Congregate Meals

Congregate Meals Bulk, Emergency Pre-plated and Frozen Meals Revised 2010 Table of Contents Section A. Definition, Purpose, and Legal Basis 1. Definitions Purpose 3. Legal Basis B. Eligibility 1. Eligible for Meals 2. Meals for Disabled persons and Volunteers 3. Meals for Staff and Guests Termination from the Program C. Unit of Service 1. Meals 2. Nutrition Education 3. Nutrition Counseling D. Support Activities 1. Nutrition Screening 2. Nutrition Education 3. Nutrition Assessment and Counseling 4. Social Activities 5. Contributions E. Location 1. Minimum Requirements 2. State and Local Requirements 3. Required Site Equipment 4. ADA Requirements Exits 6. Parking 7. Approval and Site Opening 8. Site Closure F. Access 1. Waiting List 2. Fee-For Service-Meals G. Service Delivery 1. State Contract for Meals 2. Times of Operation 3. Minimum Meal Numbers 4. Meal Orders/Order Changes 5. Special Days 6. Portion Control H. Irregular Situations 1. Extra Meals/Second Meals 2. Meal Exchange 3. Take Out Meals 4. Powdered Milk 5. Substitutions I. Alternate Vendor J. Supplies: Ordering, Handling, and Storing K. Staff L. Training 1. Personnel Orientation and In-service Nutrition Coordinator Opportunities 3. Fire/Evacuation Drills 4. First Aid, CPR, Safety M. Records 1. General 2. Documents to Reconcile 3. Program Information 4. Consumer Information Form N. Reports 1. Site to AAA or Service Provider 2. Client Tracking System 3. Vendor Reports 4. State Reports 5. Adult Day Care Centers- CACFP O. Credits, Penalties and Reimbursements 1. Vendor Credit 2. Vendor Penalties 3. CACFP Reimbursement P. Monitoring 1. MS Department of Health Inspection 2. MDHS Office of Monitoring and Program Integrity 3. MS Department of Education 4. AAA Nutrition Coordinators 5. Vendor A. Definition, Purpose, and Legal Basis 1. Definition - At least one hot or other appropriate meal provided to an eligible person in a congregate setting which (Older Americans Act of 1965, as amended (OAA), Section 331(1)): a. Is offered at least five or more days a week unless, with documented annual state approval, it is deemed such frequency is not feasible secondary to a rural location; and b. Can be offered at breakfast, lunch and/ or dinner; and c. Is identified by a printed menu, signed and dated by the Registered, Licensed Dietitian who created it, which is posted at least two weeks in advance; and d. Complies with the most recent Dietary Guidelines for Americans published by the Secretaries of the United States Department of Health and Human Services and the United States Department of Agriculture (OAA, Section 339(1)); and e. Provides a minimum of thirty-three and one-third percent (33a%) of the dietary reference intakes (DRIs) as established by the Food and Nutrition Board of the National Research Council of the National Academy of Sciences (OAA, Section 339(2)(A)); and f. Is served in a congregate setting opened at a minimum of three (3) hours a day, as defined as locations where individuals can engage in social interaction, or various other activities and services such as rehabilitative and supportive services; which can include adult day care centers and multi- generational meal sites; and g. That setting provides nutrition education, nutrition screening and other nutrition services such as nutrition counseling, as appropriate, based on the needs of program participants. 2. Purpose a. To reduce hunger and food insecurity; and b. To promote socialization of older individuals; and c. To promote the health and well-being of older individuals by assisting such individuals to gain access to nutrition and other disease prevention and health promotion services to delay the onset of adverse health conditions resulting from poor nutritional health or sedentary behavior. 3. Legal Basis a. The legal basis for the operation of the Elderly Nutrition Program is found in the Older Americans Act of 1965, as amended (OAA), Title III, Part C; and the Code of Federal Regulations, Title 45, Part 1321, as amended (45 CFR Part 1321). b. NSIP - Section 311 authorizes the Nutrition Services Incentive Program known as NSIP, which provides supplemental funding for congregate and home delivered meals served under Title III in the form of cash in lieu of commodity foods to provide incentives for the effective delivery of nutritious meals to older adults, for meals which meet OAA requirements. NSIP funds may only be used for the purchase of United States produced agricultural commodities and other foods. (1) NSIP funds are no longer under USDA oversight and should not be referred to as a USDA program or USDA reimbursement. (The Consolidated Appropriations Resolution, 2003, Public Law 108-7, amended the OAA to transfer the NSIP from the USDA to the Administration of Aging (AoA) within the Department of Health and Human Services. (Sec.311, OAA 2000)). (2) The AAA MAY use NSIP funds for food purchases from U.S. sources, or as in the case of vendor-contracted meals at a set price, in general up to 1/3 of the cost of an entire eligible meal including transportation and labor; served to eligible participants. A meal is required to meet the OAA nutrition requirements stated in Part 1, Section 1 of this document and served to individuals who meet the eligibility requirements stated in Part II, Eligibility,and who is not means tested; and those individuals are provided the opportunity to voluntarily contribute to the cost of service. (3) The AAA MAY NOT use NSIP funds for the following: Incomplete meals IF an alternate vendor is NOT used to fill the shortages or complete the meal; Second meals/helpings served to participants or Any meals served to guests or staff under 60 years of age or to anyone else who is not an eligible participant, regardless of age or circumstances. Any means tested programs such as Medicaid waiver and CACFP. c. Title XIX Medicaid waiver- While a home-delivered meal funded by the Medicaid waiver program does not fall under Title III standards, a client may not receive a duplication of services in the form of a meal from both Medicaid waiver and Title III. If a participant qualifies for a meal under Medicaid waiver, this will be the first and only choice for meal funding. If they are not deemed eligible for Medicaid waiver they can be assessed for a meal under Title III. This is effective for both Title III home-delivered and congregate meal service. d. AAAs are required in their area plans to establish procedures for coordination of services with entities conducting other