Current through Bulletin 2024-06, March 15, 2024
(1) The licensee
shall provide each resident with a safe, palatable, well-balanced diet that
meets the daily nutritional and special dietary needs of each
resident.
(2) The licensee shall
employ there enough staff to meet the dietary needs of the residents.
(3) For food services and practices, the
licensee shall ensure:
(a) there is a
dietitian employed either full-time, part-time, or on a consultant
basis;
(b) the dietitian is
certified in accordance with Title 58, Chapter 49, Dietitian Certification
Act;
(c) if a dietitian is not
employed full-time, the administrator designates a full-time person to serve as
the dietetic supervisor;
(d) if the
dietetic supervisor is not a certified dietitian, the licensee consults a
certified dietitian at least monthly, according to the needs of the residents
and documents the consultations; and
(e) the dietetic supervisor is available when
the consulting dietitian visits the facility.
(4) The licensee shall develop menus that
meet the nutritional needs of residents to the extent medically possible and
ensure the menus are:
(a) prepared in
advance;
(b) followed;
(c) different each day;
(d) posted for each day of the
week;
(e) approved and signed by a
certified dietitian; and
(f) cycled
no less than every three weeks.
(5) The licensee shall retain documentation
for at least three months for any served substitutions to the menu.
(6) The licensee shall ensure any food
sanitation inspection reports of state or local health department inspections
are available for department review.
(7) The licensee shall ensure the attending
physician or qualified registered dietitian in consultation with the physician,
orders each therapeutic diet in writing, if allowed by facility
policy.
(8) The licensee shall
ensure there is no more than a 14hour interval between the evening meal and
breakfast, unless a substantial snack is served in the evening.
(9) The licensee shall provide special eating
equipment and assistive devices for residents who need them.
(10) The licensee shall ensure the facility's
food service complies with Rule R392-100.
(11) The licensee shall ensure a one-week
supply of nonperishable staple foods and a three-day supply of perishable foods
are maintained to complete the established menu for three meals per day, per
resident.
(12) A nursing care
licensee may use trained dining assistants to aid residents in eating and
drinking if:
(a) a licensed practical
nurse-geriatric care manager, registered nurse, advance practice registered
nurse, speech pathologist, occupational therapist, or dietitian has assessed
that the resident does not have complicated feeding problems, including
recurrent lung aspirations, behaviors that interfere with eating, difficulty
swallowing, or tube or parenteral feeding; and
(b) the service plan or plan of care
documents that the resident needs assistance with eating and drinking and
defines who is qualified to offer the assistance.
(13) If the nursing care facility uses a
dining assistant, the licensee shall ensure that the dining assistant:
(a) has completed a training course from a
department-approved training program;
(b) has completed a background screening
pursuant to Rule R432-35; and
(c)
performs duties only for those residents who do not have complicated feeding
problems.
(14) A long
term care licensee shall submit the following to the department to become an
approved training program:
(a) a copy of the
curriculum to be implemented that meets the requirements of Subsection (13);
and
(b) the names and credentials
of the trainers.
(15) The
long term care licensee shall ensure a dietitian training program is approved
by the department if it includes the following:
(a) eight hours of instruction for the dining
assistant and one hour of observation by the trainer to ensure
competency;
(b) feeding
techniques;
(c) assistance with
eating and drinking;
(d)
communication and interpersonal skills;
(e) safety and emergency procedures including
the Heimlich maneuver;
(f)
infection control;
(g) resident
rights;
(h) recognizing resident
changes inconsistent with their normal behavior and the importance in reporting
those changes to the supervisory nurse;
(i) special diets;
(j) documentation of type and amount of food
and hydration intake;
(k)
appropriate response to resident behaviors; and
(l) use of adaptive equipment.
(16) The licensee shall issue a
training certificate of completion and maintain a list of the dining assistants
that identifies:
(a) the training program
provider;
(b) the telephone number
where the licensee may verify the training; and
(c) each dining assistant's name and
address.
(17) To provide
dining assistant training in a department-approved training program, the
licensee shall ensure a trainer holds a current valid license to practice as:
(a) a registered nurse, advanced practice
registered nurse or licensed practical nurse-geriatric care manager pursuant to
Title 58, Chapter 31b, Nurse Practice Act;
(b) a registered dietitian, pursuant to Title
58, Chapter 49, Dietitian Certification Act;
(c) a speech-language pathologist, pursuant
to Title 58, Chapter 41, Speech-Language Pathology and Audiology Licensing Act;
or
(d) an occupational therapist,
pursuant to Title 58, Chapter 42a, Occupational Therapy Practice Act.
(18) The licensee may suspend a
training program if the program's courses do not meet the requirements of this
rule.
(19) The licensee may suspend
a training program operated by a nursing care facility if:
(a) a federal or state survey reveals failure
to comply with federal regulations or state rules regarding feeding or dining
assistant programs;
(b) the
licensee fails to provide sufficient, competent staff to respond to
emergencies;
(c) the department
sanctions the facility for any reason; or
(d) the department determines that the
licensee is in continuous or chronic noncompliance under state rule or that the
licensee has provided sub-standard quality of care under federal
regulation.
