SERVICES DEPARTMENT. The facility shall have a dietary services department
which complies with the Food Sanitation Rules, OAR chapter 333, division 150.
(a) Admittance to the kitchen shall be
restricted to those who must enter to perform their duties, to government
inspectors, or for peer review.
Written procedures for cleaning equipment and work areas shall be prepared and
(c) Foods shall be
protected from contamination during transportation.
(d) There shall be a minimum of one week
supply of staple foods and two-day supply of perishable foods on the
Overall supervision of the dietary service shall be assigned to a full-time
dietary service director who is a registered dietician, or:
(A) Is a graduate of a dietetic technician
training program (correspondence or classroom) approved by the American
Dietetic Association or dietary management training approved by the American
Dietary Manager Association; and
Has on-site consultation provided at
(i) The consultant shall be a
registered dietician or a person with a baccalaureate degree or higher with
major studies in food, nutrition, diet therapy, or food service
(ii) The consultant
shall have at least one year of supervisory experience in an institutional
dietary service and shall participate in continuing education
(iii) The visits of the
consultant shall be of sufficient duration to review dietary systems and assure
quality food to the resident.
Responsibilities. The dietary services
director has responsibility, with guidance from the consultant if the director
is not a registered dietician, for:
Orientation, work assignments, supervision of work, and food handling technique
for dietary service staff. The director shall assure that employees who have or
exhibit signs of a communicable disease do not remain on duty;
Participation in regularly scheduled
conferences with the administrator and department heads and in the development
of dietary policy (OAR 411-085-0210
), procedures, and staff development
(C) Menu planning,
recommending and/or ordering food and supplies to be purchased, and
(3) STAFFING. The facility shall employ
supportive personnel to carry out functions of the dietary service. There shall
be food service personnel on duty at least 12 consecutive hours each
DIETS AND MENUS.
(a) Diets shall be prescribed by the
attending physician. Therapeutic menus shall be prepared and served as
A diet manual,
approved by a dietitian, shall be readily available to the attending physician,
nursing and dietary service personnel. The manual shall be reviewed at least
annually by the dietician.
(A) Menus for
regular and routine therapeutic diets shall be planned in writing at least
three weeks in advance.
current week's menu shall be posted in the dietary department and in a location
accessible and conspicuous to residents.
(C) A different menu shall be followed for
each day for a minimum of twenty-one days (this does not apply to facilities
using selective menus).
shall include fresh fruits and vegetables in season.
(E) Records of menus, as served, shall be
retained for sixty days (this does not apply to facilities using selective
(c) Menus shall
be planned and followed to meet nutritional needs of the resident in accordance
with physician orders and, to the extent medically possible, in accordance with
the recommended dietary allowances in the facility diet manual (see subsection
(4)(b) of this rule).
FOOD PREPARATION AND SERVICE.
(a) Foods shall be prepared by methods which
conserve nutritive value, flavor, and appearance. A file of recipes adjusted to
appropriate yield shall be maintained.
(b) Foods shall be attractively served in a
form cut, chopped, ground, or pureed to meet individual needs and delivered to
residents at customarily acceptable temperatures.
(c) Residents requiring assistance with
feeding shall receive timely assistance while food is at customarily acceptable
(d) An identification
system shall be established to ensure that each resident receives diet as
(e) At least three meals
or their equivalent shall be served daily at regular hours with not more than a
14 hour span between the beginning of the substantial evening meal and the
beginning of breakfast. A substantial evening meal is an offering of three or
more menu items at one time, one of which includes a high quality protein such
as meat, fish, eggs, or cheese. The meal represents no less than 25 percent of
the day's total nutritional requirements.
(f) Bedtime snacks of nourishing quality
shall be offered routinely to residents who desire one and for whom it is not
medically prohibited. Snacks of nourishing quality are those which provide
substantive nutrients in addition to carbohydrates and calories, e.g., milk and
milk drinks and fruit juice.
a resident refuses a food served, substitute foods of necessary nutritional
food elements shall be offered.
