Missouri Code of State Regulations › Title 19 - DEPARTMENT OF HEALTH AND SENIOR SERVICES › Division 30 - Division of Regulation and Licensure › Chapter 85 - Intermediate Care and Skilled Nursing Facility › Section 19 CSR 30-85.052 - Dietary Requirements for New and Existing Intermediate Care and Skilled Nursing Facilities

Current through Register Vol. 49, No. 14, July 15, 2024
PURPOSE: This rule establishes dietary requirements
				  for new and existing intermediate care and skilled nursing
				  facilities.
(1) Each resident
				shall be served nutritious food, properly prepared and appropriately seasoned,
				taking into consideration resident food preferences, to provide an adequate
				diet in accordance with the physician's order and as recommended by the
				National Research Council. Nutritional needs of residents shall be met and
				shall be based on the individual's circumstances, medical condition and goals
				of treatment as determined and justified by the physician. A qualified
				professional, such as a dietitian or registered nurse, shall regularly assess
				these needs and shall keep the physician informed of the nutritional status of
				the resident. I/II
(2) At least
				three (3) substantial meals or other equivalent shall be served daily at
				regular hours with supplementary feedings as necessary. At least two (2) meals
				shall be hot.II/III
(3) Foods shall
				be prepared and served using methods that conserve nutritive value, flavor and
				appearance. II/III
(4) Special
				attention shall be given to the texture of food given to residents who have
				chewing difficulty. II/III
(5)
				Provision shall be made to assure that hot food is served hot and cold food is
				served cold. II
(6) If a resident
				refuses food served, appropriate substitutes of similar nutritive value shall
				be offered. II/III
(7) Bedtime
				snacks of nourishing quality shall be offered to all residents unless medically
				contraindicated. III
(8) Tray
				service and dining room service for residents shall be attractive and each
				resident shall receive appropriate table service. III
(9) Each resident who is served meals in bed
				or in a chair not within the dining area shall be provided with either a table,
				an overbed table or an overbed tray of sturdy construction which is positioned
				so that the resident can eat comfortably. III
(10) A time schedule for service of meals to
				residents shall be established. Meals shall be served approximately four to
				five (4-5) hours apart and not longer than fourteen (14) hours from a
				substantial evening meal to breakfast. II/III
(11) A minimum of thirty (30) minutes shall
				be given for eating meals. Residents who eat slowly or who need assistance
				shall be given as much time to eat as necessary. II/III
(12) An identification system shall be
				established to assure that each resident receives the diet as ordered.
				II/III
(13) If the residents have
				objectionable table manners, an alternate method of meal service shall be
				provided. III
(14) There shall be
				sufficient personnel properly trained in their duties to assure adequate
				preparation and serving of food. II
(15) All facilities shall employ a food
				service supervisor who shall have overall supervisory responsibility for
				dietary services. II
(16) Menus for
				special prescribed diets shall be reviewed and approved in writing by either a
				qualified dietitian, a registered nurse or a physician. II/III
(17) If food preparation, service, or both,
				within the facility is handled through a contractual arrangement, all
				regulations governing sanitation (13 CSR 15-17), dietary service and
				contractual personnel shall be met and maintained. II/III
(18) If it is determined by the Division of
				Aging that due to the complexity of prescribed diets or that the food service
				supervisor is unable to assure compliance with the dietary requirements, the
				facility shall be required to employ, for specified periods of time, a
				qualified dietitian to serve as a consultant and until the food service
				management improves to assure that the residents' needs are being met.
				II
(19) A current record of
				purchased food shall be kept to show the kind and amount of food purchased each
				month. III
(20) Supplies of staple
				food for a minimum of a one (1)-week period and of perishable foods for a
				minimum of a three (3)-day period shall be maintained on the premises.
				II
(21) Menus for all diets shall
				be planned at least two (2) weeks in advance. If cycle menus are used, the
				cycle must cover a minimum of three (3) weeks and must be different each day of
				the week. Menus showing the foods and amounts of food to be served each day
				during the current week shall be posted where seen readily as food is prepared
				and served. Each day's menu shall show the date it was actually used and shall
				be kept on file for thirty (30) days. A list of substitutions shall be kept for
				thirty (30) days. III
(22) A file
				of standardized recipes shall be used. III
(23) A diet manual approved by the Division
				of Aging shall be readily available to attending physicians, nursing and
				dietary personnel. III
All rules relating to long-term care facilities licensed by
					 the Division of Aging are followed by a Roman Numeral notation which refers to
					 the class (either Class I, II or III) of standard as designated in section
					 198.085.1, RSMo.
*Original authority: 198.009, RSMo
					 1979.