Interpretive Guidelines Nutrition programs (C1, C2 & NSIP meals) COMPLIANCE REQUIREMENT INTERPRETIVE GUIDELINES VERIFICATION ACTIVITIES NUTRITION

Transcription

1 Interpretive Guidelines Nutrition programs (C1, C2 & NSIP meals) COMPLIANCE REQUIREMENT INTERPRETIVE GUIDELINES VERIFICATION ACTIVITIES Congregate nutrition service providers shall serve an annual average of at least one hundred meals per day, five days or more per week within the designated service area. AAA approved exceptions for rural or sparsely populated areas include provision of: 1. Less than 100 meals per day 2. Meals at least five days per week at sites throughout the service area, but not necessarily five days a week at each site. The AAA contracts with nutrition providers that serve an average of one hundred meals per day for at least five days per week, waiving average number of meal requirement only for providers in sparsely populated or rural areas, and waiving the five days per week requirement only when other providers within the county can supplement to meet the 5-day county-wide requirement. Review documentation of nutrition providers for evidence that congregate sites meet the requirement. Providers may develop menus using either the component meal pattern or the computer assisted nutrient analysis method. The computer assisted nutrient analysis method ensures target nutrients are served in accordance with current nutritional standards, while also allowing menu component flexibility. This method is encouraged for programs that serve a unique ethnic or cultural group. The computer assisted nutrient analysis method is preferred by DOEA because it permits menu development that more closely represents typical elderly eating patterns and can accommodate non-traditional menus. Dietary supplements including but not limited to Vitamin, mineral, or dietary supplements shall not be included in menus under any circumstance or situation. and Notice of Instruction, # I-SWCBS Potentially hazardous foods, shall be held and transported in a method that ensures hot food temperatures are 140 degrees Fahrenheit or higher, and cold food temperatures are 41 degrees Fahrenheit or lower (Chapter 64E-11, Florida Administrative Code). The Nutrition Program s Qualified Dietitian must approve menu substitutions prior to substitution... Substitution documentation must include but is not limited to the following: The AAA ensures providers menus follow the meal pattern established in Notice of Instruction, # I-SWCBS (and outlined in the Program and Services Handbook) or computer-assisted analysis is conducted to ensure each meal, at minimum, provides of 33 1/3 percent of the Dietary Reference Intakes/ Adequate Intakes (DRIs/AIs). Dietary supplements shall not be served or included in the nutrient analysis. Computer assisted nutrient analysis shall be conducted for menus not following, or deviating from, the component meal pattern. The AAA reviews daily temperature logs, assures through direct monitoring or through on-site temperature verification that hot food temperatures are 140 degrees Fahrenheit or higher, and cold food temperatures are 41 degrees Fahrenheit or lower. A list of appropriate alternate menu items is developed and signed by a qualified dietician (other than the caterer s), prior to being used. Nutrition substitutions are logged, justified, and kept to a minimum by proper Review menus and nutrient analysis or component meal pattern to determine compliance.. Confirm through a review of documentation (e. g. temperature logs, meal-site checklists, monitoring checklist or report) and interviews that transported foods comply with the temperature requirements. Review of documentation that menu substitutions had prior to use approval by Qualified Dietitian and contained the necessary information

