Dietary Services

PURPOSE: This rule specifies the dietary service requirements for all community residential programs and day programs subject to licensure by the department in accordance with 9 CSR 40-1.055. This rule does not apply to Residential Care Facilities (RCF) and Assisted Living Facilities (ALF) dually licensed by the Department of Health and Senior Services (DHSS). PUBLISHER’S NOTE: The secretary of state has determined that the publication of the entire text of the material which is incorporated by reference as a portion of this rule would be unduly cumbersome or expensive. This material as incorporated by reference in this rule shall be maintained by the agency at its headquarters and shall be made available to the public for inspection and copying at no more than the actual cost of reproduction. This note applies only to the reference material. The entire text of the rule is printed here. (1) Meal Preparation and Food Storage. The program must comply with state, county, and city health regulations applicable to its food and dietary components, including catered food through a contractual arrangement and food brought to the program by individuals served. Inspections must be current and in compliance with state, local, and/or city regulations and available on site. (A) All food must be purchased, prepared, and stored in accordance with safety and sanitation regulations of the DHSS Missouri Food Code, 19 CSR 20-1.025, available at: https://health.mo.gov/safety/foodsafety/pdf/ missourifoodcode.pdf. (B) All programs shall ensure— 1. Proper diet and food preparation are addressed as part of the individualized planning process, if identified as a need or goal of the individual. A. Individuals who prepare their own meals or help with meal preparation shall be assisted by staff, as needed. B. Individuals shall be assisted and educated about purchasing and safely storing food and drinks in a manner that prevents spoilage and contamination. C. Individuals shall be supported in developing meal plans and grocery lists and educated and assisted by staff, as needed, in order to meet any special dietary requirements; 2. A sufficient number of appliances and equipment are available for food preparation including, but not limited to, a stove and refrigerator, dishes, cookware, and utensils to meet the needs of individuals served. All equipment must be in safe and good operating condition and food preparation areas, appliances, and equipment are cleaned and sanitized after each use; 3. Meals and snacks are served in a clean dining area with tables, chairs, eating utensils, and dishes designed and provided to meet individual needs; 4. Handwashing accommodations including hot and cold water, soap, and hand-drying are readily accessible to individuals and staff; 5. The temperature of hot water at all faucets accessible to individuals served must be controlled by a thermostatic mixing valve or other means, so the water temperature does not exceed one hundred twenty degrees Fahrenheit (120°F); 6. Dishwasher(s) shall be supplied with an adequate amount of wash and rinse water at one hundred forty degrees Fahrenheit (140°F) at a minimum. A three- (3-) vat sink in lieu of a dishwasher may be used based on the size of the program; 7. If a three- (3-) vat sink is used, it must be of sufficient depth and size to accommodate utensils most frequently used in the preparation and serving of food; 8. If hot water is temporarily unavailable, chemicals used for sanitizing equipment, dishes, and utensils shall be used in accordance with the Environmental Protection Agency (EPA) registered label use instructions, 1200 Pennsylvania Avenue, N.W., Washington, DC 20460 available at: h t t p s : / / w w w. e p a . g ov / p e s t i c i d e - registration/selected-epa-registered-disinfectants and in accordance with the Missouri Food Code, 19 CSR 20-1.025, available at: https://health.mo.gov/safety/foodsafety/pdf/ missourifoodcode.pdf. It is recommended that single-use, disposable dishes/utensils and prepared foods be used if hot water is not for Community Residential Programs and Day Programs available. Larger cooking equipment may be washed with the EPA-registered label sanitizer product and be air dried; and 9. Programs serving ten (10) or more individuals must provide a place for handwashing adjacent to work areas that includes hot and cold water, soap, paper towels, or electrical hand-drying devices. (2) Balanced Diet. A balanced variety of healthy foods and drinks, with opportunities for choice, shall be available to individuals each day. (A) Meals and snacks shall be based on the Dietary Guidelines for Americans 2015-2020, 8th Edition, incorporated by reference and published in the Office of Disease Prevention and Health Promotion, U.S. Department of Health and Human Services, 1101 Wootton Parkway, Suite LL100, Rockville, MD 20852, available at https://health.gov/dietaryguidelines/2015/guidelines/. This rule does not incorporate any subsequent amendments or additions to the guidelines listed above. This rule does not prohibit programs from complying with guidelines set forth in newer versions of the incorporated by reference material listed in this subsection of this rule. (B) Meals and drinks shall be prepared and served at scheduled times, comparable to mealtimes in the community, or as necessary to meet individual needs and schedules. Ready access to nutritious snacks shall be available, including in the evening. (C) Meals and drinks shall be prepared and served at proper temperatures to conserve nutritive value and enhance flavor and appearance. (D) Documented consultation with a licensed dietitian or registered nurse must take place at least annually for individuals with special diets. (E) Milk provided to individuals served must be Grade A pasteurized milk or Grade A certified, pasteurized milk. (F) Cool, safe drinking water approved by the state or local public health authority must be available to individuals at all times. Single-serving cups or glasses shall be available for individuals unable to drink from a water fountain. (G) Consideration shall be given to the food habits, personal, cultural, and religious preferences, and medical needs of individuals served, including provisions for special diets for medical reasons. (H) When individuals require blended food, program staff shall prepare, measure, and serve it individually, not mixed together. (I) The consistency and texture of food shall meet each individual’s needs. Individuals shall not be fed in a prone position. (J) Individuals requiring liquid or soft diets shall be provided with nourishing, supplementary food between meals to meet their nutritional needs. (K) Meals may be served family style to provide a home-like atmosphere. (L) Individuals served shall have the opportunity to participate in planning menus and options for food substitutions. Menus should be developed at least one (1) week in advance. (M) Menus covering at least a three- (3-) month time period shall be available for review by department staff or other authorized representatives. AUTHORITY: sections 630.050 and 630.705, RSMo 2016.* Original rule filed May 14, 2020, effective Dec. 30, 2020. *Original authority: 630.050, RSMo 1980, amended 1993, 1995, 2008 and 630.705, RSMo 1980, amended 1982, 1984, 1985, 1990, 2000, 2011, 2014.