Section R9-10-423. Food Services

A.      An administrator shall ensure that:

1.        The nursing care institution has a license or permit as a food establishment under 9 A.A.C. 8, Article 1;

1.	An infection control program is established, under the		2.     A copy of the nursing care institution’s food establish-
	direction of an individual qualified according to policies		ment license or permit is maintained;
	and procedures, to prevent the development and transmis-		3.     If a nursing care institution contracts with a food estab-
	sion of infections and communicable diseases including:		lishment, as established in 9 A.A.C. 8, Article 1, to pre-
	a.      A  method  to  identify  and  document   infections		pare and deliver food to the nursing care institution:
	occurring at the nursing care institution;		a.      A  copy  of  the  contracted  food  establishment's
	b.     Analysis of the types, causes, and spread of infec-		license or permit under 9 A.A.C. 8, Article 1 is
	tions and communicable diseases at the nursing care		maintained by the nursing care institution; and
	institution;		b.     The nursing care institution is able to store, refriger-
	c.      The development of corrective measures to mini-		ate, and reheat food to meet the dietary needs of a
	mize or prevent the spread of infections and commu-		resident;
	nicable diseases at the nursing care institution; and		4.     A registered dietitian:
	d.     Documentation of infection control activities includ-		a.      Reviews a food menu before the food menu is used
	ing:		to ensure that a resident’s nutritional needs are being
	i.      The collection and analysis of infection control		met,
	data,		b.     Documents the review of a food menu, and
	ii.     The  actions   taken  related  to   infections  and		c.      Is available for consultation regarding a resident’s
	communicable diseases, and		nutritional needs; and
	iii.   Reports of communicable diseases to the gov-		5.     If a registered dietitian is not employed full-time, an indi-
	erning authority and state and county health		vidual is designated as a director of food services who
	departments;		consults with a registered dietitian as often as necessary
2.	Infection control documentation is maintained for at least		to ensure that the nutritional needs of a resident are met.
	12 months after the date of the documentation;	B.	A registered dietitian or director of food services shall ensure
3.	Policies and procedures are established, documented, and		that:
	implemented that cover:		1.     Food is prepared:
	a.      Handling  and  disposal   of  biohazardous  medical		a.      Using methods that conserve nutritional value, fla-
	waste;		vor, and appearance; and
	b.     Sterilization, disinfection, and storage of medical		b.     In a form to meet the needs of a resident such as cut,
	equipment and supplies;		chopped, ground, pureed, or thickened;
	c.      Using personal protective equipment such as aprons,		2.     A food menu:
	gloves,  gowns,  masks,  or  face  protection   when		a.      Is prepared at least one week in advance,
	applicable;		b.     Includes the foods to be served on each day,
	d.     Cleaning of an individual's hands when the individ-		c       Is conspicuously posted at least one day before the
	ual's hands are visibly soiled and before and after		first meal on the food menu will be served,
	providing a service to a resident;		d.     Includes  any  food  substitution  no  later  than   the
	e.      Training of personnel members, employees, and vol-		morning of the day of meal service with a food sub-
	unteers in infection control practices; and		stitution, and
	f.      Work   restrictions   for   a   personnel   member   with   a		e.      Is maintained for at least 60 calendar days after the
	communicable disease or infected skin lesion;		last day included in the food menu;
4.	Biohazardous medical waste is identified, stored, and dis-		3.     Meals and snacks for each day are planned and served
	posed of according to 18 A.A.C. 13, Article 14 and poli-		using the applicable guidelines in http://www.health.gov/
	cies and procedures;		dietaryguidelines/2010.asp;
5.	Soiled linen and clothing are:		4.     A resident is provided:
	a.      Collected in a manner to minimize or prevent con-		a.      A diet that meets the resident's nutritional needs as
	tamination;		specified in the resident's comprehensive assessment
	b.     Bagged at the site of use; and		and care plan;
	c.      Maintained separate from clean linen and clothing		b.     Three meals a day with not more than 14 hours
	and  away   from  food  storage,   kitchen,  or  dining		between the evening meal and breakfast except as
	areas; and		provided in subsection (B)(4)(d);
6.	A personnel member, an employee, or a volunteer washes		c.      The option to have a daily evening snack identified
	hands or uses a hand disinfection product after a resident		in subsection (B)(4)(d)(ii) or other snack; and
	contact and after handling soiled linen, soiled clothing, or		d.     The option to extend the time span between the eve-
	potentially infectious material.		ning meal and breakfast from 14 hours to 16 hours
			if:

i.         A resident group agrees; and

ii.        The resident is offered an evening snack that includes meat, fish, eggs, cheese, or other pro- tein, and a serving from either the fruit and veg- etable food group or the bread and cereal food group;