2 Date of substitution, the original menu item, the substitution made, the reason for the substitution and the signature of the employee authorizing the substitution. Finally, the volume and frequency of substitutions must be justified by the reasons provided.. planning. Menu Substitutions must follow Nutrition Program s qualified dietitian s menu substitutions list. Temperature checks shall be taken, and documented, on a daily basis. Thermometers must be correctly calibrated at least weekly, to ensure accuracy. Temperatures must be taken at the following times: If a Nutrition provider prepares the meals a sample temperature must be taken and recorded when the food is leaving the production area, when the food is received by the nutrition site and at the time the meal is served. Thermometers must be clean and sanitized between uses. Congregate Sites shall be neat and clean, have adequate lighting and ventilation and adhere to the applicable food safety and hygiene regulations outlined in Chapter 381, Florida Statutes and Chapter 64E-11, Florida Administrative Code. Nutrition Each nutrition service provider shall obtain the advice of a licensed (or licensed and registered) dietitian. Nutrition counseling is provided for clients that have high-risk nutritional score (any score higher than 5.5 on the assessment tool) or may be identified through a screening/intake process, by self-referral, or by referral from a caregiver or other concerned party. A written or oral diet order from the client s physician shall be on file prior to providing nutritional counseling. In the event the licensed dietitian is unable to obtain written or oral authorization from the physician, the licensed dietitian may use Daily temperature checks are taken with a calibrated thermometer at the appropriate times. Congregate Meal sites are in compliance with sanitation and food safety requirements Each nutrition provider obtains the services of a Qualified Dietitian (not the caterer s dietician) either through employment or written contract. The initial counseling session, to the extent possible, must be face-to-face and comply with the requirements. Review selected temperature logs to confirm that temperatures are recorded correctly and comply with hot and cold temperature requirements. Verify throughmonitoring reports, staff inquiries, and/or site visits that sites utilize the required proper food safety and hygiene regulations. Review qualified dietitian s credentials. (Minimum qualification is for a dietitian to be licensed in the state of Florida. License may be verified at Floridahealth.com.) Review Qualified Dietitian s contract (if applicable) and malpractice insurance. Review documentation ensuring counseling provided is in accordance with requirements. Documentation may include doctors orders, client files, nutrition assessment, the nutrition care plan, dietary orders, nutrition advice, progress notes, and recommendations related to the client s health or the client s food or supplement intake, or

3 professional discretion in providing nutrition counseling. This service must be provided by a Florida Licensed Dietitian (IAW FAC Chapter 64B8-43). Any qualified dietitian providing nutrition counseling should be covered by malpractice insurance. Nutrition counseling shall consist of individualized advice and guidance to persons.a Qualified Dietitian or a registered dietetic technician under the supervision of a Qualified Dietitian evaluates the clients nutritional needs, conducts a comprehensive nutrition assessment, and develops a nutrition care plan in accordance with Chapter 64-B8-43, Florida Administrative Code. any client examination or test results. Responsibilities of the Dietitian/Nutritionist include, but are not limited to monitoring of Food Service, training staff and volunteers in areas of nutrition, food service management, and sanitation, assist in developing participant s satisfaction surveys, coordinating nutrition education, providing nutritional counseling developing food and menu standards for food service contract; and reviewing and approving menus and menu substitutions. Assist in the development of menus with the advisory council. A registered dietetic technician may assist the qualified dietitian in the screening and assessmsent process. The provider s Qualified Dietitian shall develop a written annual nutrition education plan that documents subject matter, presenters and materials to be used. The AAA, Qualified Dietitian may develop a single educational curriculum, which may be used by multiple sites. Congregate sessions shall be a minimum of 15 minutes in length. Each nutrition service provider shall maintain written documentation, for monitoring purposes that include the date of the presentation, name and title of presenter, lesson plan or curriculum, and number of persons in attendance. The documentation requirement for materials delivered to The AAA ensures that Qualified Dietitian is required to monitor Food Service, provide training (nutrition, food service management and sanitation) to all meal site staff and volunteers, assist in satisfaction survey development, coordinate nutrition education to participants, develop food and menu standards, provide nutritional counseling and review and approve menus and substitutions. A qualified dietitian may have the assistance of a registered dietetic technician in the screening and assessment process... The providers Qualified Dietitian has developed a written annual nutrition plan that documents subject matter and materials used. The AAA Qualified Dietitan may develop a curriculum that may be used at multiple sites. Review documentation such as menus, menu substitutions and written menu substitution policy, volunteer and staff training records, satisfaction surveys, nutrition education session agendas and meeting notes that evidence that the Qualified Dietitian is satisfactorily meeting the requirements. Review nutrition screening documentation and training records to assure that qualified staff performed the screenings. that nutrition education sessions for congregate and home delivered meal clients was provided by a Qualified Dietitian and contains the appropriate requirements.

