Current through Vol. 41, No. 13, March 15, 2024
(a)
General. The CAH shall directly provide or contract for organized
food and nutritional services that are directed and staffed by qualified
personnel. If the CAH has a contract with an outside food management company to
provide services on-site or cater food to the CAH, the company shall comply
with all requirements specified in this section.
(b)
Organization.
(1) Clinical nutritional services shall be
under the supervision and direction of a licensed/registered dietitian on a
full-time, part-time, or consultant basis. The dietitian shall be responsible
for approval of menus and modified diets, review of clinical policies and
procedures, evaluation of nutritional services and staff continuing education.
If dietitian services are provided on a part-time or consultant basis, the
responsibilities of the dietitian shall be clearly defined in a written job
description and summary reports of consultant visits shall be written and on
file. The dietitian shall be responsible for, or shall designate a person in
writing, to carry out clinical nutritional activities. The clinical nutritional
activities shall include but not be limited to patient and family counseling on
modified diets as needed, any required nutritional assessments, and development
of clinical nutritional policies and procedures. If dietitian services are
provided on a part-time or consultant basis, a dietitian shall be available for
telephone consultation daily and shall be able to approve menus and modified
diets electronically.
(2) The food
and nutritional services manager may or may not be a licensed/registered
dietitian. If the manager is not a licensed/registered dietitian or certified
dietary manager, the manager shall be responsible only for administrative
management and shall not direct clinical nutritional activities.
(3) Personnel shall be adequate in number and
training to carry out the preparation and serving of foods and other related
functions with the proper and necessary sanitary procedures. The food service
personnel shall complete a basic orientation program before working in the food
service area. This orientation shall include, but not be limited to: basic
dietary guidelines, infection control including food safety, and fire and
safety precautions.
(c)
Services and facilities.
(1)
Equipment used in the preparation and handling of food shall bear the seal of
the National Sanitation Foundation (NSF) or comply with the requirements of the
NSF (Rules and Regulations Pertaining to Food Establishments).
(2) A nourishment room accessible to the
nursing staff shall be provided for the preparation and serving of light
refreshments. This room shall be equipped with equipment for warming food, a
refrigerator, and a lavatory. This room may serve as the location for an ice
machine.
(d)
Diets
and menus.
(1) At least three (3)
palatable meals or their equivalent shall be served daily, at regular times
with not more than fifteen (15) hours between a substantial evening meal and
breakfast. Menus shall be planned and followed to meet nutritional needs of
patients, in accordance with the prescribing physician or practitioner diet
orders and to the extent medically possible, in accordance with the Dietary
Reference Intakes (DRIs) of the Food and Nutrition Board of the Institute of
Medicine, National Academy of Sciences.
(2) All diets shall be prescribed by the
physician or practitioner responsible for the care of the patient. Modified
diets shall be prescribed according to the latest edition of the Oklahoma Diet
Manual or other equivalent approved manual. The Oklahoma Diet Manual or other
equivalent approved diet manual shall be approved by the licensed/registered
dietitian, the medical and professional staff and the governing body. The
manual shall be available to all medical, nursing, and food service
personnel.
(3) Nourishments shall
be available and may be offered at anytime in accordance with approved diet
orders.
(4) Menus covering all
prescribed diets shall be approved, dated, and periodically reviewed by a
licensed/registered dietitian. Modified diet orders not covered with an
approved menu shall be planned in writing, reviewed, and approved by a
licensed/registered dietitian. The licensed/registered dietitian approval of
the modified diet may be performed electronically.
(5) The portioning of menu servings shall be
accomplished with the use of portion-control serving utensils.
(6) All modified diets shall be prepared
separately, as necessary, from regular diets.
(7) An identification system shall be
established to ensure that each patient receives the prescribed diet as
ordered.
(e)
Food
preparation and storage.
(1)
Potentially hazardous food, as defined in chapter 256 of this Title, shall be
maintained at one hundred-forty (140)oF
(approximately 60oC) or above or at an internal
temperature of forty-one (41)oF
(approximately5oC) or below. A product thermometer
shall be available, metal stem-type numerically scaled indicating temperature,
accurate to plus or minus two (2) degrees F and used to check internal food
temperatures.
(2) Milk and milk
products shall be served, handled and stored in accordance with the
requirements of Chapter 256 of this Title.
(3) All ice which is in contact with food or
drink shall come from a source approved by the Department. Storage,
transportation, handling, and dispensing shall be in a sanitary manner,
approved by the Department in accordance with Chapter 256 of this
Title.
(f)
Sanitation.
(1) The food and
nutritional services shall be inspected and approved by state or local health
agencies and licensed as a Food Service Establishment. Written reports of the
inspections; e.g., Food Establishment Inspection Report Forms, shall be
maintained with notations made of the action taken to correct
violations.
(2) Storage,
preparation, and serving of food shall be in compliance with the requirements
of Chapter 256 of this Title, including adequate and proper space for each
activity.
(3) The system used for
dishwashing shall be approved by the Department and operated in accordance with
approved procedures and requirements of Chapter 256 of this Title.
(4) Garbage and refuse shall be kept in
durable, easily cleanable, insect-proof and rodent-proof containers that do not
leak and do not absorb liquids. Adequate carriers and containers shall be
provided for the sanitary collection and transportation of garbage and refuse
from food service areas to the place of disposal in accordance with the
requirements of Chapter 256 of this Title.
Added at 12 Ok Reg 1555,
eff 4-12-95 (emergency); Added at 12 Ok Reg 2429, eff 6-26-95; Amended at 17 Ok
Reg 692, eff 12-16-99 (emergency); Amended at 17 Ok Reg 2992, eff 7-13-00;
Amended at 20 Ok Reg 1664, eff 6-12-03