 30 days.
(6) Records
of food purchased shall be kept available for one year.
(7) Standardized recipes, adjusted to appropriate
yield, shall be maintained and used in food preparation.
(h) Food shall be prepared by methods which
conserve nutritive value, flavor and appearance. Food shall be served attractively
at appropriate temperatures and in a form to meet individual needs.
(i) Nutritional Care.
(1) Nutritional care shall be integrated in the
patient care plan.
(2) Observations and
information pertinent to dietetic treatment shall be recorded in patient's medical
records by the dietitian.
(3) Pertinent
dietary records shall be included in patient's transfer discharge record to ensure
continuity of nutritional care.
(j) In-service training shall be provided for all
dietetic service personnel and a record of subject areas covered, date and duration
of each session, and attendance lists shall be maintained.
(k) Food Storage.
(1) Food storage areas shall be clean at all
times.
(2) Dry or staple items shall be
stored at least 30 cm (12 inches) above the floor, in a ventilated room, not subject
to sewage or waste water backflow, or contamination by condensation, leakage,
rodents or vermin.
(3) All readily
perishable foods or beverages capable of supporting rapid and progressive growth f
microorganisms which can cause food infections or food intoxication shall be
maintained at temperatures of 7°C (45°F) or below, or at 60°C
(140°F) or above, at all times except during necessary periods of preparation
and service. Frozen food shall be stored at -18°C (0°F) or below.
(4) There shall be a reliable thermometer in each
refrigerator and in storerooms used for perishable food.
(5) Pesticides, other toxic substances and drugs
shall not be stored in the kitchen area or in storerooms for food and/or food
preparation equipment and utensils.
(6)
Soaps, detergents, cleaning compounds or similar substances shall not be stored in
food storerooms or food storage areas.
(l) Sanitation.
(1) All kitchens and kitchen areas shall be kept
clean, free from litter and rubbish and protected from rodents, roaches, flies or
other insects.
(2) All utensils,
counters, shelves and equipment shall be kept clean, maintained in good repair and
shall be free from breaks, corrosions, open seams, cracks and chipped
areas.
(3) Plasticware, china and
glassware that is unsightly, unsanitary or hazardous because of chips, cracks or
loss of glaze shall be discarded.
(4)
Ice which is used in connection with food or drink shall be from a sanitary source
and shall be handled and dispensed in a sanitary manner.
(5) Kitchen wastes that are not disposed of by
mechanical means shall be kept in leakproof, nonabsorbent, tightly closed containers
and shall be disposed of as frequently as necessary to prevent a nuisance or
unsightliness.
(m) All
utensils used for eating, drinking and in the preparation and serving of food and
drink shall be cleaned and disinfected after each usage.
(1) Gross food particles shall be removed by
scraping and prerinsing in running water.
(2) The utensils shall be thoroughly washed in hot
water with a minimum temperature of 43°C (110°F), using soap or detergent,
rinsed in hot water to remove soap or detergent and disinfected by one of the
following methods or an equivalent method approved by the Department:
(A) Immersion for at least two minutes in clean
water at 77°C (170°F).
(B)
Immersion for at least 30 seconds in clean water at 82°C (180°F).
(C) Immersion in water containing bactericidal
chemical as approved by the Department.
(3) After disinfection the utensils shall be
allowed to drain and dry in racks or baskets on nonabsorbent surfaces. Drying cloths
shall not be used.
(4) Results obtained
with dishwashing machines shall be equal to those obtained by the methods outlined
above and all dishwashing machines shall meet the requirements contained in Standard
No. 3 as amended in April 1965 of the National Sanitation Foundation, P.O. Box 1468,
Ann Arbor, MI 94106.
1. Amendment of
subsection (a) and new NOTE filed 5-30-2023; operative 5-30-2023. Submitted to OAL
for filing and printing only pursuant to Health and Safety Code section 1275(g)
(Register 2023, No. 22).
Note: Authority cited: Sections 20, 21, 1275 and 1276, Health
and Safety Code. Reference: Sections 1250 and 1254, Health and Safety
Code.
