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CALIFORNIA CODE OF REGULATIONS
TITLE 22. SOCIAL SECURITY
DIVISION 5. LICENSING AND CERTIFICATION OF HEALTH FACILITIES, HOME HEALTH AGENCIES, CLINICS, AND REFERRAL AGENCIES
CHAPTER 1. GENERAL ACUTE CARE HOSPITALS
ARTICLE 3. BASIC SERVICES
Date:
08/31/2009
Document:
22 CCR 70273 (2011)
ยง 70273. Dietetic Service General Requirements
(a) The dietetic service shall provide food of the quality and quantity to meet the patient's needs in accordance with physicians' orders and, to the extent medically possible, to meet the Recommended Daily Dietary Allowances, 1974 Edition, adopted by the Food and Nutrition Board of the National Research Council of the National Academy of Sciences, 2107 Constitution Avenue, Washington, DC 20418, and the following:
(1) Not less than three meals shall be served daily.
(2) Not more than 14 hours shall elapse between the evening meal and breakfast of the following day.
(3) Nourishment or between meal feedings shall be provided as required by the diet prescription and shall be offered to all patients unless counterordered by the physician.
(4) Patient food preferences shall be respected as much as possible and substitutes shall be offered through use of a selective menu or substitutes from appropriate food groups.
(5) When food is provided by an outside food service, all applicable requirements herein set forth shall be met. The hospital shall maintain adequate space, equipment and staple food supplies to provide patient food service in emergencies.
(b) Policies and procedures shall be developed and maintained in consultation with representatives of the medical staff, nursing staff and administration to govern the provision of dietetic services. Policies shall be approved by the medical staff, administration and governing body. Procedures shall be approved by the medical staff and administration.
(c) The responsibility and the accountability of the dietetic service to the medical staff and administration shall be defined.
(d) A current diet manual approved by the dietitian and the medical staff shall be used as the basis for diet orders and for planning modified diets. Copies of the diet manual shall be available at each nursing station and in the dietetic service area.
(e) Therapeutic diets shall be provided as prescribed by a person lawfully authorized to give such an order and shall be planned, prepared and served with supervision and/or consultation from the dietitian. Persons responsible for therapeutic diets shall have sufficient knowledge of food values to make appropriate substitutions when necessary.
(f) A current profile card shall be maintained for each patient indicating diet, likes, dislikes and other pertinent information concerning the patient's dietary needs.
(g) Menus.
(1) Menus for regular and routine modified diets shall be written at least one week in advance, dated and posted in the kitchen at least three days in advance.
(2) If any meal served varies from the planned menu, the change shall be noted in writing on the posted menu in the kitchen.
(3) Menus shall provide a variety of foods in adequate amounts at each meal.
(4) Menus should be planned with consideration for cultural and religious background and food habits of patients.
(5) A copy of the menu as served shall be kept on file for at least 30 days.
(6) Records of food purchased shall be kept available for one year.
(7) Standardized recipes, adjusted to appropriate yield, shall be maintained and used in food preparation.
(h) Food shall be prepared by methods which conserve nutritive value, flavor and appearance. Food shall be served attractively at appropriate temperatures and in a form to meet individual needs.
(i) Nutritional Care.
(1) Nutritional care shall be integrated in the patient care plan.
(2) Observations and information pertinent to dietetic treatment shall be recorded in patient's medical records by the dietitian.
(3) Pertinent dietary records shall be included in patient's transfer discharge record to ensure continuity of nutritional care.
(j) In-service training shall be provided for all dietetic service personnel and a record of subject areas covered, date and duration of each session and attendance lists shall be maintained.
(k) Food Storage.
(1) Food storage areas shall be clean at all times.
(2) Dry or staple items shall be stored at least 30 cm (12 inches) above the floor, in a ventilated room, not subject to sewage or waste water backflow, or contamination by condensation, leakage, rodents or vermin.
(3) All readily perishable foods or beverages capable of supporting rapid and progressive growth of microorganisms which can cause food infections or food intoxication shall be maintained at temperatures of 7 degrees C (45 degrees F) or below, or at 60 degrees C (140 degrees F) or above, at all times, except during necessary periods of preparation and service. Frozen food shall be stored at -18 degrees C (0 degrees F) or below.
(4) There shall be a reliable thermometer in each refrigerator and in storerooms used for perishable food.
(5) Pesticides, other toxic substances and drugs shall not be stored in the kitchen area or in storerooms for food and/or food preparation equipment and utensils.
(6) Soaps, detergents, cleaning compounds or similar substances shall not be stored in food storerooms or food storage areas.
(l) Sanitation.
(1) All kitchens and kitchen areas shall be kept clean, free from litter and rubbish and protected from rodents, roaches, flies and other insects.
(2) All utensils, counters, shelves and equipment shall be kept clean, maintained in good repair and shall be free from breaks, corrosions, open seams, cracks and chipped areas.
(3) Plasticware, china and glassware that is unsightly, unsanitary or hazardous because of chips, cracks or loss of glaze shall be discarded.
(4) Ice which is used in connection with food or drink shall be from a sanitary source and shall be handled and dispensed in a sanitary manner.
(5) Kitchen wastes that are not disposed of by mechanical means shall be kept in leakproof, nonabsorbent, tightly closed containers and shall be disposed of as frequently as necessary to prevent a nuisance or unsightliness.
(m) All utensils used for eating, drinking and in the preparation and serving of food and drink shall be cleaned and disinfected or discarded after each usage.
(1) Gross food particles shall be removed by scraping and prerinsing in running water.
(2) The utensils shall be thoroughly washed in hot water with a minimum temperature of 43 degrees C (110 degrees F), using soap or detergent, rinsed in hot water to remove soap or detergent and disinfected by one of the following methods or an equivalent method approved by the Department:
(A) Immersion for at least two minutes in clean water at 77 degrees C (180 degrees F).
(B) Immersion for at least 30 seconds in clean water at 82 degrees C (180 degrees F).
(C) Immersion in water containing bactericidal chemical as approved by the Department.
(3) After disinfection the utensils shall be allowed to drain and dry in racks or baskets on nonabsorbent surfaces. Drying cloths shall not be used.
(4) Results obtained with dishwashing machines shall be equal to those obtained by the methods outlined above and all dishwashing machines shall meet the requirements contained in Standard No. 3 as amended in April 1965 of the National Sanitation Foundation, P.O. Box 1468, Ann Arbor, MI 48106.
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