federal or federally assisted programs for older individuals at the local level, and shall include language addressing how they will prevent duplication of meal service between these two programs and how they will monitor this. (Sec. 306 (42 U.S.C. 3026)) B. Eligibility (OAA, Section 307(a)(13)(A) and (I)) Congregate nutrition services shall be available to eligible persons, particularly those in greatest economic and social need, including low-income minority older individuals, older individuals with limited English proficiency and those at nutritional risk. 1. Except when noted in Section (c) below, when eligibility is determined and documented by an active Consumer Information Form (CIF) on file and/or documented in the current state approved client tracking system, congregate meals will be provided to: a. Any person 60 years of age or older; and b. The spouse of an eligible person, regardless of age (with a notation on the screening form that he/she is the spouse of a 60+ participant), however; c. In the event funding is such that there are not enough congregate meal allotments for all persons aged 60 or older who apply, the priority services waiting list guidelines set forth by each AAA will serve to determine services. 2. Provided all the above eligible potential service recipients needs are met, congregate nutrition services MAY be made available to: a. Disabled persons*, regardless of age (with a notation on the screening form specifying circumstances), when: (1) The disabled person resides in housing facilities occupied primarily by older persons at which congregate nutrition services are provided; or (2) The disabled person resides at home with and accompanies an eligible participant to the congregate site; and b. Volunteers, regardless of age, who provide meal-related services regularly during meal hours IF his/her having a meal does not deprive an eligible older person from having a meal, they sign the meal sign in sheet and meet the criteria established in Section M. Records. *A disability is defined as a mental or physical impairment, or a combination of mental and physical impairment(s), that results in substantial functional limitations in one or more areas of major life activity such as self-care, learning, mobility, capacity for independent living, cognitive functioning, etc. 3. A meal MAY be offered to paid staff members and/or guests of any age ONLY IF: a. The staff member/guest pays the full cost of the meal; and b. An eligible person will not be deprived of a meal. 4. Termination from the Program – Each AAA will establish a system delineating the criteria for termination of a participant from the congregate meals program. Once a participant is placed on the program, they cannot be terminated without sufficient rationale. This rationale will be documented on the participant’s Consumer Information Form. Recommendation for termination can be made by program staff with approval from the AAA director. This information will be found in the AAA Area Plan, updated annually or as needed. C. Unit of Service 1. Meals – One meal served to an eligible person is one unit of service. Except as described in Section H, Irregular Situations, Title III C-1 money may not be used for second meals. 2. Nutrition Education - Entered into the current state approved client tracking system, defined as one unit per attendee per session as a nutrition education unit, for required NAPIS reporting. 3. Nutrition Counseling – Entered into the current state approved client tracking system, is defined as one individualized session per participant, and required on NAPIS reporting. D. Support Activities 1. Nutrition Screening-(OAA, Section 339(2)(J)) What and When - Nutrition screening is completed on every recipient of the OAA Nutrition Program through the Nutrition Risk Assessment of the Consumer Information Form (CIF) and/or current state approved client tracking system and updated at a minimum annually. The Nutrition Risk Assessment is comprised of the twelve questions in this section. Two scores are derived from the CIF. a. A Nutritional Risk Assessment score, with a possibility of 0 to 6 points, indicates the potential for nutritional concerns and risk. Nutrition risk scores are a required field and compiled and filed for the NAPIS report. This score contributes to the Total Consumer score. b. The Total Consumer score, which is the sum of all scores on the CIF, will determine participant level of services, including meal service. c. A Nutrition Risk Assessment Score of 6 or greater, which is defined as high risk by the OAA, signals the need for further nutrition intervention, such as referral to a medical doctor, or registered dietitian for nutritional assessment and counseling. A diagnosis of diabetes automatically places the participant at high nutritional risk with a score of 6. 2. Nutrition Education (OAA, Section 330 (3), 331 (3) (339 (J)) a. What- Nutrition education is a program to promote better health by providing accurate and culturally sensitive nutrition, physical fitness, or health, as it relates to nutrition, information and instruction to participants, caregivers, or participants and caregivers in a group or individual setting overseen by a registered dietitian or individual of comparable expertise. In addition, community nutrition resources and services shall be provided. When and by Who - Nutrition education shall be provided to participants in a group setting at least quarterly. Nutrition education shall be planned/scheduled by the nutrition coordinator/service provider and presented by a registered dietitian, county extension agent, or other qualified person, using printed material, demonstrations, audio-visual presentations, lectures, and/or small group discussions. b. Documentation of the topic, presenter, number of attendees, and date of nutrition education shall be retained at the AAA and may be kept at the site as well; and c. Entered into current state approved client tracking system or other form of documentation as one unit per attendee per presentation as a nutrition education unit, for required NAPIS reporting. d. Expenses, if any, shall be anticipated and included in the program budget. 