4.24 ICF – Meal Procedures/Family Style Dining

Purpose

The individuals of Park West are to all have the opportunity to participate in all aspects of family-style dining, meal preparation, consumption, and clean-up.

Safe Food Handling

• All Direct Support Professionals (DSPs) and individuals are to wash their hands prior to any contact with food; this means prior to preparation, eating, before/after handling meat, and other times as needed when non-food items have been touched.

• All foods are to be served within 15 minutes of removal from temperature control (stove for hot foods, refrigerator for chilled foods). Prior to serving the food, the temperature must be measured to ensure hot foods are at least 140 degrees and cold foods are not to be more than 40 degrees. Foods that have been texture modified may have to be heated in the microwave to ensure they are at least 140 degrees before it is served to the individual.
• Dishes, serving bowls, cookware, and utensils must be clean and free of chips, nicks, or cracks.

• Food that is cross-contaminated must be discarded; this includes leftovers on a person’s plate as well as food that has been touched or come into contact with other contaminants.

• Leftovers must be stored in the refrigerator immediately after the meal; only save food times that contain a large enough serving to be used for another meal the following day. All stored leftovers must be tightly covered and labeled with what it is and the date it was prepared. This includes pitchers, such as prepared powdered drink mix or juices.

• If an individual has not participated in the meal, it is permissible to save the portions of the food listed on their menu unless it is something that can be prepared in a single serving size such as eggs and oatmeal. Prepare a place for the individual, cover it tightly, label and date it, and then store it in the refrigerator. At no time after the meal should leftover food be stored on the counter, stove, or microwave.

•  The purchaser will make every attempt not to purchase food items with bones.  However, if it is unavoidable the food should be removed from the bone prior to serving/Texturizing.

Food Service

• All individuals participating in the meal are to have a full place setting consisting of: a knife, fork, spoon, napkin, and other dishes appropriate for the menu items served (examples include: plate for most items, bowls for fruit or liquids, glasses, mugs). The only exception to this is if it is indicated in the individuals’ PCP that they are not to have certain utensils due to safety concerns. This full place setting is to be used regardless of the individuals’ food texture.

• Individuals with orders for adaptive equipment are to use it for all meals and snacks; this information is displayed on their placemat.

• Per Medicaid all meals must be served within the time frame set forth in the dietary policies, please note that per the PCP any individual has the right to eat outside of the below-listed timelines:
  • Breakfast 6:15a to 7:15a, and up to 9:30a on the weekends
  • Lunch 11:30a to 12:30p
  • Dinner 4:30p to 5:30p

• A variety of condiments should be available on both tables at all meals. For example, if salad is on the menu at least two salad dressings should be set out on each table. Salt and pepper may also be offered to individuals whose diet orders allow it and Mrs. Dash or other salt-free alternatives should be offered to those with sodium restrictions.

• Individuals who use wheelchairs should be offered regular dining room chairs if it is safe for them. Those who require Hoyer transfers, use wheelchairs to help them sit upright, or due to drop seizures are not expected to sit in regular chairs.

• Food is to be served in bowls or platters on the table and not pre-plated on individual plates at the stove.

• Each individual is encouraged to serve him/herself, this can be with hand-over-hand assistance as necessary. Individuals who need texture modifications should be encouraged to measure out their own portions and help complete the modifications when possible. Even if an individual takes their own serving, the DSP is responsible to ensure the food is the correct texture for their consumption, for example, if an individual who needs finely chopped food serves him/herself a roll, the DSP is to assist the individual in proper texture modification. If the individual eats any food of the wrong texture an incident report must be written.

• All individuals must be present in the kitchen before food is placed on the table unless otherwise indicated in the person’s PCP.

• Individuals must be given the opportunity to eat at their own pace and not hurried.

• Beverages may be prepared in advance. Each individual may pour their own beverage prior to the meal or this task may be assigned to one individual for all. Hot liquids may be poured and served by the DSP staff.

• Each table must contain the items needed for the meal, it is not permitted to pass items from one table to the other table.

Diet Orders

• All individuals are encouraged to follow their specific diet plan that is created by the Dietician.

• Everything listed on the menu must be offered and the DSP is responsible for reading all of the individuals’ menus in order to provide the items listed or appropriate alternatives.

• Each DSP is responsible for ensuring individuals with texture modifications receive the correct texture and that electric grinders and other manual tools are available in the apartment. Guides for correct sizes and how to get them are in the dietary/recipe book as well as being posted inside the cabinet doors in the kitchen and are as follows below:
  • Pureed food must be free of chunks and with no thin liquids
  • Ground food must be sufficiently moist and the consistency of small curd cottage cheese
  • Chopped foods must be the consistency of a fruit cocktail
  • Liquids can be thickened to nectar, honey, and pudding consistency by following the instructions on the can of thickening powder
  • Any food items that have bone should be deboned prior to texturizing

Substitutions

• DSPs must offer an appropriate substitution for any menu item that is not available or is refused.

• Food dropped by an individual must be replaced, for example, if an individual has bad tremors and drops food off their spoon, the DSP must offer more food to ensure the individual receives the full portion size.

• The individual is to choose the substitution made so the DSP is to present items to choose from to ensure the substitution is appropriate such as vegetable for vegetable, starch for a starch, meat for meat, etc. In addition, the dietary/recipe book contains a guide with suggested substitutions.

• When substitutions are made, the DSP is responsible for documenting them on the computer on the designated form.

Training/Role Modeling

• DSP staff are expected to complete mealtime programs and swallowing strategies as listed on the placemat/PCP. To ensure this is completed all DSPs are to be seated at the table near the individuals who need the most assistance, they should not stand or hover over the individuals while they are eating.

• All individuals are to be encouraged to feed themselves to the best of their ability, if they are unable to do so DSP staff must provide hand-over-hand assistance.

• All DSP staff working in the apartment are expected to role model appropriate meal skills, this includes the social aspect such as conversation, asking for items to be passed, demonstrating good manners, napkin usage, and eating.

• DSP staff who cannot consume part of the meal due to ethnic, medical, moral, or religious reasons are excused from consuming that meal item but they must disclose the reason to their supervisor prior.

• Inappropriate behaviors displayed by individuals during meals must be managed by the DSPs using interventions from the individuals’ behavior support plan or PCP.

• To ensure the continuous training of the DSP staff in the area of family-style dining, designated staff will conduct family-style dining audits on a regular basis to provide feedback and guidance as well as to gauge the skills of the DSP staff.

Last Revised: 4/29/22