8.02 – Dietary Services

Purpose

The purpose of Dietary Service is to assess, recommend, and provide individuals with diets that meet their nutritive, therapeutic, and social needs. 

Charting and Documentation

• The nutritional aspects of individual care will be under the direction of a qualified dietitian with the approval of the physician, as needed.
• A nutrition assessment and care plan will be done within 30 days of admission. Assessments will be completed yearly thereafter.
• Progress notes will be written in Advisor, as needed, for significant weight changes or other significant nutrition issues.
• Individuals and their families will be counseled concerning general or modified diet regimens when needed.
• Dietitian will participate, as appropriate, in Person Centered Plan meeting.

Dietary Staff

• Each apartment will employ a sufficient number of personnel to meet the needs of the individuals and functions of the Dietary Department. Apartment staff will receive training during orientation emphasizing sanitation, dishwashing procedures, storage techniques, food preparation, normal nutrition, portion control, menu reading, infection control, and other policies and procedures of the dietary department.
• In-service Training: The dietitian will provide in-service training programs specifically designed to further the working knowledge and understanding of the apartment personnel as needed.

Nutritional Adequacy of Diets

• The nutritional needs of the individuals will be met to the extent medically possible and the diets will meet the DRIs of the Food and Nutrition Board of the Institute of Medicine of the National Academies.
• Meals will be planned and served to meet the nutritional needs of the individuals. Menus will be analyzed for nutrient content by the dietitian and will be planned using MyPlate guidelines. Each individual will receive at least three meals and an evening snack daily. Adequate substitutes will be made available to individuals refusing items on the scheduled menu.
• Meal Frequency: The individuals will receive meals and snacks according to the following schedule, to ensure that meals are provided at proper intervals unless indicated differently per the individual’s plan:
  • Breakfast served from 6:15a.m. to 7:15a.m. except on weekends. On weekends and holidays, breakfast may be served until 9:30a.m.
  • Lunch served from 11:30a.m. to 12:30p.m.
  • Dinner served from 4:30p.m. to 5:30p.m.
  • Snack served at 8:15p.m. unless otherwise necessary due to activities or preference.

Menu Planning

• Purpose: To ensure that nutritious menus are planned in advance, to preclude inadequate storage of supplies, and to serve as a permanent record of meals prepared.
• Procedure:
  • It will be the responsibility of the dietitian to write the menus. Individuals’ food preferences and the cooking skills of staff and individuals will be considered.
  • The menu will be a four-week cycle and change twice a year (spring/summer and fall/winter).  It will offer a sufficient variety of foods in adequate amounts.
  • Menus will be posted on each apartment’s computer along with a menu schedule of dates which will be utilized for purchasing, preparing, and serving meals.
  • It will be the policy of Park West Court Apartments to maintain a one-week staple food supply and a two-day perishable food supply in each apartment all times.  A supply of emergency food items will also be available in each apartment.
• Portion control: To aid in proper interpretation and utilization of the menu, portions will be listed for all items. The portions listed on the menus refer to the cooked weight of each item. Portion control utensils such as spoodles, measuring spoons, measuring cups, and diet scales will be used for accurate portioning during meal service.
• Menu Substitutions
  • All substitutions to the menu must be approved by the dietitian. If the dietitian is not available, the appropriate substitution must be made by following the menu substitution guidelines posted in the kitchen.
  • Substitutions must be documented on the Substitution List on the apartment computers and will be kept on file for a period of one year.  The dietitian will follow up with training of staff regarding any inappropriate substitutions.
• Modified Diets
  • Modified diets are intended to correct, treat, or prevent a health problem or nutritional deficiency and may be altered in texture to enable an individual to safely eat.
  • All modified diets are prescribed by the interdisciplinary team, which includes a physician and registered dietitian.  Texture needs may be assessed by the speech pathologist.
  • All modified diet menus are written by the dietitian and, whenever possible, will follow the regular diet menus.
  • Modified menus will be posted on the apartment computers.
  • Therapeutic and texture modified diet information is located in each apartment.
  • Commercial supplements are prescribed by the physician as an addition to an individual’s diet when needed.

