(A) Each nursing home shall have a kitchen
and other food service facilities which are adequate for preparing and serving
appetizing food for all residents. The
nursing home shall develop and implement a policy addressing its method for
accommodating religious, ethnic and cultural and personal
preferences.
(B)
The nursing home shall store, prepare, distribute and
serve food under sanitary conditions and in a manner that protects it against
contamination and spoilage in accordance with food service requirements of
Chapter 3717-1 of the Administrative Code.
(B)
(C) Each nursing home
shall provide at least three nourishing, palatable, and appetizing meals daily
to all residents at regular hours
comparable to normal
mealtimes in the community. The meals shall
be
varied and meet the nutritional needs of the residents and be capable of
provide
providing the dietary referenced intake of the "Food
and Nutrition Board" of the "National Academy of Science."
For scheduled meal services, there shall be at least
a four-hour interval of time between the mid-point of the breakfast and the
mid-point of the noon meal and between the mid-point of the noon and mid-point
of the evening meal.
Food shall be prepared and
served in a form that meets the resident's individual needs based on the
assessment conducted pursuant to rule
3701-17-10
of the Administrative Code, the plan of care required by rule
3701-17-14
of the Administrative Code, allow for resident choice, and accommodate
religious, ethnic, cultural and personal preferences. There shall be no
more than sixteen hours between the evening meal and breakfast. Each nursing
home shall offer a nourishing snack, consisting of a choice of beverages and a
food item from a basic food group, after the evening meal. Food substitutes of
similar nutritive value shall be offered to residents who refuse the food
served and serving size may be adjusted according to resident preference. The
nursing home shall accommodate a resident's preference or medical need to eat
at different intervals.
(C)
(D) A nursing home may
provide any alternate format of meal service that otherwise meets the
requirements of this rule, if the residents agree to participate in the meal
service and the home:
(1)
Uses precautions to
Ensures safe food handling practices to prevent
contamination of food being served; and
(2) Assists residents when
necessary.
(D)
(E) Each nursing home
shall maintain at all times sufficient food supplies for residents. The home
shall maintain at least two days' supply of perishable food items and at least
one week's supply of staple food items. The amount of such supplies shall be
based on the number of meals that the nursing home provides and the nursing
home's census.
(E)
(F) Each nursing home shall have planned menus
for all meals
,
which
that are approved by the dietitian
required by paragraph (K) of this rule, for all meals
, including complex therapeutic diets, at least one
week in advance.
Menus shall be varied and be based
on a standard meal planning guide published, or approved by a licensed or
registered dietitian in accordance with acceptable standards or practice, or
both. The nursing home shall maintain records for all meals, including
complex therapeutic diets, as served. The
meal records shall be kept on file in the nursing home for at least
one year
three
months after being served and made available to the director upon
request. The records shall indicate the date that each meal was served along
with any food substitutions from the menu.
(F) Food shall be prepared and
served in a form that meets the resident's needs based on the assessment
conducted pursuant to rule
3701-17-10
of the Administrative Code.
(G) Safe, fresh, and palatable drinking water
shall be accessible for residents at all times.
(H)
. Complex
therapeutic
All diets shall be:
(1) Ordered by a physician or other licensed
health professional acting within
the
applicable
their scope of
practice;
(2) Prepared and provided
in accordance with the instructions of a dietitian pursuant to the
verified diet order; and
(3) Adjusted as ordered by a physician,
dietitian or other licensed health professional acting within
the applicable
their scope of practice.
(I) The nursing home shall monitor each
resident's nutritional intake and make adjustments in accordance with the
resident's needs. Notification of any significant unplanned or undesired weight
change shall be made to the resident's attending physician and the dietitian
required by paragraph (K) of this rule. "Significant unplanned or undesired
weight change" means a five per cent weight gain or loss over a one month
period, a seven and one-half per cent or more weight gain or loss over a three
month period, or a ten per cent or more weight gain or loss over a six month
period.
(J) The nursing home shall store,
prepare, distribute and serve food under sanitary conditions and in a manner
that protects it against contamination and spoilage in accordance with food
service requirements of Chapter 3717-1 of the Administrative
Code.
(K)
(J) Each nursing home
shall employ a dietitian, who may be hired on a full-time, part-time or
consultant basis, to plan,
manage
direct and implement dietary services that meet
the residents' nutritional needs and comply with the requirements of this rule.
If the home does not have the full-time equivalent of a dietitian, the nursing
home shall designate a person who meets the qualifications specified in
paragraph (H) of rule
3701-17-07
of the Administrative Code, to serve as the food service manager. The part-time
or consultant dietitian, at a minimum, shall consult monthly
, or sooner, if needed, with the food service manager.
Each nursing home shall ensure that the dietitian performs the following
functions:
(1) Assesses, plans,
manages
monitors and
implements
evaluates
nutritional services that meet the needs of the residents;
(2) Oversees the development and
implementation of policies and procedures which assure that all meals are
prepared and served as ordered and that food service personnel maintain
safe and sanitary conditions in procurement,
storage, preparation, distribution and serving of food;
(3) Monitors
at
least quarterly, or more often as determined by the dietitian, food
preparation staff
,
and staff responsible for carrying out the duties
specified in this rule
, and residents on complex
therapeutic diets;
(4)
For each resident receiving a
Evaluate residents' response to new complex
therapeutic
diets
diet, on an on-going basis:
, and the home's compliance in the provision of such diet,
within one month after the nursing home commences providing the diet. For the
purposes of this provision, "new" means either a food regimen that the nursing
home has never before supervised or a food regimen that has been prescribed for
a resident for the first time; and
(a)
Determine that
the diet ordered is appropriate according to the resident's individual
nutritional care plan;
(b)
Monitor the resident's nutritional intake and
acceptance of the diet;
(c)
Evaluate the home's compliance in the provision of the
diet; and
(d)
Adjust nutritional care plans and diets as
needed.
(5)
Oversees, or arranges for, the training of staff in performing the duties
specified in this rule and in the preparation of
special
foods for all
diets. Trained unlicensed staff, including the dietary manager, may perform
routine tasks that:
(a) May be assigned
pursuant to Chapter 4759. of the Revised Code and this rule; and
(b) Do not require professional judgment or
knowledge.
(L)
(K) Tube feedings and
parenteral nutrition shall be
ordered by a physician or
other licensed health professional acting within their scope of practice
and administered by the appropriate licensed health professionals in
accordance with acceptable standards of practice. Tube feedings shall not be
used for convenience or when in conflict with treatment decisions, or a
resident's advance directive, in accordance with applicable provisions of
Chapters 1337. and 2133. of the Revised Code.