481—57.21 (135C) Dietary.
	 57.21(1) Dietary staffing.
	  a.   	 In facilities licensed for over 15 beds, persons in charge of meal planning and food preparation shall complete the home study course on sanitation and food preparation offered by the department. (III)
	  b.   	 In facilities licensed for over 15 beds, food service personnel shall be on duty during a 12-hour span extending from the preparation of breakfast through supper. (III)
	  c.   	 There shall be written work schedules and time schedules covering each type of job in the food service department. These work and time schedules shall be posted or kept in a notebook which is available for use in the food service area in facilities over 15 beds. (III)
	 57.21(2) Nutrition and menu planning.
	  a.   	 Menus shall be planned and followed to meet nutritional needs of residents in accordance with the physician’s orders. (II)
	  b.   	 Menus shall be planned and served to include foods and amounts necessary to meet the recommended daily dietary allowances of the Food and Nutrition Board of the National Research Council, National Academy of Sciences. (II) Recommended daily dietary allowances are:
	 (1) 	 Milk - two or more cups served as beverage or used in cooking;
	 (2) 	 Meat group - two or more servings of meat, fish, poultry, eggs, cheese or equivalent; at least four to five ounces edible portion per day;
	 (3) 	 Vegetable and fruit group - four or more servings (two cups). This shall include a citrus fruit or other fruit and vegetable important for vitamin C daily, a dark green or deep yellow vegetable for vitamin A at least every other day, and other fruits and vegetables, including potatoes;
	 (4) 	 Bread and cereal group - four or more servings of whole-grain, enriched or restored;
	 (5) 	 Foods other than those listed will usually be included to meet daily energy requirements (calories) to add to the total nutrients and variety of meals.
	  c.   	 At least three meals or their equivalent shall be served daily, at regular hours. (II)
	 (1) 	 There shall be no more than a 14-hour span between substantial evening meal and breakfast. (II, III)
	 (2) 	 To the extent medically possible, bedtime nourishments shall be offered routinely to all residents. Special nourishments shall be available when ordered by physician. (II, III)
	  d.   	 Menus shall include a variety of foods prepared in various ways. The same menu shall not be repeated on the same day of the following week. (III)
	  e.   	 Menus shall be written at least one week in advance. The current menu shall be located in an accessible place in the dietetic service department for easy use by persons purchasing, preparing, and serving food. (III)
	  f.   	 Records of menus as served shall be filed and maintained for 30 days and shall be available for review by departmental personnel. When substitutions are necessary, they shall be of similar nutritive value and recorded on the menu or in a notebook. (III)
	  g.   	 A file of tested recipes adjusted to the number of people to be fed in the facility shall be maintained. (III)
	 57.21(3) Dietary storage, food preparation, and service.
	  a.   	 All food and drink shall be clean, wholesome, free from spoilage, and safe for human consumption. (II, III)
	  b.   	 The use of foods from salvaged, damaged, or unlabeled containers shall be prohibited. (III)
	  c.   	 All perishable or potentially hazardous food shall be stored at safe temperatures of 45°F (7°C) or below, or 140°F (60°C) or above. (III)
	  d.   	 No perishable food shall be allowed to stand at room temperature any longer than is required to prepare and serve. (III)
	  e.   	 Supplies of staple foods for a minimum of a one-week period and of perishable foods for a minimum of a two-day period shall be maintained on the premises. Minimum food portion requirements for a low-cost plan shall conform to information supplied by the nutrition section of the department of health. (II, III)
	  f.   	 Table service shall be attractive. Dishes shall be free of cracks, chips, and stains. (III)
	  g.   	 If family-style service is used, all leftover prepared food that has been on the table shall be properly handled. (III)
	  h.   	 Poisonous compounds shall not be kept in food storage or preparation areas. (II)
	 57.21(4) Sanitation in food preparation area.
	  a.   	 “Food Service Sanitation Manual”, revised 1976, U.S. Department of Health, Education, and Welfare, Public Health Service, U.S. Government Printing Office, Washington, D.C., shall be used as the established, nationally recognized reference for establishing and determining satisfactory compliance with food service sanitation.