Food Preparation/Meal Service

• Foods are to be prepared in such a way that ensures food safety and conserves nutritional value, flavor, appearance and wholesomeness.
• Staff will be trained by a dietitian during orientation and staff meetings, as needed, to ensure that all foods are served at their optimum nutritive value and are appetizing in appearance, texture, and aroma.
• A notebook of standardized recipes will be maintained in the kitchen area and will be used in meal preparation.
• Raw fruits and vegetables will be thoroughly washed before being cooked or served.
• Frozen food will be thawed in the refrigerator, in a microwave oven as part of the continuous cooking process, or under cold running water; never on the counter.
• Only clean and sanitized utensils will be used in food preparation.
• Tops of all cans will be washed before opening.
• Food will be prepared on surfaces that have been cleaned, rinsed, and sanitized.
• Foods are prepared to avoid cross-contamination between raw and cooked foods. Separate cutting boards for raw meats, poultry, fish products and fresh fruits and vegetables.
• Meat and poultry will be cooked to a safe minimum temperature. Typically, hot foods will be heated to at least 165-180 degrees. Hot food is to be held at 140 degrees or above. Staff will use thermometers to ensure proper temperatures are reached.
• Meal Service
  • Staff will follow the procedures of Policy 4.24 Meal Procedure/Family Style Dining.
  • During serving time, food is protected from contamination and growth of any pathogenic organism. Among the measures taken are:
    • Serve foods at an appropriate temperature (40 degrees or below and 140 degrees or above). Serve within 15 minutes of removal from temperature control devices.
    • Avoid manual contact with food whenever possible. Use suitable utensils to handle food and ice.
    • Foods with an abnormal appearance or odor will not be served and will be discarded.
    • Foods that have been cooked and then refrigerated shall be thoroughly and rapidly reheated to at least 165 degrees.
  • Food will be served in appropriate quantities, as per the menu.  Proper portion control utensils will be utilized.
  • Food will be served in the appropriate texture for the individual, such as regular, chopped, ground or pureed foods.  Liquids will also be served in the appropriate texture of thin, nectar-thick, or honey-thick.
  • Utensils, cups, glasses, and dishes will be handled in such a way as to avoid touching food contact surfaces.
  • The dietitian and/or other designated staff will monitor meal service periodically.

Food Purchasing and Storage

• Food will be purchased and stored in such a way to ensure that it is safe for consumption and stored properly.
• All food will be purchased from sources that have been approved or are considered satisfactory by the local Health Department. The purchased food must be cleaned, wholesome, and free from spoilage.
• Only pasteurized milk will be purchased. All milk and milk products will only be purchased from suppliers who meet the standards of quality set by local and state or federal laws and regulations.
• Only eggs with clean uncracked shells will be purchased. No raw eggs will be served.
• Home-canned foods will not be purchased or used.
• Authorized personnel will purchase grocery items based on the menu and special needs of the individuals.
• The dietitian will monitor food purchases.
• Food Storage Procedure:
  • All staple foods will be stocked on shelves at least twelve inches off the floor. The storage area should be clean, cool, dry and protected from dust, flies, rodents, and other vermin.
  • Poisonous and toxic materials such as cleaning agents are stored separately from food, paper, cleaned equipment, utensils and food preparation areas.
  • All refrigerated foods and foods in dry storage will be properly sealed with tight fitting lids, covered, or wrapped.
  • All dry and refrigerated foods will be dated with the purchase date.
  • Foods stored in containers other than the original shall be labeled with the name of the item and the date of purchase.  No fresh item will be placed into a container until it has been emptied.
  • Refrigerated foods will be stored below 40 degrees Fahrenheit and frozen foods will be stored at zero degrees or below.  Refrigerators and freezers are equipped with thermometers and will be checked periodically.
  • Perishable foods must be stored at the proper temperature as soon as they arrive in the apartment.
  • Meats should be divided into meal size portions, placed in freezer bags, and labeled with item, amount, and date purchased.
  • Refrigerated meats should be stored in an area below any cooked or fresh products to prevent contamination.
  • Any meat which is allowed to thaw must be used within 24 hours.  Pre-cooked foods which have thawed are to be thrown away at once.  Any food which has been defrosted may not be refrozen.
  • Foods which need to be chilled for services may be stored in the refrigerator until ready to be used.  Once opened, high acid foods such as fruits and juices should be removed from cans and stored in covered airtight plastic containers, labeled and dated.
  • Leftovers will be labeled, dated and promptly refrigerated (within one hour).
  • Dry and refrigerated/frozen foods will be kept according to the recommended maximum time periods.  Additional information on storage of specific types of foods is located in the recipe books.
    • Dry Items:
      • Canned and jarred foods 6 to 12 months
      • Cereals, pastas, beans, spices 6 months
    • Frozen Foods:
      • Meat 1 to 6 months
      • Processed foods 6 months to 1 year
      • Frozen fruits/vegetables 1 year
    • Refrigerated Foods:
      • Fresh fruits/vegetables 1 week
      • Fresh meats/poultry 2 to 5 days
      • Processed meats 5 days to 2 weeks
      • Meats, thawed cooked within 24 hours
      • Leftovers 2 days
      • Milk 5 days
      • Cheese 7 days to 6 months
      • Eggs in shell 1 week
  • All food items will be rotated. The oldest stock of any item is to be used first. When stocking shelves, place the new item in the back, moving the old item to the front.

