Ala. Admin. Code r. 420-5-17-.19

Current through Register Vol. 43, No. 02, November 27, 2024

Section 420-5-17-.19 - Dietetic Services

Those facilities located within a hospital or nursing home shall meet the dietary licensure requirements of that facility. In the inpatient hospice classified as a health care-limited care facility, the provision of dietary services shall comply with the following:

(1)Staffing. A consulting qualified dietitian is available to assist in nutritional assessment menu planning, inservicing staff and evaluating safe food production. This information shall be included in the quality assurance program. A facility which does not provide the services of a certified dietary manager must, as a minimum, train all employees through the county health departments' food managers training course or a comparable course.

(a) If consultant dietetic services are used, the consultant's visits are at appropriate times and of sufficient duration and frequency based upon the size and needs of the hospice to provide continuing liaison with medical and nursing staffs, advice to the manager, patient counseling, guidance to the supervisor and staff of dietetic service, approval of all menus, and participation in development or revision of dietetic policies and procedures and in planning and conducting inservice education programs.

(b) The hospice employees sufficient supportive dietetic personnel competent to provide a hygienic dietary service that meets the daily nutritional and special dietary needs of patients, and provides palatable and attractive meals.

(2)Preparation and Service of Food. Foods are prepared by methods that conserve nutritive value, flavor, and appearance and are attractively served. Prepared food is maintained on the serving line at 140 degree F. Cold food, particularly susceptible food such as milk, etc., shall be maintained at less than 45 degree F. at serving. If a patient refuses food served, appropriate substitutes of similar nutritive value are offered during that meal.

(a) If patients require assistance in eating, food shall be maintained at 100 degree F. serving temperature until assistance is provided.

(b) Dietetic service personnel shall practice hygienic food handling techniques.

(c) Employees engaged in the handling, preparation, and serving of food shall:

1. Wear clean clothing at all times.

2. Shall have hair appropriately covered with hair nets or caps.

3. Wash their hands thoroughly before starting work each day, immediately after contact with any soiled matter, immediately after working with raw meats, and before returning to work after leaving the work area. Personnel with infections, or open cuts may not handle foods.

(d) Food service employees shall not be assigned duties outside the dietetic service that interfere with the sanitation, safety, or time required for dietetic work assignments.

(e) There shall be no use of tobacco products in the dietary department.

(f) The public, patients, and employees shall be allowed to eat or smoke only in designated areas.

(3)Sanitary Conditions. Food is procured from sources approved or considered satisfactory by state authorities and stored, prepared, distributed, and served under sanitary conditions. Waste is disposed of properly, i.e., kitchen garbage and trash shall be placed in containers with tight fitting lids and stored in a screened or refrigerated space pending removal. Kitchen garbage and trash shall not be allowed to accumulate in the kitchen and shall be removed from the premises at frequent intervals. After emptying, all soiled garbage and trash cans shall be washed thoroughly inside and out and dried before reuse.

(a)Protection from contamination. All foods and food ingredients shall be so packaged, stored, handled and served as to be protected from dust, flies, roaches, rats, unsanitary handling, droplet infection, overhead leakage, sewage backflow, and any other contamination. Sugar, syrup and condiment receptacles shall be provided with tight fitting lids, and shall be kept covered when not in use. Refrigerated food shall be covered, labeled and dated. All foods removed from original container shall be properly protected and labeled.

(b)Ice. All ice used in the inpatient hospice shall be made of water obtained from a source approved by the State Board of Health. Ice shall be protected from splash, drip, and hand contamination during storage and service. All ice shall be free of visible trash and sediment. Ice scoops shall be stored in a manner so as to protect them from becoming soiled or contaminated between usage.

(c) Families are allowed to store home cooked food for their patient. This storage shall be readily available and meet the same standards as foods prepared by the hospice. Food brought from home will not be commingled with the food prepared for other patients.

(4)Storage and Service of and Ice Cream. All milk and fluid milk products shall be served only from the original containers in which they were received from the distributor provided, however, that this shall not apply to cream for coffee, cereals, and milk mixed drinks which may be dispensed from a readily cleanable container approved for such use.

(a) Milk and fluid milk products shall not be stored so that any bottle or container from which the milk or milk products is to be poured or consumed may become submerged in water, or so that their tops may become contaminated from drip or contact with foods, ice, etc.

