Title 22 requires:

1. Condiments are available at each meal unless contraindicated by the diet.

Are the dietary aids placing condiments on the trays? If condiments are provided in containers on the tray carts, are the CNAs offering condiments when they deliver trays?

2. Recipes for all items that are prepared for regular and therapeutic diets shall be available and used.

 

Look for the current week's recipe binder in use during food preparation. Are there recipes or instructions for how to prepare the therapeutic diet food items and mechanically altered foods?

3. Food is served with appropriate eating utensils.

 

Does every resident receive a full place setting? Does the puree diet tray receive at least 2 spoons and even a fork and knife if desired?

4. A current profile card is maintained with diet order, likes, and dislikes, allergies to foods, diagnosis and special information for food served to each individual resident.

 

Ask to see the cardex, computerized profile cards, rand files, etc. and check that all information required is present. Are assistive devices listed, instructions for bag lunches for dialysis, supplements ordered with meals, etc. If tray cards are lost, or computers down, there should be sufficient information in the profile card to make an accurate tray card.

5. All menus are approved by the dietitian.

 

Does each page and week of the menu have RD signature? If the menu has been changed for a special event, facility preference, or to rotate emergency food supplies, has the menu been signed and approved by the RD and therapeutic diets extended on the menu?

6. Menus are planned with consideration of cultural background and food habits of patients.

 

Has the facility adjusted menus for the cultural and ethnic preferences of residents?

7. If a meal served varies from the planned menu, the change and reason for the change is noted on the posted menu in the kitchen.

 

Review the menus in the kitchen and ask cooks and dietary manager if everything on the menu is being served, look in the refrigerators for the foods per menu for the day's meals. Ask if substitutions are being written on the menu or if a menu substitution log is used. Monitor for over-use of menu substitutions.

8. Menus shall be revised quarterly.

 

Ask if there is a dining committee and resident council reviewing menus at least quarterly and implementing resident choices. Recommend the facility keep minutes of each meeting and a log of all menu revisions. Date and sign and approve by RD each time revisions are implemented.  

9. Menus shall be adjusted to include seasonal commodities.
 

Are the fresh fruits and vegetables being adjusted to seasonal availability? Review menus and observe meal service for use of fresh/seasonal foods. If canned or frozen is used when menu states fresh, find out why, and discuss choices with the dietary manager.

 

10. A copy of the menu as served is kept on file for at least 30 days.
 

Ask to see the filed menus for the last 30 days. Are the changes and substitutes written, dated and signed and reasons for changes included? Or are substitute logs filed with the dated menus?

 

11. Itemized records of food purchases are kept for one year.

Check grocery vendor receipts/invoices and ask if 1 year is kept on file or available to print from the online order history.

Click here to view Title 22 regulations for Dietary departments.