3. Nutrition Assessment and Counseling (336, 339 (J)) NOTE: THE ACTIVITIES IN THE FOLLOWING SECTION ARE RECOMMENDED BY THE NEWEST REVISION TO THE OLDER AMERICANS ACT, HOWEVER DUE TO LIMITED FUNDING AND RESOURCES, MAY NOT BE FEASIBLE AT THIS TIME. WHILE THESE ACTIVITIES ARE NOT REQUIRED, DEVELOPMENT IS ENCOURAGED. a. What and When – (1) A more specialized activity, which may be included as a component of the nutrition education program. The provision of professional, individualized advice and guidance to individuals who are at nutritional risk because of their health or nutritional history, dietary intake, medications use or chronic illnesses, about options and methods for improving their nutritional status, performed by a Registered Dietitian (RD, LD), working with the individual’s physician as appropriate, in accordance with state law and policy. (2) Participants who are designated at high nutritional risk on the Nutrition Risk Assessment section of the Consumer Information Form (CIF), through scoring a 6 or above, or have a diagnosis of Diabetes Mellitus are candidates for follow-up nutrition assessment and counseling. (3) Participants at high nutritional risk shall be referred to the appropriate health professional within six months of entry into service. b. Who and How – (1) At this time, individual dietary evaluation and counseling for therapeutic needs is not provided directly. Clients needing these services are to be referred to a local hospital, their private physician or registered dietitian. The AAA will assist in making this referral. (2) As this component of the OAA Nutrition Program is developing, clients may be referred to their individual physician until funding and/or contract services with a Registered Dietitian (RD, LD) are available. (3) The health care provider may choose to follow-up though his/her office, or refer the participant to a Register Dietitian. (4) The AAA/service provider may partner with a Registered Dietitian (RD/LD) through the local hospital, medical groups or private contractors. (5) Participants with a diagnosis of diabetes may be referred to a Registered Dietitian, certified diabetic educator or a local diabetes self-management class. c. A notation will be made on the CIF and/or the current state approved client tracking system in the notes section, stating to whom the client was referred and the date referred. 4. Social Activities - Games, outings, art appreciation, gardening, crafts, fitness programs, site clubs, etc. shall be demonstrated by a list or calendar of monthly activities. 5. Contributions (OAA, Section 307(a)(13)(C)(i)(ii); 45 CFR, 1321.67) - Participants shall be encouraged and provided an opportunity to contribute voluntarily and confidentially to the cost of the meals for the express purpose of expanding nutrition services. AAAs/service providers may develop and post a suggested contribution schedule for meals, but shall not deny any eligible person a meal if he/she is unable or unwilling to contribute to the cost of the meal service. Minimally, signage noting that donations are accepted and there is a box for cash donations visible in the meal dining area. a. Safekeeping and Accountability - Contributions shall be safeguarded against loss, mishandling, or theft. Each congregate site shall have a lock box with a space in the top or other appropriate container into which contributions may be placed confidentially. The container shall be kept locked at all times, except at set times, preferably weekly, when two people shall access the box, count the contributions, and certify the amount. Between meal hours, the container shall be stored in a secure place. b. Direct Services Documentation - For those AAAs who provide direct services, site personnel shall purchase a money order or cashier=s check, indicate on it the service that generated the income (congregate meals and/or home-delivered meals), and forward it to the AAA/PDD. c. Indirect Services Documentation - For those AAAs who provide indirect services, site personnel shall certify the program income, indicate the service from which the income was generated (congregate and/or home-delivered), and forward the income to the service provider who shall, in turn, forward a contribution report to the AAA/PDD. E. Location (OAA, Section 307(a)(13)(D)) Congregate nutrition sites shall be located at approved private or public community facilities, and meeting rooms, particularly churches, schools, community centers, and senior centers that meet the following requirements: 1. Are clean and neat and have adequate lighting, heating, cooling, and ventilation; 2. Meet all applicable state and local health, fire, safety, building, zoning, and sanitation laws, ordinances, and codes and have annual inspections by the local fire and *health authorities (with a plan for corrective action if deficiencies are noted). Requirements for the safe and sanitary facilities and food handling are described in the 2009 USDA Food Code and the DAAS Food Safety and Sanitation Manual for the Older Americans Act Nutrition Program. Current health inspection documentation and fire inspection documentation must be posted at each facility or kept in a secure location at the facility, available on request. It is the responsibility of the AAA to insure that inspections are kept current by calling the inspecting entity to make an appointment for inspection, if it is about to expire. A cost may be incurred for the inspection and program costs should be anticipated. 3. Required Equipment on Site a. If bulk meals are served, the site must have a kitchen or approved area for the set-up and dispensing of bulk meals and a three-compartment sink or approved alternative sink set up as specified in The Food Safety and Sanitation Manual for washing, rinsing, and sanitizing utensils. b. Congregate sites where frozen meals are stored, reheated/cooked, and served to participants and hot food/bulk, pre-plated sites may need to be reheated must have: Freezer(s) with the capacity to hold five (5) days of frozen meals for all participants served from that site(including those for homebound if their meals are not delivered immediately upon receipt from vendor). The frozen meals may be removed from the outer delivery boxes and stacked in the freezer(s) by meal, by day (e.g. all of Monday=s together, all of Tuesday=s together, etc) to ensure that all congregate participants receive the identical meal on the same day and consume the week=s variety of nutrients as planned by the vendor=s dietitian. Freezers must contain a freezer/refrigerator thermometer (not a food or oral thermometer) to ensure that a temperature between 0-20 Fahrenheit is maintained at all times. To ensure safety from contamination and /or theft freezers must remain locked at all times and a designated person responsible for the key. c. Oven(s), conventional and/or microwave, for reheating/cooking. 