4 homebound clients shall include the date of distribution, copy of distributed material, and number of clients receiving the information. Nutrition education and related client and health instruction or information is provided, or planned and directed by, or under the direction of, a Qualified dietitian,cooperative extension agents or trained meal site or wellness coordinators, under the direction of the Qualified Dietitian, may provide such education activities. Nutrition education is provided at each site and distributed to each home delivered meal client a minimum of once a month. The providers Qualified Dietitian shall develop a written annual nutrition education plan that documents subject matter, presenters and materials to be used. The AAA, Qualified Dietitian may develop a single educational curriculum, which may be used by multiple sites. Congregate sessions shall be a minimum of 15 minutes in length. Each nutrition service provider shall maintain written documentation, for monitoring purposes that include the date of the presentation, name and title of presenter, lesson plan or curriculum, and number of persons in attendance. The documentation requirement for materials delivered to homebound clients shall include the date of distribution, copy of distributed material, and number of clients receiving the information. All food service staff and volunteers must receive semi-annual training on the prevention of food borne illness. Staff and Volunteers must be trained prior to assuming food service assignments. Nutrition education and/or health information is provided at each congregate site and distributed to each congregate and home-delivered meal recipient, as directed or provided by a licensed dietitian. Individuals with comparable expertise or special training may provide nutrition education. A formal program exists which provides Congregate Nutrition Education. Education is provided in a group setting on a regular basis on topics of physical fitness, culturally sensitive nutrition, and health. A formal program is required for Home Delivered Meal Education that regularly distributes nutrition and health documentation to individuals who receive home delivered meals. Food service staff and volunteers must be trained prior to the start of working in the nutrition programs. All meal site staff and volunteers are trained in the area of nutrition, food service management, and sanitation. Review documentation that formal programs are providing nutrition education at least one time on a monthly basis for those individuals who participate in congregate and home delivered meal programs. Verify that educational programs are provided by qualified individuals such as a licensed dietitian, individuals with comparable expertise or special training (a person with a bachelor s or Master s degree in Home Economics, Family and Consumer Services, Human Sciences with an emphasis in Nutrition or Dietetics). that food staff and volunteers were trained. All food preparation staff must work under the supervision of a Certified Food Protection Manager who ensures the application A Certified Food Protection Manager must supervise

5 all food preparation staff. The manager must maintain that mealsites are supervised by current certification IAW FAC 64E-11, Food Hygiene Codes. of hygienic techniques and practices in food preparation and service. A Certified Food Protection Manager is an individual who has successfully completed a course in accordance with FAC 64E-11, Food Hygiene Codes and sanitation course and maintains a current certificate of completion. a Food Protection Manager who has a current certification IAW FAC 64E-11, Food Hygiene Codes Reference: Notice of Instruction, # I-OVCS,Programs and Services Handbook Programs that do not prepare their own food must have a Certified Food Protection Manager responsible for the storage, display and serving of food for meal sites, but the Certified Food Protection Manager does not have to be present at all times. (Refer FAC 64E-11) New managers must be certified as a Food Protection Manager within 90 days of employment. The AAA may grant an extension up to 180 days. The manager must be present during food service operations. Programs that do not prepare their own food must have a Certified Food Protection Manager responsible for the storage, display and serving of food for meal sites, but the Certified Food Protection Manager does not have to be present at all times. (Refer FAC 64E-11) New managers must be certified as a Food Protection Manager within 90 days of employment. The AAA may grant an extension up to 180 days. Provider shall maintain locally required fire safety and as applicable health meal site inspections documentation, maintain quarterly site inspection documentation using the meal site checklist, maintain daily food temperature logs; and maintain menu substitution lists. The provider utilizes the current monitoring forms. Reference: Home and Community-Based Services Handbook Certified Food Protection Managers must be on staff at meal sites that do not prepare their own food. New site managers must be certified within 90 days of employment or 180 days if the AAA grants an extension. Managers must be present during food service operations. Review documentation such as daily temperature logs, menu substitution lists, meal-site compliance checklists, Public health Department or DBPR inspections, county first inspections, quarterly site inspection reports, and AAA monitoring reports that supports that providers maintain fire safety, inspection documentation. Review documentation that supports that Certified Food Protection Managers are on staff and fulfilling their duties at meal sites that do not prepare food. The AAA is responsible for ensuring meal providers are monitored for fire safety, health inspections (as applicable),that Site Managers are currently certified food protection managers, meal site check list are used and findings are corrected, that daily temperature logs are completed and meal substitution policies are written and adhered. If a client is enrolled in CCE and receives home delivered meals Home delivered meals provided by the CCE program Review documentation that evidences

