Current through Reg. 49, No. 38; September 20, 2024
(a) A center must
adopt and enforce written policy and procedures to ensure that a minor, while
at the center, receives:
(1) a nourishing,
well-balanced diet as recommended by the American Academy of Pediatrics or Food
and Nutrition Board of the National Research Council, National Academy of
Sciences; or
(2) a diet ordered by
a minor's prescribing physician.
(b) If a minor's meals and snacks are
supplied by an adult minor or a minor's parent, the center's written policy and
procedures must:
(1) include a written signed
agreement between the center and the adult minor or minor's parent that
includes:
(A) a statement that the adult
minor or minor's parent is responsible for providing the appropriate meals and
snacks for the minor in accordance with this section;
(B) the responsibilities of the center and
the responsibilities of the adult minor or minor's parent concerning the
provision of meals and snacks; and
(C) actions that may be taken by the center
if the adult minor or minor's parent fails to provide meals and snacks for the
minor as agreed;
(2)
describe the actions that will occur if an adult minor or minor's parent fails
to provide the minor's meals and snacks or fails to provide meals and snacks in
accordance with the minor's prescribed diet, which must include that the center
ensures that the minor receives the meals and snacks as required in this
section while at the center; and
(3) ensure an adult minor or minor's parent
receives nutritional counseling as described in § 550.5101 of this
division (relating to Nutritional Counseling).
(c) If the center provides meals and snacks
directly or under contract, the center must employ or contract with a dietitian
as described in § 550.411(b) of this subchapter (relating to
Rehabilitative and Ancillary Professional Staff and Qualifications).
(1) The dietitian is responsible for the
overall operation of the dietary service.
(2) The dietitian must participate in regular
conferences with the administrator and nursing director to provide information
about approaches to identified nutritional problems.
(3) The dietitian must participate in the
development of dietary support staff policies.
(4) The center must employ sufficient dietary
support staff who meet the qualifications to carry out the functions of the
dietary service.
(5) The dietitian
must ensure that a minor has a diet:
(A) that
meets the daily nutritional and special dietary needs of a minor, based upon
the acuity and clinical needs of a minor; or
(B) as prescribed by a minor's prescribing
physician.
(6) The
dietitian is required to review a minor's plan of care for any known food
allergy and special diet ordered by a minor's prescribing physician as often as
necessary for changes to a minor's dietary needs.
(d) If a center provides meals and snacks
directly or under contract:
(1) a dietitian
must develop a menu that:
(A) is prepared at
least one week in advance;
(B) is
written for each type of diet; and
(C) varies from week to week, taking the
general age-group of minors into consideration;
(2) the center must post the current week's
menu in a conspicuous location so an adult minor and a minor's parent may see
it; and
(3) the center must retain
menus for 30 days.
(e) If
a center provides meals and snacks directly, the center must retain records of
menus served and food purchased for 30 days. The center must keep a list of
minors receiving special diets and a record of the diets in the minors' medical
records for at least 30 days.
(f)
The center must:
(1) provide tables that
allow minors to eat together when possible;
(2) provide assistance to minors, as
needed;
(3) serve food on
appropriate tableware; and
(4)
ensure clean napkins, bibs, dishes, and utensils are available for each
use.
(g) A center must
coordinate with an adult minor or a minor's parent to ensure special eating
equipment and utensils are available for a minor at the center if
needed.
(h) An identification
system, such as tray cards, must be available to ensure that all food is served
in accordance with a minor's diet.
(i) A center must monitor and record food
intake of all minors as follows.
(1)
Deviations from normal food and fluid intake must be recorded in a minor's
medical record.
(2) In-between meal
snacks, and supplementary feedings, either as a part of the overall plan of
care or as ordered by a minor's prescribing physician, including special diets,
must be documented using professional practice standards.
(j) The center must serve a minor meals and
snacks as specified in this section and as outlined in a minor's plan of care.
(1) If breakfast is served, a morning snack
is not required.
(2)
Notwithstanding the provisions of this section, a minor must not go more than
three hours without a meal or snack being offered, unless a minor is
sleeping.
(3) The center must offer
at least one snack to a minor who is served at the center for less than four
hours.
(4) The center must offer
one meal, or one meal and one snack, equal to one third of a minor's daily food
needs to a minor who is served at the center for four to seven hours.
(5) The center must offer two meals and one
snack, or two snacks and one meal, equal to one half of a minor's daily food
needs to a minor who is served at the center for more than seven
hours.
(6) The center must ensure
that a supply of drinking water is always available to each minor and is served
at every snack, mealtime, and after active play.
(k) The center must:
(1) purchase food from sources approved or
considered satisfactory by federal, state, and local authorities;
(2) store, prepare, and serve food under
sanitary conditions, as required by the Department of State Health Services
food service sanitation requirements; and
(3) dispose of garbage and refuse
properly.
(l) The center
must provide safe and proper storage and service of a minor's meals and snacks
provided by an adult minor and minor's parent.
(m) Dietary service staff must be in good
health and practice hygienic food-handling techniques. Staff with symptoms of
communicable diseases or open, infected wounds may not work at the center until
the center receives written documentation from a health care professional that
the staff member is released to return to work or, the signs and symptoms which
relate to the communicable disease are no longer evident.
(n) Dietary service staff must wear clean,
washable garments, wear hair coverings or clean caps, and have clean hands and
fingernails.
(o) Routine health
examinations must meet all local, state, and federal codes for food service
staff.
