Current through Register Vol. 51, No. 19, September 20, 2024
A.
Services Provided. Services may be provided directly by the facility or the
facility may contract with a food management company, a caterer, or another
facility. The facility and the food management company (or caterer or facility
providing service) shall comply with these regulations. Food service personnel
shall comply with COMAR 10.15.03 Food Service Facilities.
B. Supervision.
(1) In a nursing home with more than 50 beds,
overall supervisory responsibilities for the food service department and food
production shall be assigned to a full-time qualified dietetic service
supervisor. It shall be the responsibility of the supervisor to delegate relief
duties to an individual qualified to serve as relief as stated in Regulation
.09I of this chapter.
(2) In a
nursing home with 50 or fewer beds, exceptions may be made by the Department to
allow the supervisor to share cooking responsibilities with the full-time
cook.
C. Consultation.
(1) If the supervisor is not a licensed
registered dietitian, the individual shall receive regularly scheduled
consultation from a licensed registered dietitian. In all instances sufficient
consultation shall be provided to fulfill all required
responsibilities.
(2) There shall
be a signed agreement between the facility and the consultant dietitian
specifying hours and frequency of service responsibilities, and registration
number if applicable.
(3)
Consultation services shall be documented by written reports.
D. Staffing.
(1) A sufficient number of food service
personnel shall be employed to perform efficiently the functions of the food
and nutrition service and meet the dietary needs of the residents.
(2) Working hours shall be scheduled to
ensure that the nutritional needs of the residents are met.
(3) Nursing, housekeeping, laundry, or other
personnel may not be used as food service staff. Exceptions, such as in a
culture change setting, shall be based on the written approval of the
Department. The kitchen may not be used for any purpose other than the
preparation of food.
E.
Adequacy of Diet.
(1) The food and
nutritional needs of residents shall be met in accordance with physicians'
orders.
(2) To the extent medically
possible, the Recommended Dietary Allowances of the Food and Nutrition Board,
Commission on Life Sciences, and National Research Council, adjusted for age,
sex, and activity, shall be observed.
(3) The Diet Manual for Long-Term Care
Residents, as published by the Department, or any other similar reference
material that contains food allowances and guides for regular and therapeutic
diets, shall be used.
F.
Therapeutic Diets. Therapeutic diets shall be planned, prepared, and served as
prescribed by the attending physician:
(1)
Therapeutic diets shall be planned by a licensed registered
dietitian;
(2) Preparation and
serving shall be supervised by a qualified dietetic supervisor; and
(3) A current diet manual shall be available
to medical, nursing, and dietetic staff.
G. Frequency and Quality of Meals.
(1) At least three meals or their equivalent
shall be offered daily, at regular times, with not more than 14-hour intervals
between the substantial evening meal and breakfast.
(2) A substantial evening meal is an offering
of three or more menu items at one time, one of which includes a high quality
protein such as meat, fish, eggs, or cheese. This meal represents at least 20
percent of the day's total nutritional requirements.
(3) To the extent medical orders permit,
bedtime nourishments shall be offered routinely to all residents.
(4) If a four or five meal a day plan is
used, the meal pattern to provide this plan shall be approved by the
Department.
H. Advance
Planning and Posting of Menus.
(1) Residents
shall be given the opportunity to participate in planning menus. Menus shall be
written at least 1 week in advance.
(2) The current week's basic menu shall be
posted in one or more easily accessible places in the food services department
and in the common areas.
(3) Menus
shall include alternatives of similar nutritive value that give residents the
opportunity to choose meals that they prefer. The dietary preferences of a
resident shall be ascertained, including preferences arising from a resident's
religious, cultural, and ethnic heritage, and efforts shall be made to meet
those preferences.
I.
Menus Served as Planned. Food sufficient to meet the nutritional needs of
patients shall be prepared as planned for each meal. When menu changes are
necessary, substitutions shall provide equal nutritional value.
J. Retention of Records. Menus as served and
records of food purchased for consumption by patients shall be filed on the
premises for a period of 30 days.
K. Preparation of Food.
(1) Foods shall be prepared by methods that
conserve nutritive value, flavor, and appearance, and shall be served at proper
temperatures, in a form to meet individual needs.
(2) Standardized recipes adjusted to
appropriate yield shall be followed. Standardized recipes are those recipes
which have been tested by the nursing home or another source and that ensure
consistent quality and quantity.
L. Resident-Directed Meal Pattern. If a
resident-directed meal pattern is provided, the following is required:
(1) Counseling the residents regarding the
risks and benefits of a resident-selected diet which is documented within the
medical record; and
(2) Approval of
the pattern by both the resident's physician and a licensed registered
dietitian.