4. Are free of architectural barriers which limit the participation of older persons, including those with disabilities, to ensure compliance with the Americans with Disabilities Act of 1990 (ADA) as related to the following: a. Restrooms shall be adequate and accessible and contain toilet tissue, a soap dispenser (a hand-held, portable one is acceptable), disposable hand towels, and a waste container; and in addition, meet sanitation standards as outlined in the Food Safety and Sanitation manual. b. Tables and chairs shall be sturdy and appropriate for eligible participants. 5. Have clearly marked exits that are obvious to the observer and have an evacuation plan posted of the room(s) used by the elderly participants. (Example: There could be a drawn diagram of the room(s) with AYOU ARE HERE@ marked with an AX@ and the exit doors clearly noted.) 6. Have adequate parking space; 7. Are approved by the Area Agency on Aging (AAA) with a completed and approved Site Inspection Report on file with the DAAS prior to opening a new site or relocating an established one; and 8. Will not be closed, temporarily or permanently, without the AAA notifying the DAAS and the vendor two (2) weeks prior, except in an emergency. F. Access - An eligible person may enter the service system through appropriate referral. In the event there is a waiting list for congregate meal service, fee-for-service options may be made available. Fee-For-Service Meals – Meals purchased at full cost by a participant. These meals may not be counted as Title III meals for reporting purposes on NAPIS nor for NSIP purposes. The AAA may make available to individuals who meet the criteria for a congregate meal, and who are to be placed on a waiting list, the option of purchasing a congregate meal. The participant will pay for the full cost of meal until the participant no longer needs the meal and cancels the service; or they reach the top of the waiting list and subsequently stop paying for the meal. This information must be clearly documented on the Consumer Information Form. G. Service Delivery 1. a. State Contract for Meals-Mississippi elects to contract with a sole statewide vendor through means of an open bid RFP process every three years. All meals provided through the Older Adult Nutrition Program must be provided by the vendor. b. The exception to this rule is the few adult day care sites which have been grandfathered in to provide self prepared meals. The AAA must request a waiver annually in the area plan for these programs. c. No other programs may start a self-preparation site as this weakens the state contract and value pricing. Existing self-preparation sites must meet all food safety and sanitation standards, have minimally an annual health department inspection, score and permit to operate and have a Servesafe certified employee present on duty during service and preparations hours. Serving a high-risk population as in elderly day care clients, may warrant a health department inspection three times a year. This determination is left to the discretion of the local health department. 2. Times of Operation - Except for holidays designated by the DAAS, unforeseen emergency situations, or scheduled training, sites shall be open and meals shall be served five (5) days a week, 52 weeks a year, three (3) consecutive hours per day so that participants may eat a leisurely meal, enjoy social contact, and take advantage of supportive services. If it is not feasible or cost-effective to provide congregate nutrition service five (5) days a week due to location, lack of participation and/or transportation, etc., the AAA shall request approval annually from the DAAS for the site to be open less than five (5) days. 3. Minimum Meal Numbers - Sites shall serve a minimum average, over a five day period, of twenty (20) total meals (congregate and home-delivered combined) per day. This is a quality issue, and will not affect eligibility of the meal. a. Delivering less than twenty meals to a site is not cost effective, nor does the food, whether bulk or pre-plated, retain adequate temperatures to meet Health Code requirements. The vendor is not required to deliver to a site where an average of less than twenty meals are served however they are not restricted from entering into a mutual agreement with the AAA, if so agreed upon. b. To serve less than twenty (20) total meals at a site, the AAA shall provide a written justification annually and receive written approval from the DAAS. c. In the event a congregate site does not have the required 20 participants, if the rest of the participants are made up of home-delivered meals, there must be a clear documentation trail showing that the home-delivered meals are paid for from Title III, C-2 funds and the congregate meals from C-1. 4. Meal Orders/Meal Order Changes a. Meal Orders - Site personnel shall encourage participants to use a reservation system to accurately forecast and order meals and keep the number of unserved meals to a minimum. Meal orders shall be placed to the commissary via fax or e-mail (not the phone) by AAA nutrition coordinators/service providers only (not site managers). Meals ordered and not consumed by an eligible participant, including second meals, may not be paid for with Title III, C-1 funds, except as noted in Section ((H), (1), (d)) below. b. Meal Order Changes - Meal order changes must be made to the commissary via fax or e-mail only by AAA nutrition coordinators/service providers only (not site managers) no later than 2:00 p.m. on the day before the change is to take effect. The vendor is not expected to honor phone orders/order changes or messages of any kind relayed through drivers. 5. Special Days - Congregate participants may have up to four (4) field trips per year, excluding times when the sites may be closed for an election, training, health fair, or other community activity. For those days when sites will be closed, AAAs/service providers shall order via fax or e-mail shelf-stable meals or picnic lunches for congregate participants at least two (2) weeks prior to the time they will be needed. 