Section 483.480 - Condition of participation: Dietetic services(a)Standard: Food and nutrition services.(1) Each client must receive a nourishing, well-balanced diet including modified and specially-prescribed diets.(2) A qualified dietitian must be employed either full-time, part-time, or on a consultant basis at the facility's discretion.(3) If a qualified dietitian is not employed full-time, the facility must designate a person to serve as the director of food services.(4) The client's interdisciplinary team, including a qualified dietitian and physician, must prescribe all modified and special diets including those used as a part of a program to manage inappropriate client behavior.(5) Foods proposed for use as a primary reinforcement of adaptive behavior are evaluated in light of the client's nutritional status and needs.(6) Unless otherwise specified by medical needs, the diet must be prepared at least in accordance with the latest edition of the recommended dietary allowances of the Food and Nutrition Board of the National Research Council, National Academy of Sciences, adjusted for age, sex, disability and activity.(b)Standard: Meal services.(1) Each client must receive at least three meals daily, at regular times comparable to normal mealtimes in the community with-(i) Not more than 14 hours between a substantial evening meal and breakfast of the following day, except on weekends and holidays when a nourishing snack is provided at bedtime, 16 hours may elapse between a substantial evening meal and breakfast; and(ii) Not less than 10 hours between breakfast and the evening meal of the same day, except as provided under paragraph (b)(1)(i) of this section.(2) Food must be served- (i) In appropriate quantity;(ii) At appropriate temperature;(iii) In a form consistent with the developmental level of the client; and(iv) With appropriate utensils.(3) Food served to clients individually and uneaten must be discarded.(c)Standard: Menus.(1) Menus must- (i) Be prepared in advance;(ii) Provide a variety of foods at each meal;(iii) Be different for the same days of each week and adjusted for seasonal changes; and(iv) Include the average portion sizes for menu items.(2) Menus for food actually served must be kept on file for 30 days.(d)Standard: Dining areas and service. The facility must-(1) Serve meals for all clients, including persons with ambulation deficits, in dining areas, unless otherwise specified by the interdisciplinary team or a physician;(2) Provide table service for all clients who can and will eat at a table, including clients in wheelchairs;(3) Equip areas with tables, chairs, eating utensils, and dishes designed to meet the developmental needs of each client;(4) Supervise and staff dining rooms adequately to direct self-help dining procedure, to assure that each client receives enough food and to assure that each client eats in a manner consistent with his or her developmental level: and(5) Ensure that each client eats in an upright position, unless otherwise specified by the interdisciplinary team or a physician.