Dietary Requirements for Residential Care Facilities and Assisted Living Facilities

PURPOSE: This rule establishes standards for meeting dietary needs of residents in residential care facilities I and II. Editor’s Note: All rules relating to long-term care facilities licensed by the department 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 1986. (1) Each resident shall be served food prepared and served under safe, sanitary conditions that is prepared consistent with the preferences of the resident and in accordance with attending physician’s orders. The nutritional needs of the residents shall be met. Balanced nutritious meals using a variety of foods shall be served. Consideration shall be given to the food habits, preferences, medical needs and physical abilities of the residents. II/III (2) Each resident shall receive and the facility shall provide at least three (3) meals daily, at regular times comparable to normal mealtimes in the community. At least two (2) meals daily shall be hot. II/III (3) There shall be no more than fourteen (14) hours between a substantial evening meal and breakfast the following day, except when a nourishing snack is provided at bedtime. Up to sixteen (16) hours may elapse between a substantial evening meal and breakfast the following day if a resident group agrees to this meal span, and a nourishing snack is served. III (4) Fresh water shall be available to the resident at all times. II/III (5) Dining room service for residents shall be attractive and each resident shall receive appropriate table service. III (6) Menus shall be planned in advance and shall be readily available for personnel involved in food purchase and preparation. Food shall be served as planned although substitutes of equal nutritional value and complementary to the remainder of the meal can be made if recorded. III (7) A three (3)-day supply of food shall be maintained in the facility. III (8) If a physician prescribes in writing a modified diet for a SENIOR SERVICES resident, the resident may be accepted or remain in the facility if— (A) The physician monitors the resident’s condition on a regular periodic basis and at least quarterly; II (B) The diet, food preparation and serving is reviewed at least quarterly by a consulting nutritionist, dietitian, registered nurse or physician and there is written documentation of the review; II/III (C) The modified diet menu is posted in the kitchen and includes portions to be served; III and (D) The facility has entered into a written agreement for dietary consultation with a nutritionist, dietitian registered nurse or physician. III (9) Nothing in this rule shall be construed as taking precedence over the resident’s right to make decisions regarding his or her eating and dining preferences. (A) In assisted living facilities, information about the resident’s eating and dining preferences shall be incorporated in his or her individualized service plan based on an assessment that includes the resident’s culture, life-long routines, habits, patterns and preferences. III (B) In assisted living facilities, if the resident’s eating and dining preferences have a potential health risk, staff shall inform the resident or his or her legally authorized representative of the potential health risks and document this in his or her individualized service plan. III AUTHORITY: sections 198.076, RSMo 2000 and 198.005 and 198.073, RSMo Supp. 2006.* This rule originally filed as 13 CSR 15-15.052. Original rule filed July 13, 1983, effective Oct. 13, 1983. Emergency amendment filed Aug. 1, 1984, effective Aug. 13, 1984, expired Dec. 10, 1984. Amended: Filed Sept. 12, 1984, effective Dec. 13, 1984. Amended: Filed Aug. 1, 1988, effective Nov. 10, 1988. Moved to 19 CSR 30-86.052, effective Aug. 28, 2001. Amended: Aug. 23, 2006, effective April 30, 2007. *Original authority: 198.005, RSMo 2006; 198.073, RSMo 1979, amended 1984, 1992, 1999, 2006; and 198.076, RSMo 1979, amended 1984.