6. Portion Control a. Proper Utensils - Site personnel shall use only the utensils specified in the vendor=s daily Site Serving Instructions guide to insure that each participant receives the proper serving size. If a utensil is lost or misplaced, the AAA nutrition coordinator/service provider/site manager shall request a replacement from the commissary office (not the driver) and it shall be sent with the driver the following day or, if it is not in stock at the time, as soon as it is received from the supplier. b. AStretching@- Site personnel shall NOT Astretch@ food to compensate for vendor shortage(s), unacceptable food items, or unexpected participant Adrop ins,@ but shall use an alternate vendor (see below) to fill such shortages or unacceptable items and document the same. If it is not feasible to secure food from an alternate vendor, site personnel shall give properly measured meal components to as many participants vailable food will serve, using the utensils specified in the Site Serving Instructions guide and record the missing meal(s) or meal components as shortages. c. “Provide versus serve@- site personnel are no longer required to place all items on the plate if a participant requests that they do not receive a food item. Site personnel may provide a serving of all food items to each participant, and shall NOT Askip@ giving all meal components to all participants; however, if a participant requests not to be given and/or refuse to eat a certain food item, the item does not have to be served on the plate. Participants have the right not to eat a meal or part of a meal, but site personnel may not cut back on orders of certain foods or milk or offer extras to another participant until it is refused. The correct amount of food for the number of participants must be ordered and provided. H. Irregular Situations 1. Extra Meals/Second Meals - Whenever there is an extra congregate meal, it shall be taken to the following, if possible: a. A congregate participant too ill* to come to the site; or b. An eligible person on the home-delivered waiting list. c. Required documentation on the meal log is the name of the participant the meal was given to and social security number, (located on the CIF, which should be completed if the client is on a waiting list). *If the congregate person is still ill after two weeks, he/she shall be reassessed for home-delivered service unless there is a doctor's statement indicating that the condition is temporary, in which case the congregate meal will be resumed when he/she returns to the site. If it is not feasible to deliver the meal to one of the above, it may be given to: d. A congregate participant, as a second helping, with a notation placed by his/her name on the Monthly Client Service Report that it is a second helping. This meal MAY NOT be claimed for Title III nor NSIP reimbursement as a second meal. e. Second meals may only be paid for with Title III, C-1 funds if there is available, current documentation, at the site and AAA, designating this person has been assessed as severely underweight by a registered dietitian (RD, LD) or a Medical Doctor and would benefit from extra food. A reassessment by the above mentioned participant must be completed every 6 months to be considered current. f. No senior may be denied a meal because another senior is receiving more than one meal. 2. Meal Exchange - While it should not be actively promoted nor become a common practice, it is within the custom of charity and good will to allow, in unusual circumstances, a well congregate participant to freely and temporarily Agive up@ his/her meal to an especially needy, eligible homebound person on the waiting list. In rare instances when this may be done, the meal shall be so documented. If the congregate person learns of the need and freely chooses to give his/her meal to the needy homebound person after he/she has already signed in at the site, a line should be drawn through his/her name and the name of the homebound person receiving the meal shall be entered on the home-delivered service log. 3. Take-Out Meals - Take-out congregate meals are not allowed. Congregate meals are intended to be eaten at the site and participants or their representatives shall NOT pick up and/or take meals from the site. Because of health, safety, and legal liability considerations resulting from possible foodborne illnesses, participants should be discouraged from taking any food leftover from their own or anyone else's meal from the site and made to understand that doing so is at their own risk. Exceptions: Cake, cookies, bread, rolls, and fresh fruit MAY be taken from the site to eat later IF they are wrapped (Note: citrus fruit and bananas do not need to be wrapped). Wrapping material shall not be provided by the site, AAA, local service provider, or vendor. 4. Powdered milk - All congregate sites, even those serving frozen meals, should do everything in their power to serve fluid milk, as it has been shown consistently that the reconstituted milk is not being used, nor even being reconstituted. Sanitation concerns are frequently documented in centers that do reconstitute the powdered milk, and the milk is not made sufficiently ahead of time to chill to improve palatability. Not consuming the milk does not benefit the nutritional status of the participant, which is a goal of the program. a. In the event powdered milk must be used by a site, it first must be offered to the participants daily. It is in violation of the previous guideline to not provide the powdered milk. If it is refused every day in the week, it can then be offered to participants to be taken home as a non-perishable food item on Friday for use in cooking. b. If powdered milk is taken home by congregate participants, the site shall provide a biannual nutrition education session on how to use powdered milk in recipes along with a demonstration taste testing and take home recipes. 5. Substitutions -Substitutions shall not arbitrarily be made by the vendor. In extreme and/or rare instances when a change must be made the manager will verify with the vendor dietitian that the substitution meets the nutritional specifications of the original food item(s). The vendor shall notify the State and the AAA Nutrition Coordinators of menu changes via phone, fax, e-mail, or other electronic means, as soon as possible. Documentation of substitutions must be noted on meal tickets by site manager. I. Alternate Vendor 1. AAA Nutrition Coordinators/service providers/site managers may purchase meals or portions of meals from an alternate meal source to substitute for meals ineligible only in the following situations: a. The vendor fails to deliver any meal(s)*, or an entree which is equal in value to an entire meal, or any other portion of the meal(s); b. All or any portion of the meal(s) is deemed unacceptable, for any reason(s), including time temperature violations; c. Meals are not delivered by 11:15 a.m. and/or according to the specifications in the contract executed by the vendor and the DAAS. * Frozen Meals Exception - If, after frozen meals have been delivered to recipient homes, it is learned that they lack components or contain unacceptable components, the vendor shall discuss the matter with the AAAs and make the adjustments to the invoice accordingly. 