Food and nutritional services

(a) General. The CAH shall directly provide or contract for organized food and nutritional services that are directed and staffed by qualified personnel. If the CAH has a contract with an outside food management company to provide services on-site or cater food to the CAH, the company shall comply with all requirements specified in this section. (b) Organization. (1) Clinical nutritional services shall be under the supervision and direction of a licensed/registered dietitian on a full-time, part- time, or consultant basis. The dietitian shall be responsible for approval of menus and modified diets, review of clinical policies and procedures, evaluation of nutritional services and staff continuing education. If dietitian services are provided on a part-time or consultant basis, the responsibilities of the dietitian shall be clearly defined in a written job description and summary reports of consultant visits shall be written and on file. The dietitian shall be responsible for, or shall designate a person in writing, to carry out clinical nutritional activities. The clinical nutritional activities shall include but not be limited to patient and family counseling on modified diets as needed, any required nutritional assessments, and development of clinical nutritional policies and procedures. If dietitian services are provided on a part-time or consultant basis, a dietitian shall be available for telephone consultation daily and shall be able to approve menus and modified diets electronically. (2) The food and nutritional services manager may or may not be a licensed/registered dietitian. If the manager is not a licensed/registered dietitian or certified dietary manager, the manager shall be responsible only for administrative management and shall not direct clinical nutritional activities. (3) Personnel shall be adequate in number and training to carry out the preparation and serving of foods and other related functions with the proper and necessary sanitary procedures. The food service personnel shall complete a basic orientation program before working in the food service area. This orientation shall include, but not be limited to: basic dietary guidelines, infection control including food safety, and fire and safety precautions. (c) Services and facilities. (1) Equipment used in the preparation and handling of food shall bear the seal of the National Sanitation Foundation (NSF) or comply OAC 310:667 OKLAHOMA STATE DEPARTMENT OF HEALTH 79 September 13, 2019 with the requirements of the NSF (Rules and Regulations Pertaining to Food Establishments). (2) A nourishment room accessible to the nursing staff shall be provided for the preparation and serving of light refreshments. This room shall be equipped with equipment for warming food, a refrigerator, and a lavatory. This room may serve as the location for an ice machine. (d) Diets and menus. (1) At least three (3) palatable meals or their equivalent shall be served daily, at regular times with not more than fifteen (15) hours between a substantial evening meal and breakfast. Menus shall be planned and followed to meet nutritional needs of patients, in accordance with the prescribing physician or practitioner diet orders and to the extent medically possible, in accordance with the Dietary Reference Intakes (DRIs) of the Food and Nutrition Board of the Institute of Medicine, National Academy of Sciences. (2) All diets shall be prescribed by the physician or practitioner responsible for the care of the patient. Modified diets shall be prescribed according to the latest edition of the Oklahoma Diet Manual or other equivalent approved manual. The Oklahoma Diet Manual or other equivalent approved diet manual shall be approved by the licensed/registered dietitian, the medical and professional staff and the governing body. The manual shall be available to all medical, nursing, and food service personnel. (3) Nourishments shall be available and may be offered at anytime in accordance with approved diet orders. (4) Menus covering all prescribed diets shall be approved, dated, and periodically reviewed by a licensed/registered dietitian. Modified diet orders not covered with an approved menu shall be planned in writing, reviewed, and approved by a licensed/registered dietitian. The licensed/registered dietitian approval of the modified diet may be performed electronically. (5) The portioning of menu servings shall be accomplished with the use of portion-control serving utensils. (6) All modified diets shall be prepared separately, as necessary, from regular diets. (7) An identification system shall be established to ensure that each patient receives the prescribed diet as ordered. (e) Food preparation and storage. (1) Potentially hazardous food, as defined in chapter 256 of this Title, shall be maintained at one hundred-forty (140)oF (approximately 60oC) or above or at an internal temperature of forty-one (41)oF (approximately 5oC) or below. A product thermometer shall be available, metal stem-type numerically scaled indicating temperature, accurate to plus or minus two (2) degrees F and used to check internal food temperatures. (2) Milk and milk products shall be served, handled and stored in accordance with the requirements of Chapter 256 of this Title. (3) All ice which is in contact with food or drink shall come from a source approved by the Department. Storage, transportation, handling, and dispensing shall be in a sanitary manner, approved by the Department in accordance with Chapter 256 of this Title. (f) Sanitation. OAC 310:667 OKLAHOMA STATE DEPARTMENT OF HEALTH 80 September 13, 2019 (1) The food and nutritional services shall be inspected and approved by state or local health agencies and licensed as a Food Service Establishment. Written reports of the inspections; e.g., Food Establishment Inspection Report Forms, shall be maintained with notations made of the action taken to correct violations. (2) Storage, preparation, and serving of food shall be in compliance with the requirements of Chapter 256 of this Title, including adequate and proper space for each activity. (3) The system used for dishwashing shall be approved by the Department and operated in accordance with approved procedures and requirements of Chapter 256 of this Title. (4) Garbage and refuse shall be kept in durable, easily cleanable, insect-proof and rodent-proof containers that do not leak and do not absorb liquids. Adequate carriers and containers shall be provided for the sanitary collection and transportation of garbage and refuse from food service areas to the place of disposal in accordance with the requirements of Chapter 256 of this Title.