Special Activities

• An individual may have foods and activities comparable to those normally obtained in the community.
• Holiday menus will be written by the dietitian. Birthday parties, outings and similar events require a one-week written notice of the selected menu. The dietitian will make any necessary adjustments to the menu to meet modified diet needs.

Behavior Modification Program

• Foods can serve as an easy reward in behavior modifications; however, food can also be a poor alternative and should be used only as a last resort.
• If it becomes necessary that food be used in behavior modification, care must be taken to maintain nutritional adequacy and dietary modification needs.
• Give thought to the type of food used in a reward situation. Example: raisins instead of candy.
• Consult the dietitian in any case of behavior modification where food is an issue. This is mandatory when the individual in question is on a dietary modification or is at nutritional risk.
• Under no circumstances should:
  • Water be withheld for behavior modification purposes.
  • Food be denied for behavior modification purposes.

Maintenance of Sanitary Conditions

• Sanitary conditions must be maintained in the storage, preparation, and serving areas.
• The Case Managers will maintain cleaning schedules for all equipment and areas in the dietary department and will instruct personnel on the proper methods of cleaning equipment and work areas.
• Waste containers will be made of inflammable, cleanable material. Containers will be kept covered when not in use. Plastic bags will be used to line these containers. The containers will be emptied and cleaned at least once per day and treated with disinfectant.
• Each kitchen area should be maintained in good repair and should be kept clean and free from any accumulation of garbage or filth.
  • Floors will be swept twice per day and washed at least once per day. Except for emergencies, all floor cleaning should be done during those periods when the least amount of food and drink is exposed.
  • All walls and ceilings should be free from any accumulation of soot, grease, dust, spray, etc., and kept in good repair. Protective wall shields used behind equipment should be attached so that they do not provide a harborage for vermin, roaches, etc.
• Adequate ventilation is provided to prevent undue condensation or accumulation of offensive and/or dangerous fumes, gases, or odors.
• Adequate and convenient hand washing facilities are provided.
• All utensils and equipment, cloths, sponges, and brushes used in connection with food should be easy to clean and kept in good repair. All utensils should be free from stains, cracks, chips, and splinters. Materials which will corrode should not be used on any surface which may come in contact with food. Cloths used in wiping or drying utensils must be clean and should not be used for any other purpose.
• All utensils and small appliances not washed, rinsed, and sanitized mechanically should be cleaned and sanitized manually. See Care and Cleaning of Equipment in Dietary Book for procedure.
• Clean and sanitized utensils and equipment should be stored on shelves or in cupboards that are clean, dry and protected from flies, splash, overhead leakage, condensation, and other contamination. Utensils such as glasses and cups should be covered or inverted to protect them from dust and other contamination. Stored silverware should be readily removable without handling the tines, blades, or bowls.
• Live animals or fowls should not be kept in any room where food is prepared, served, or stored.
• Food should not be prepared or stored in any room used for sleeping or living quarters.
• Rodents and insects should be controlled by all practical means necessary. If they become a problem, the maintenance department should be notified immediately. No insecticides or traps should be used without the permission of the maintenance department.
• All staff and individuals should wear clean garments and should be clean and neat while preparing food. This includes washing hands and fingernails prior to handling food or after coming in contact with a contaminated surface. Staff or individuals should not prepare food when they are ill or have infected sores or wounds.
• Cleaning Schedule: The following schedule will be maintained for the cleaning of the equipment indicated:
  • After each use: dishes and cookware, small appliances, cutting board, counters, range and oven if necessary, dishwasher, microwave oven, dining tables/chairs
  • Daily: ranges, range hood, sinks, floors, coffee maker, refrigerator/freezer (if needed)
  • Weekly: refrigerator, freezer, ranges and ovens, range vents, pantry/cabinets
  • Bi-Monthly: coffee maker
  • See CARE AND CLEANING OF EQUIPMENT PROCEDURES in Dietary Book for detailed information on cleaning kitchen items.

Last Revised: 9/13/21