2. Payment - If an alternate meal source is used, the AAA shall pay the alternate meal source(s) or individual who paid for the meals per AAA policies. The AAA will bill the vendor the contract price of the food replaced, less the mileage expense, for picking up food from the alternate meal source. 3. Commencement - The AAA will maintain a list including the complete name(s), mailing address(es), and phone number(s) of prospective alternate meal sources in their site areas to be used when meals or portions of meals need to be replaced. The vendor will be notified when alternate meals have been ordered and the reason. 4. Agreement - The AAA will maintain an agreement with the prospective alternate meal source(s). The AAA Nutrition Coordinator shall send the list to their service providers and/or site managers. 5. Food Substitution -At the beginning of the contract, the vendor shall provide the AAA Nutrition Coordinators/service providers with a food substitution list so that food purchased from an alternate meal source, in the event of default by the vendor, may be of like value to that being replaced. 6. Credit - When an alternate meal source is NOT used to replace vendor shortages, the vendor shall issue a credit to the AAA based on the following allocations: Food Group Meal Cost Percentage Meat/Meat Alternative 100% Fruit/Salad 15% Milk 15% Vegetable 10% Dessert (other than fruit) 10% Bread/Bread Alternative 5% Margarine 2% Condiments 2% CACFP reimbursed meals, provided through Adult Day Care Centers may not be credited, all components must be provided for the meal. 7. Alternate Meal Sources - Should alternate meals be obtained, that is, not from the state contract approved meals vendor, the alternate meals must be procured from a licensed food service establishment with a current ‘A’ rating from the MS State Department of Health, exhibited by a copy on file at the site. A copy of the establishment’s health inspection must be obtained before food may be served. This may be obtained from the MS State Department of Health website for all licensed food establishments. J. Supplies: Ordering, Handling, and Storing 1. AAAs/service providers/site managers shall keep one week=s disposable congregate and home-delivered supplies on hand at each site at all times and order necessary supplies from the vendor on the day/time schedule requested by the vendor. 2. If due to storage or delivery limitations, this schedule is not beneficial to both the site and the vendor, an alternative arrangement for supplies is acceptable, if both parties are in agreement. 3. Site personnel shall make every effort to safeguard all supplies from pilferage and/or inappropriate use, such as packing home-delivered meals in congregate supplies or serving congregate meals in home-delivered supplies. The vendor shall maintain an ongoing record of supplies delivered to each site. 4. Supplies shall be commercially packaged for individual use and shall be stored at the site in closed containers on clean shelves above the floor and handled in a way that they are protected from contamination at all times. Supplies may not be stored on the same shelf, below or next to chemicals. K. Staff – There shall be an adequate number of staff to manage the program=s fiscal and administrative responsibilities. Records for documenting in-kind match shall be kept of volunteers= time and activities. 1. Registered Dietitian - The meals program shall be operated under the direction of the DAAS registered and licensed dietitian (RD, LD). Menus and nutritional information is prepared by a registered and licensed dietitian. **NOTE: As expansion of the Title III programs continue including 1) in the area of nutrition assessment of high risk participants, education and nutrition counseling, and 2) chronic disease prevention through health promotion activities including evidence based disease prevention programs, the services of a Registered Dietitian (RD, LD) will become more in demand beyond what has been required before. While not currently a requirement at the local level, contracting with a credentialed nutrition professional on an as needed basis is suggested to meet the growing need for health and nutrition related services. Title III C-1 and D funding may be used for such services as described. 2. Nutrition Coordinator - The AAA nutrition coordinator shall oversee the management and administration of the entire meals program. She/he or the service provider shall determine the supervisory functions of the site managers; plan training in food service safety and sanitation techniques and practices for all site personnel, including volunteers; and consult with the dietitian when desired and as necessary. 3. Site Manager - The site manager shall direct the day-to-day details and logistics of the entire meal program under and according to the supervision of the AAA nutrition coordinator/service provider. 4. Volunteers may be recruited and shall be supervised. Volunteers who handle food, including delivery must adhere to all food safety and sanitation requirements. 5. Delivery Drivers for congregate feeding sites that also serve as distribution points for home-delivered meals, delivery drivers hired by the AAA or service provider must adhere to all standards of food safety. L. Training The following training is required; training documentation shall be retained; and sufficient funds shall be budgeted to cover training expenses, if necessary: 1. Personnel Orientation and Inservice - All paid staff and volunteer food service workers shall have orientation training prior to working in the program and at a minimum yearly training. AAA nutrition coordinators/service providers shall plan and schedule the training which shall include, at a minimum, the following: a. Nutrition Coordinator/Service Provider - Routine management and administrative procedures, record keeping systems, reporting requirements, program requirements and sanitation and food safety and meal service; b. Site Manager – (1) Food Safety and Sanitation based on the Food Safety and Sanitation