(b) All purchased ice cream and other frozen desserts shall be from an approved source. No contaminating substance shall be stored with or over containers of ice cream. Ice cream dippers, spatulas, etc., shall be stored between uses in clean running water in a sanitary manner.

(c) Equipment used for dispensing or storage of ice cream or other frozen desserts shall be thoroughly cleaned following each use.

(d) Raw eggs shall not be served.

(e) Dry milk powder may be used in cooked products or special formulas. Milk made from dry milk powder shall not be served as a beverage.

(5)Physical Facilities. Location and space requirements. Food service facilities shall be located in a specifically designated area and shall include the following rooms and/or spaces: kitchen, dishwashing, food storage and dining room.

(a) Kitchen.

1. Size and dimensions. The kitchen shall be of such size and dimensions as to:

(i) Permit orderly and sanitary handling and processing of food.

(ii) Avoid overcrowding and congestion of operations.

(iii) Provide at least 3 feet between working areas. Such space shall be wider than 3 feet if it is used as a passageway.

(iv) Provide a ceiling height of at least 8 feet.

2. Equipment. As a minimum, the kitchen shall have the following:

(i) Range. Facilities classified as large shall have a heavy duty, institutional type range.

(ii) Refrigeration. Facilities classified as large shall provide institutional or commercial type refrigeration. But in no case shall space be less than 2 cubic feet per bed for refrigerated space. Freezer space shall, as a minimum, be provided at a rate of 1 cubic foot per bed of frozen food storage. Each unit shall be supplied with a thermometer.

(iii) Stainless steel cooking and baking counter or table.

(iv) Commercial type dishwashing machine, with clean dish counter and soiled dish counter.

(v) Ice machine/maker.

(vi) Fire extinguisher, 10 lb. carbon dioxide or other type approved by local or state fire marshal.

(vii) Rack, pots and pans.

(viii) Three-compartment sink with rinsing compartments equipped to maintain supplied water at a minimum of 180 degree F.

(ix) Containers for flour, sugar, coffee, tea, etc.

(x) Garbage cans with tight-fitting covers.

(xi) Coffee maker.

(xii) Storage space for silverware and cutlery.

(xiii) Pots, pans, silverware, dishes, etc.

(xiv) Clock.

(xv) Separate sink for meat and vegetable preparation.

(xvi) Food mixers.

(xvii) Adequate storage space.

(xviii) Tray set up facilities, adequate to maintain food at proper temperatures (hot foods 140 degree F. or greater - cold foods 45 degree or below).

(xix) Storage for tray set up utensils (dishes, table flatware, trays, etc.).

(xx) Blender.

(b) Food storage. A well-ventilated, food storage room or pantry shall be provided. Adequate shelving, bins, suitable cans, and/or raised platforms shall be performed. Perishable food shall be stored at least 4 inches above the floor. The storage room shall be of such construction as to prevent the invasion of rodents and insects, the seepage of dust and water leakage, or any other source of contamination.

(c) Water heating equipment. Facilities for heating an ample supply of water, with adequate pressure, for all washing purposes shall be provided. Equipment shall be capable of heating water to a temperature of not less than 180 degree F.

(d) Floors. Floors in food service areas shall be of such construction as to be easily cleaned, sound, smooth, nonabsorbent, without cracks or crevices, and shall be kept in good repair. Painted concrete floors are not acceptable. Where wet cleaning methods are employed, the floors shall be provided with approved and conveniently located facilities for the disposal of floor wash water.

(e) Walls and ceilings. Walls and ceilings of food service area shall be of tight and substantial construction. The walls and ceilings shall be without horizontal ledges and shall be washable up to the highest level reached by splash and spray. Roofs and walls shall be maintained free of leaks. All openings to the exterior shall be provided with doors or windows which will prevent the entrance of rain or dust during inclement weather.

(f) Screens on outside openings. Openings to the outside shall be effectively screened or suitable provisions made equal to screening. Screen doors shall open outward and shall be equipped with self-closing devices.

(g) Lighting. The kitchen and dining room shall be provided with unobstructed natural light through windows equivalent to not less than 10 percent of the floor area. Artificial light properly distributed and of an intensity of not less than 50 foot candles shall be provided.

