Dietary services

The facility shall provide for the dietary needs of the residents and provide dietary services in conformance with the food service sanitation manual issued by the department. Dietary services must include: 1. A qualified director of dietary services must be designated to be responsible for the dietary service of the facility. a. A director of dietary services is: (1) A dietitian licensed to practice in North Dakota and registered by the academy of nutrition and dietetics or its predecessor or successor organization; (2) A graduate of a dietetic technician or dietetic assistant training program approved by the academy of nutrition and dietetics or it predecessor or successor organization; (3) A certified dietary manager, certified by the certifying board for dietary managers; (4) A graduate of a state-approved course that provides ninety or more hours of instruction in dietary service supervision in a health care institution with consultation from a licensed and registered dietitian; or (5) An individual trained and experienced in food service supervision and management in a military service equivalent to the program described in paragraph 2 or 4. b. If the director of dietary services is not a licensed and registered dietitian, regularly scheduled consultation from a consultant licensed and registered dietitian must be obtained at least monthly. 2. Dietary service personnel and all personnel who are actively engaged in assisting residents with eating must be in good health and practice hygienic food handling techniques. 3. Menus for all diets must be planned in accordance with the recommended dietary allowances of the food and nutrition board of the national research council, national academy of science. Sufficient food must be prepared as planned for each meal to meet the nutritional needs of residents. a. Menus must be written at least one week in advance. The current week's menus must be located in the dietary services area for easy use by dietary services staff. b. When changes in the menu are necessary, substitutions must provide equal nutritive value. The change and the reason for the change must be noted in writing on the menu. c. Menus of food served must be filed and maintained for thirty days. d. Menus must be adjusted to address the requests of the residents when possible. 4. Therapeutic diets when prescribed by the licensed health care practitioner. 5. At least three meals or the equivalent must be served daily, at regular times. a. There must be no more than a fourteen-hour span between a substantial evening meal and breakfast unless a nourishing snack is provided at bedtime. Up to sixteen hours may elapse between a substantial evening meal and breakfast the following day if the residents agree to this meal span and a nourishing evening snack is served. b. A substantial evening meal is an offering of three or more menu items at one time, one of which includes a high quality protein item such as meat, fish, egg, or cheese. c. Snacks must be offered at bedtime daily. 6. A current diet manual, approved by the medical staff or medical director, must be readily available. 7. Providing each resident with food prepared by methods that conserve nutritive value, flavor, and appearance. The food must be attractively served at the proper temperatures and in a form to meet individual needs. Equipment must be provided and procedures established to: a. Maintain hot food above one hundred forty degrees Fahrenheit [60 degrees Celsius] during dishing. b. Ensure that cold foods leave the kitchen at no more than forty-five degrees Fahrenheit [7.22 degrees Celsius]. 8. Table service for all who can and will eat at a table. For those not eating at a table, the proper eating equipment must be available and used. 9. Facilities for the general dietary needs of the residents, and for the maintenance of sanitary conditions in the storage, preparation, service and distribution of food.