(6) DOCUMENTATION. Resident's response to
diet shall be recorded in the clinical record when there are significant
ASSISTANT. Facilities may use dining assistants to assist residents with
feeding and hydration. "Dining Assistant" means a person 16 years of age or
older who has successfully completed a Department-approved Dining Assistant
training course and competency evaluation. Dining assistants include volunteers
participating in facility volunteer programs who feed residents.
Resident selection criteria:
(A) The facility must ensure that a dining
assistant feeds and hydrates only residents who have no complicated feeding
problems including, but not limited to, difficulty swallowing, recurrent lung
aspirations and tube or parenteral/IV feedings.
The facility Director of Nursing
Services, RN Care Manager or RN Charge Nurse must assess and document resident
selection for dining assistance. The resident assessment must be based on, but
is not limited to:
(i) The resident's
appropriateness for dining assistance;
(ii) The resident's feeding and hydration
(iii) The resident's
communication, behavior and interpersonal skills;
(iv) Risk factors including nausea (acute and
ongoing), difficulty swallowing, seizure disorders, acute gastrointestinal
issues, vomiting; and
resident's latest MDS assessment and plan of care.
(C) The documented assessment must be updated
promptly after any significant change of condition and reviewed quarterly.
Scope of Duties:
(i) Assist residents with eating and
(ii) Transport residents
to and from dining area;
Distribute meal trays;
accurate meal delivery by verification with accompanying meal card;
(v) Provide assistance in preparing residents
for meals including, but not limited to, placement of eye glasses, washing
hands and face and placement of clothing protector;
(vi) Assist with insertion of dentures for
residents that can self direct care;
(vii) Set up meal tray for residents
including, but not limited to, opening food packets, positioning and cutting
(viii) Provide minimal
assistance with positioning, as needed, for feeding and hydration
(ix) Measure and record food
and fluid intake.
(ii) Assist with tube
feeding or IV nutrition;
Assist with insertion of dentures for residents unable to self direct
(iv) Provide standby
assistance with ambulation or activities requiring gait belt;
(v) Assist with food containing
(vi) Turn, lift or
extensively reposition residents; and
(vii) Other CNA tasks including oral
Training. A Department-approved facility Dining Assistant training course must
include, at a minimum, 16 hours of training and evaluation in the following
topics and subject matters and as identified in Exhibit 86-2, which is attached
to and made a part of these rules
(i) Scope of authorized
duties and prohibited tasks.
Feeding and hydration techniques.
(iii) Skills for assisting with feeding and
(iv) Communication and
Appropriate responses to resident behavior.
(vi) Recognizing changes in residents that
are inconsistent with their normal behavior and the reporting of those changes
to the registered nurse (RN) or licensed practical nurse (LPN).
(vii) Safety and emergency procedures
including the abdominal thrust.
(viii) Infection control.
(ix) Assisting residents with
(xi) Abuse prevention and
Instructors of the Department-approved facility Dining Assistant training
course must be licensed/certified in one of the following disciplines:
registered nurse, registered dietician, occupational therapist or speech
"Successful completion" means a passing score on a written exam for a
Department-approved facility Dining Assistant training course and satisfactory
completion of competency evaluation as determined by the instructor. A
Department-approved certificate will be issued to each dining assistant upon
Department will evaluate, select and approve at least one Dining Assistant
training course curriculum which includes the topic and subject matters
contained in Exhibit 86-2. The Department will periodically
re-evaluate its selection and approval.
Supervision of dining assistants
(A) Dining assistants must work under the
supervision of a registered nurse or licensed practical nurse. A registered
nurse or licensed practical nurse must be readily available to respond to
urgent or emergent resident needs.
(B) In an emergency, dining assistants must
immediately obtain appropriate staff assistance including the use of the
resident call system.
(e) Facilities must ensure that dining
assistants perform only those tasks for which they are trained and permitted to
(f) It is the
responsibility of the facility Director of Nursing Services, RN Care Manager or
licensed Charge Nurse to ensure that dining assistants are oriented to the
specific residents to whom they are assigned prior to providing dining
(g) Maintenance of
records. Facilities must maintain a record of all facility dining assistants.
The record must contain a copy of each dining assistant's certificate for
successful completion of a Department-approved Dining Assistant training
course. Upon request, a facility will share copies of dining assistant training
certificates with other facilities