(h) Ventilation. The food service area shall be ventilated in a manner that will maintain comfortable working conditions, remove objectionable odors and fumes, and prevent excessive condensation.

(i) Employee toilet facilities. Toilet facilities shall be provided for employees. Toilet rooms shall not open directly into any room in which food is prepared, stored, displayed, or served, nor into any room in which utensils are washed or stored. Toilet rooms shall include a lavatory, soap dispenser, towel cabinets, hot and cold water, and covered receptacle and shall be well lighted and ventilated.

(j) Hand washing facilities. Hand washing facilities shall be provided in all food production and serving areas. Sinks shall be equipped with a soap dispenser and a supply of soap, disposable towels, covered receptacle, and hot and cold water through a mixing valve or combination faucet. The use of a common towel is prohibited. Hands shall not be washed in sinks where food is prepared.

(k) Refrigeration facilities. Where separate refrigeration can be provided, temperatures for storing perishable foods are: 32 degrees to 38 degrees F. for meats, 40 degrees F. for dairy products, 45 degrees to 50 degrees F. for fruits and vegetables. If it is impractical to provide separate refrigeration, the temperature shall be maintained at 38 degrees to 45 degrees F.

(l) Equipment and utensil construction. Equipment and utensils, except single service utensils, shall be so constructed as to be easily cleaned and shall be kept in good repair. No cadmium plated, lead, or readily corrodible utensils or equipment shall be used.

(m) Separation of kitchen from patient room and sleeping quarters. Any room used for sleeping quarters shall be separated from the food service area by a solid wall without communicating openings. Sleeping accommodations, such as a cot, bed, or couch, shall not be permitted within the food service area.

(6)Food handling procedures.

(a) Floors, walls, and ceilings of all rooms in the food service area shall be free of an accumulation of rubbish, dust, grease, dirt, insects, etc.

(b) All equipment within the food service area shall be clean and free from dust, grease, and dirt, etc.

(c) Tables and counters upon which food is served shall be kept clean. Tablecloths, if used, shall be clean. Cloth napkins shall be laundered after each use. Cloths used for wiping tables, counters, fountains, etc., shall be kept in a sanitizing solution between uses.

(d) All repeated service utensils shall be thoroughly cleaned after each use. Single service utensils shall be used only once. All multi-use utensils shall be thoroughly cleaned following each use or meal period. Multi-use utensils used for storage shall be thoroughly cleaned when emptied, or more often if necessary.

(e) Dishes and utensils washing, disinfection and storage.

1. Dishwashing water shall be changed with sufficient frequency to avoid contamination. Final rinse water of a minimum of 180 degree F. shall be kept clean and clear.

2. All repeated service and multi-service utensils and dishes, after washing and rinsing, shall be sanitized by:

(i) Immersion for at least one-half minute in clean, hot water at a temperature of at least 180 degree F.; or

(ii) Immersion for at least one minute in a clean solution at least 50 parts per million of chlorine and at a temperature of at least 75 degree F.; or

(iii) Immersion for at least one minute in a clean solution containing at least 12.5 parts per million of available iodine, pH not higher than 5.0, and at a temperature of at least 75 degree F.; or

(iv) Other methods approved by the State Board of Health.

3. If properly maintained, 180 degree F. dishwashers may be used for the cleaning of multi-use utensils. Procedures that must be followed for acceptable results include:

(i) Adequate scraping of utensils.

(ii) Monitoring of predetermined temperature.

(iii) Maintaining clean equipment.

(iv) Residue-free solutions.

(v) Monitoring of cleaning and germicidal solutions in the low temperature process (the concentration of chemical in the rinse spray shall be maintained at least 50 ppm or as recommended by the manufacturer of the chemical).

(vi) Thoroughly air drying the cleaned utensils.

4. After washing, rinsing, disinfecting, and drying, all repeated service and multi-use utensils and dishes shall be stored in a clean place that is dry, protected from flies, roaches, dust, splash and other contamination from hands and clothing.

5. All unused single service utensils shall be stored in the same manner as repeated service utensils.

Author: Jimmy D. Prince

Ala. Admin. Code r. 420-5-17-.19

New Rule: Filed August 20, 1993; effective September 23, 1993. Repealed and New Rule: Filed June 14, 2000; effective July 19, 2000.

Statutory Authority:Codeof Ala. 1975, §§ 22-21-20, etseq.