Manual, the Mississippi Food Code 10.0 and Servsafe instruction, (2) Meal service, with detailed instruction on congregate meal service requirements, counting and claiming, participant eligibility, and correct food portioning using the Site Serving Instructions guide; (3) Site operations; (4) Site record keeping; (5) Contribution policy and cash reconciliation; (6) Community resources; (7) Coordinating volunteers; and (8) Methods of referrals. c. Volunteers - Site procedures and various volunteer activities when they first enter the program and anytime thereafter as deemed necessary by the AAA/ service provider. Specifically, any volunteer which deals with the handling, distribution and/or delivery of meals must receive training on basic food safety and sanitation and meal eligibility. d. All Staff - Participant confidentiality; all aspects of food safety and sanitation; and procedures for handling emergencies – medical, fire or disaster, which includes being able to locate participants' emergency contact information and to evacuate participants safely. e. Any person who administers a Consumer Information Form must receive training, with documentation retained. f. Training is documented via sign-in sheets with date, topic/training title. A training log of employees and volunteers may be kept to compile all employee training in one at-a-glance form. (See appendix). 2. Training Opportunities for Nutrition Coordinators – While not mandatory, the following are opportunities to learn and share regarding the Older Adult Nutrition Program: a. Quarterly Menu and Nutrition Program Meetings-Attendance at the quarterly menu meetings and the DAAS meetings that follow, as well as any other special meetings called by the DAAS dietitian is encouraged to allow input and discussion from all areas of the state, due to the rapidly changing Title III program. b. ServeSafe –It is recommended that at least one person under advisement of the AAA, for example, a service provide or site manager, or the Nutrition Coordinator, be ServeSafe certified to act as a resource person and lead trainer due to the importance of food safety and sanitation in the high risk older population we serve. c. 3. Fire/Evacuation Drills for participants should take place at least once every six months and documentation by sign-in sheets kept at the site and/or sent in to the AAA as designated by the AAA; and 4. Instruction in general first aid, cardiopulmonary resuscitation (CPR), and the Heimlich maneuver is recommended for everyone working with older persons. M. Records 1. General - Adequate records shall be maintained on each participant to ensure the accuracy and authenticity of the number of eligible congregate participant meals served each day. To the greatest extent possible, all participant information and service records will be recorded in and all forms, sign-in sheets, and records should be drawn from current state approved client tracking system. All records and reports shall be made available for audit, assessment, or evaluation on demand by authorized representatives of area, state, and federal agencies. Except for audit purposes, recipient confidentiality shall not be violated and information about or obtained from an individual shall not be disclosed without that individual's written consent. However, the individual shall not be denied services if he refuses to provide written consent. 2. Documents to Reconcile - To determine that congregate persons received meals on certain dates and to assure that the meals paid for were served to eligible persons, the meal numbers on the following documents must reconcile: a. Sign-in Sheets- The Daily Service Unit Form, large spacing, printed from the current state approved client tracking system is recommended or a similar form, printed via the AAA’s/service providers, affixed with the date and the signature or mark of each person receiving a congregate meal (with the site manager signing and initialing the name of any eligible person who refuses or prefers not to sign, but with no one person signing for the majority of the participants); b. Monthly Client Service Reports (also known as AService Logs@) which shall be printed from current state approved client tracking system by the AAAs/service providers and sent to each site manager who shall complete and return it to the AAA/service provider who shall, in turn, reconcile by funding source the number of meals listed on the monthly report to the number of meals paid for; c. Meal Tickets; and d. Vendor Invoice. 3. Program Information shall include: a. All reconciled program documents, including Sign-In Sheets with the signature or mark of each person receiving a congregate meal (see details above); b. Waiting List of persons eligible for congregate meal service; c. Contribution Policy information provided to participants; d. Nutrition Education Documentation listing the topic, presenter, number of attendees, and date; and e. Program Income Records noting the daily/weekly contribution amounts. f. Volunteer Records showing that the person is a bonafide volunteer at that site or for that AAA and has received all orientation and annual training, and thus able to receive a meal, paid for with C-1 congregate, after signing the meal sign-in sheet for that day. 4. Participant Information is contained in the Consumer Information Form, which shall: a. Be completed by trained personnel prior to services being received, and updated annually, either on the anniversary date of the participant=s entrance into the system (recommended system) OR at a single point in time, e.g. October, for continuation or termination of meal services with additional assessments made whenever necessary and/or appropriate; b. Identify eligibility status for services; c. Contain emergency information such as the elderly person=s family or contact person and a record of any special health, medical, or dietary needs, when appropriate; d. List all services provided to the person in accordance with NAPIS/MIS reporting procedures, and e. All forms with each previous form filed together kept at the AAA, and a copy of the most recent form kept at the site, or, if the AAA has progressed to a paperless system and all documentation can be located in the client tracking system. f. Be entered into current state approved client tracking system within ten days of completion. N. Reports 1. Site to AAA or Service Provider On Friday or the last food service day of each week, site managers shall mail/scan to the AAAs the site=s delivery tickets and original sign-in sheets for that week, retaining a copy at the site, or by any other written procedure designated by the AAA so that meal count information is entered in to the client tracking system by the current DAAS designated due date. 2. AAA Nutrition Coordinator/Data Entry Person to Client tracking system By the current DAAS designated due date, AAA nutrition coordinators shall insure meal count and nutrition education units are provided to the data entry person/entered into the client tracking system. 