5.        A resident is provided with food substitutions of similar nutritional value if:

a.         The resident refuses to eat the food served, or

b.        The resident requests a substitution;

6.        Recommendations and preferences are requested from a resident or the resident's representative for meal planning;

7.        A resident requiring assistance to eat is provided with assistance that recognizes the resident's nutritional, physi- cal, and social needs, including the use of adaptive eating equipment or utensils;

8.        Tableware, utensils, equipment, and food-contact sur- faces are clean and in good repair;

9.        A resident eats meals in a dining area unless the resident chooses to eat in the resident's room or is confined to the resident's room for medical reasons documented in the resident’s medical record; and

10.     Water is available and accessible to residents.

C.      If a nursing care institution has nutrition and feeding assis- tants, an administrator shall ensure that:

1.        A nutrition and feeding assistant:

a.         Is at least 16 years of age;

b.        If applicable, complies with the fingerprint clear- ance card requirements in A.R.S. § 36-411;

c.         Completes a nutrition and feeding assistant training course within 12 months before initially providing nutrition and feeding assistance;

d.        Provides nutrition and feeding assistance where nursing personnel are present;

e.         Immediately reports an emergency to a nurse or, if a nurse is not present in the common area, to nursing personnel; and

f.         If the nutrition and feeding assistant observes a change in a resident’s physical condition or behav- ior, reports the change to a nurse or, if a nurse is not present in the common area, to nursing personnel;

2.        A resident is not eligible to receive nutrition and feeding assistance from a nutrition and feeding assistant if the res- ident:

a.         Has difficulty swallowing,

b.        Has had recurrent lung aspirations,

c.         Requires enteral feedings,

d.        Requires parenteral feedings, or

e.         Has any other eating or drinking difficulty that may cause the resident’s health or safety to be compro- mised if the resident receives nutrition and feeding assistance from a nutrition and feeding assistant;

3.        Only an eligible resident receives nutrition and feeding assistance from a nutrition and feeding assistant;

4.        A nurse determines if a resident is eligible to receive nutrition and feeding assistance from a nutrition and feed- ing assistant, based on:

a.         The resident’s comprehensive assessment,

b.        The resident’s care plan, and

c.         An assessment conducted by the nurse when making the determination;

5.        A method is implemented that identifies eligible residents that ensures only eligible residents receive nutrition and feeding assistance from a nutrition and feeding assistant;

6.        When a nutrition and feeding assistant initially provides nutrition and feeding assistance and at least once every

three months, a nurse observes the nutrition and feeding assistant while the nutrition and feeding assistant is pro- viding nutrition and feeding assistance to ensure that the nutrition and feeding assistant is providing nutrition and feeding assistance appropriately;

7.        A nurse documents the nurse’s observations required in subsection (C)(6); and

8.        A nutrition and feeding assistant is provided additional training:

a.         According to policies and procedures, and

b.        If a nurse identifies a need for additional training based on the nurse’s observation in subsection (C)(6).

Historical Note

Adopted effective January 28, 1980 (Supp. 80-1). Section repealed by final rulemaking at 8 A.A.R. 2785, effective October 1, 2002 (Supp. 02-2). New Section R9-10-423 made by exempt rulemaking at 19 A.A.R. 2015, effective October 1, 2013 (Supp. 13-2). Amended by exempt

rulemaking at 19 A.A.R. 3334, effective October 1, 2013 (Supp. 13-4). Amended by exempt rulemaking at 20

A.A.R. 1409, pursuant to Laws 2013, Ch. 10, § 13; effec- tive July 1, 2014 (Supp. 14-2).