	  b.   	 Residents shall not be allowed in the food preparation area. (III)
	  c.   	 In facilities licensed for over 15 beds, the kitchen shall not be used for serving meals to residents, food service personnel, or other staff. (III)
	  d.   	 All foods, while being stored, prepared, displayed, served, or transported shall be protected against contamination from dust, flies, rodents, and other vermin. (II, III)
	  e.   	 Food shall be protected from unclean utensils and worn surfaces, unnecessary handling, coughs and sneezes, flooding, drainage, and overhead leakage. (II, III)
	  f.   	 All appliances and work areas shall be kept clean. (III)
	  g.   	 There shall be written procedures established for cleaning all work and serving areas in facilities over 15 beds. (III)
	  h.   	 A schedule for duties to be performed daily shall be posted in each food area. (III)
	  i.   	 All cooking equipment in facilities of 15 or more beds shall be provided with a properly sized exhaust system and hood to eliminate excess heat, moisture, and odors from the kitchen. (III)
	  j.   	 Spillage and breakage shall be cleaned up immediately. (III)
	  k.   	 All garbage not mechanically disposed of shall be kept in nonabsorbent, cleanable containers pending disposal. All filled containers shall be covered and stored in a sanitary manner. (III)
	  l.   	 The food service area shall be located so it will not be used as a passageway by residents, guests, or nonfood service staff. (III)
	  m.   	 The walls, ceilings, and floors of all rooms in which food is prepared and served shall be in good repair, smooth, washable, and shall be kept clean. (III)
	  n.   	 There shall be no washing, ironing, sorting or folding of laundry in the food service area. Dirty linen shall not be carried through the food service area unless it is in sealed, leakproof containers. (III)
	  o.   	 Ice shall be stored and handled in such a manner as to prevent contamination. Ice scoops should be sanitized daily and kept in a clean container. (III)
	  p.   	 There shall be no animals or birds in the food preparation area. (III)
	  q.   	 No dishes or cooking utensils shall be towel dried. (III)
	  r.   	 In facilities over 15 beds, a mechanical dishwasher is required. (III)
	  s.   	 If there is a dishwashing machine, it must provide a wash temperature of 140°F (60°C) to 160°F (71°C) and a rinse temperature of 170°F (76°C) to 180°F (82°C). In a freestanding residential care facility licensed for 15 or fewer beds, a wash and rinse temperature of 140°F (60°C) to 160°F (71°C) shall be acceptable. (III)
	  t.   	 A three-compartment pot and pan sink with 110°F (43°C) to 115°F (46°C) water for washing, a compartment for rinsing with water at 170°F (76°C) to 180°F (82°C) for sanitizing with space for air drying, or a two-compartment sink with access to a mechanical dishwasher for sanitizing all utensils shall be provided. (III)
	  u.   	 All dishes, silverware, and cooking utensils shall be stored above the floor in a sanitary manner, in a clean, dry place protected from flies, splashes, dust, and other contaminants. (III)
	  v.   	 Procedures for washing and handling dishes shall be followed in order to protect the welfare of the residents and employees. Persons handling dirty dishes shall not handle clean dishes without washing their hands. (III)
	  w.   	 Dishes, silverware, and cooking utensils shall be properly cleaned by prerinsing or scraping, washing, sanitizing, and air-drying. (III)
	 57.21(5) Hygiene of food service personnel.
	  a.   	 Food service personnel shall be free of communicable diseases and practice hygienic food-handling techniques. In the event food service employees are assigned duties outside the dietetic service, these duties shall not interfere with sanitation, safety, or time required for dietetic work assignments. Personnel recovering from a diagnosed intestinal infection shall submit a report from their physician showing freedom from infection before returning to work in the food service department. (II, III)
	  b.   	 Employees shall wear clean, washable uniforms that are not used for duties outside the food service area. (III)
	  c.   	 Hairnets shall be worn by all food service personnel. Individuals with beards shall provide for total enclosure of facial hair. (III)
	  d.   	 Clean aprons and hairnets shall be available for use by other personnel in emergency situations. (III)
	  e.   	 Persons handling food shall be knowledgeable of good hand-washing techniques. A hand-wash sink shall be provided in or adjacent to the food service area. Continuous on-the-job training on sanitation shall be encouraged. (III)
	  f.   	 The use of tobacco shall be prohibited in the kitchen. (III)
	 57.21(6) Food and drink. All food and drink consumed within the facility shall be clean and wholesome and comply with local ordinances and applicable provisions of state and federal laws. (II, III)