.13 Dietetic Services.

A. Services Provided. Services may be provided directly by the facility or the facility may contract with a food management company, a caterer, or another facility. The facility and the food management company (or caterer or facility providing service) shall comply with these regulations. Food service personnel shall comply with COMAR 10.15.03 Food Service Facilities.

B. Supervision.

(1) In facilities exceeding 50 beds, overall supervisory responsibilities for the dietetic service shall be assigned to a full-time qualified dietetic service supervisor. It shall be the responsibility of the supervisor to delegate relief duties to a person qualified to serve as relief. (See Supportive Personnel, Regulation .07J, of this chapter.)

(2) In facilities with 26—50 beds, exceptions may be made by the Department to allow the supervisor to share cooking responsibilities with the full-time cook.

(3) In facilities with 25 beds or fewer, responsibility may be assigned to the full-time cook.

(4) If a facility can demonstrate that because of the experience and training of its personnel and the physical layout and equipment, less supervisory personnel is required, the Department may modify the above requirements for supervision.

C. Consultation.

(1) If the supervisor is not a dietitian, the individual shall receive regularly scheduled consultation from a registered dietitian or other qualified person. In all instances sufficient consultation shall be provided to fulfill all required responsibilities.

(2) There shall be a signed agreement between the facility and the consultant dietitian specifying hours and frequency of service responsibilities, and registration number if applicable.

(3) Consultation services shall be documented by written reports.

D. Staffing.

(1) A sufficient number of food service personnel shall be employed to carry out efficiently the functions of the dietetic service and meet the dietary needs of the patient.

(2) Working hours shall be scheduled to insure that the dietetic needs of the patients are met.

(3) Nursing, housekeeping, laundry, or other personnel may not be utilized as dietetic staff. Exceptions may be made only upon the written approval of the Department. The kitchen may not be used for any purpose other than the preparation of food.

E. Adequacy of Diet. The food and nutritional needs of patients shall be met in accordance with physicians' orders. To the extent medically possible, the current "Recommended Dietary Allowances of the Food and Nutrition Board of the National Research Council, National Academy of Sciences", adjusted for age, sex, and activity shall be observed.

Agency Note: The "Diet Manual for Long-Term Care Patients" as published by the Department, which contains food allowances and guides for regular and therapeutic diets may be used.

F. Therapeutic Diets. Therapeutic diets shall be planned, prepared, and served as prescribed by the attending physician:

(1) Therapeutic diets shall be planned by a registered dietitian or other qualified person;

(2) Preparation and serving shall be supervised by a qualified dietetic supervisor;

(3) A current diet manual shall be available to medical, nursing, and dietetic staff.

G. Frequency and Quality of Meals. At least three meals or their equivalent shall be served daily, at regular times with not more than 14-hour intervals between the substantial evening meal and 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. This meal represents no less than 20 percent of the day's total nutritional requirements. To the extent medical orders permit, bedtime nourishments shall be offered routinely to all patients. If the four-or five-meal-a-day plan is used, the meal pattern to provide this plan shall be approved by the Department.

H. Advance Planning and Posting of Menus. Menus shall be written at least 1 week in advance. The current week's basic menu shall be posted in one or more easily accessible places in the dietetic service department and in the patient area.

I. Menus Served as Planned. Food sufficient to meet the nutritional needs of patients shall be prepared as planned for each meal. When menu changes are necessary, substitutions shall provide equal nutritional value.

J. Retention of Records. Menus as served and records of food purchased for consumption by patients shall be filed on the premises for a period of 30 days.

K. Preparation of Food. Foods shall be prepared by methods that conserve nutritive value, flavor, and appearance, and shall be served at proper temperatures, in a form to meet individual needs. Standardized recipes adjusted to appropriate yield shall be followed. Standardized recipes are those recipes which have been tested by the facility or another source which assure consistency in quality and quantity.