3. Vendor Reports The vendor will provide to DAAS, in May and November, a Semi-annual Meal Numbers Report; and a Self-assessment Report, which includes the results of client satisfaction surveys administered prior to the second and fourth quarter menu cycles. 4. State Reports The AAAs shall provide any additional information or reports requested by the DAAS via the current state approved client tracking system. The State nutrition coordinator shall conduct a regular statewide analysis of the nutrition program and the state meal contract vendor from information submitted by the AAAs. 5. Adult Day Care Centers-CACFP CACFP reports are absolutely due to designated DAAS staff, no later than the date specified on the Reports Due Date Calendar. Failure of one site to submit information may affect filing of the CACFP claim for all Adult Day Care Centers and affect the statewide sponsorship. While mail is acceptable, is must reach the state office by the due date. There may be no late submissions. To avoid delays from the mail, preferably, the AAA/service provider may fax or scan a copy of the report and keep the original on file at the AAA and a copy at the site. Required documentation is a. the completed CACFP-4 Cost worksheet b. Monthly CACFP report page c. Any food receipts for snacks or additional food items d. Current roster with changes O. Credits, Penalties and Reimbursements 1. Vendor Credit a. The AAA MAY claim vendor credit IF: (1) The vendor fails to deliver meals or portions of meals or fails to deliver meals by the stated time, or if meals or portions of meals are deemed unacceptable AND (2) The site manager/service provider/AAA does NOT use an alternate vendor to fill the shortage. b. The vendor shall credit the AAA according to percentages listed below: Meat/Meat Alternative 100% Fruit/Salad 41% Milk 15% Vegetable 10% Dessert (other than fruit) 10% Bread/Bread Alternative 5% Margarine 2% Condiments 2% 2. Penalties to Vendor - After three occurrences per site, at the discretion of the AAA, a penalty is permitted to be imposed upon the vendor, in addition to the cost the AAA bills the vendor for meal replacement. a. These occurrences reflect the most critical situations when the provider will impose the penalty of $100 per site, in addition to, the delivery cost of substitute meals, including salary, mileage and food purchase. Vendor must credit the Area Agency on Aging in each planning and service area as need arises. These occurrences include: (1) No meal delivery; (2) Meals arriving beyond the agreed upon time; (3) Meal shortages; and, (4) Sub-standard temperatures at point of delivery and /or unacceptable food quality. b. The penalty for Congregate Meals will be $100 per site even if an alternate meal source is used. c. The penalty for Frozen Meals delivered to the site at any time other than the agreed upon designated date will include $100, plus one shelf-stable meal for each participant, the expense of paying a driver an hourly wage to deliver meals to participants, and vehicle mileage for delivering meals. This amount shall be credited to the AAA. d. The penalty for Adult Day Care Meals deemed ‘not allowed’ due to failure of vendor to comply with laws, regulations, and/or guidelines will result in cost of the alternate meals and payment of meals disallowed. 3. CACFP (Child and Adult Care Food Program) Reimbursement - Providers of adult day care services are eligible to receive funds from Mississippi Department of Education based on federally published rates by participating in the State Unit on Aging sponsored program. ADC Providers must a. Serve a creditable meal; b. Comply with all program policies and procedures; c. File a monthly report to the SUA; d. Maintain a completed and approved application on file for each participant; e. Attend training given three times a year by the SUA; and f. Be monitored three times each year by MDHS Division of Monitoring/Program Integrity. P. Monitoring 1. The Mississippi Department of Health, Division of Sanitation will conduct a site inspection annually to determine food safety and sanitation standards are followed. This is not a pass/fail inspection, however corrective action must be taken and follow up by the inspector will take place within the time period determined by the inspector. A report will be sent to the AAA. While some local health departments may keep up a schedule, it is the responsibility of the AAA or the provider to call for an appointment before an inspection has passed one year. The cost for this service, if any, shall be anticipated and included in the program budget. 2. The State Department of Human Services' Office of Monitoring/Program Integrity shall monitor once a year the: a. AAA nutrition program; and the b. Food service vendor; and c. Shall monitor CACFP sites three times a year. 3. Mississippi Department of Education monitors a percentage of CACFP, for Adult Day Care Programs annually, unannounced. 4. AAA nutrition coordinators are required to monitor each nutrition site annually using the same tools used by Program Integrity, Office of Monitoring. Any findings or concerns shall be followed up on, in person, to insure the required changes have taken place. More frequent site visits are encouraged to provide technical assistance and assist is any revisions that should take place to insure the nutrition program is provided correctly. AAA nutrition coordinators should informally monitor or visit the vendor commissary during early morning hours once a year or as often as possible for the benefit of themselves and the overall nutrition program they manage. 5. The vendor conducts a site visit to 75% of all sites yearly including those with hot bulk, pre-plated and frozen delivery. While monetary penalties are not incurred from these reports, the findings are meant to give the site, service provider and AAA knowledge of problems and potential problems on meal service, food safety and sanitation; as well as health inspections.