Dietary Requirements for New and Existing Intermediate Care and Skilled Nursing Facilities

PURPOSE: This rule establishes dietary requirements for new and existing intermediate care and skilled nursing facilities. Editor’s Note: 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. (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 AUTHORITY: section 198.009, RSMo 1986.* This rule originally filed as 13 CSR 1514.052. Original rule filed July 13, 1983, effective Oct. 13, 1983. Amended: Filed Aug. 1, 1988, effective Nov. 10, 1988. Amended: Filed Jan. 3, 1992, effective Aug. 6, 1992. Moved to 19 CSR 30-85.052, effective Aug. 28, 2001. ** *Original authority: 198.009, RSMo 1979. **Pursuant to Executive Order 21-09, 19 CSR 30-85.052, sections (14), (16), and (21) was suspended from April 15, 2020 through December 31, 2021.