6 through the CCE program, then the client is subject to the requirements of the CCE program, including co-pay. Thus, the meal provider may not request NSIP reimbursement for the CCE meals. Reference: Notice of Instruction, # I-OVCS are subject to the co-pay requirement of the CCE program. NSIP reimbursement is not allowed for CCE meals. that co-pays were received from CCE provided meals by program participants. Documentation supports that providers neither requested or received NSIP reimbursements for CCE provided meals. -HDM All hot home-delivered meals for the noon meal shall be delivered no earlier than 10:30 a.m. and no later than 2:30 p.m. More than one meal may be delivered each day, provided proper storage and heating facilities are available in the home and the participant is able to consume the second meal independently or with available assistance. All food shall be individually packaged, and transported in secondary insulated food carriers immediately under conditions that will ensure temperature control during delivery and prevent contamination and spillage. Cold and hot food shall be packaged and packed separately. Potentially hazardous foods shall be held and transported in a method that ensures hot food temperatures are 140 degrees Fahrenheit or higher and cold food temperatures are 41 degrees Fahrenheit or lower as defined in Chapter 64E-11, Florida Administrative Code. Each provider shall monitor temperatures of all hot and cold potentially hazardous food items at least quarterly. When meals are delivered frozen to participants, the temperature shall be a maximum of 20 degrees Fahrenheit or the food shall be frozen solid. Reference:Programs and Services Handbook and Nutrition Program Compliance Review Checklist attached to NOI # I-OVCS -HDM Each provider shall monitor temperatures of all hot and cold potentially hazardous food items at least quarterly. Temperature checks shall be done on a random and rotating basis to assure that all food is served at the proper temperature. Whenever temperature noncompliance is identified, weekly temperatures shall be monitored until corrective action has been achieved.. Documentation of these temperature checks shall be maintained by providers and monitored by the area agencies. AAA s ensure through observation and monitoring, and through review of qualified dietitian s reports that meals are packaged separately and that foods are transported in appropriate containers to maintain temperatures within required ranges. AAA s also observe equipment used to transport equipment and confirms provider s delivery times for hot home delivered meals are between 10:30 am and 2:30 pm. AAA or qualified dietitian takes temperatures of food portions of home-delivered meals, noting results. Each provider shall monitor temperatures of all hot and cold potentially hazardous food items at least quarterly.in every county that provides home-delivered meals is required to perform temperature checks at random on a rotating schedule. Providers are required to maintain temperature logs that evidence that temperature checks were performed and document discrepancies in temperature checks that include additional weekly monitoring until problems are resolved. AAA is required to monitor home delivered meal Review materials evidencing home delivered meal providers comply which may include delivery procedures, daily temperature logs, meal-site compliance checklists and AAA monitoring reports. Review documentation such as temperature logs, monitoring reports, and corrective action plans that evidence that providers perform temperature checks and perform additional monitoring as discrepancies arise. Review AAA monitoring reports and corrective action plans to confirm that the AAA monitors temperature compliance for meal providers.

7 COMPLIANCE REQUIREMENT INTERPRETIVE GUIDELINES VERIFICATION ACTIVITIES provider temperature logs. Corrective action plans are documented as necessary for areas of noncompliance. Nutrition providers are required to develop and maintain a record of each client which documents the following eligibility for services: emergency care information, need for and referral to other appropriate services. Providers are responsible for maintaining documentation of each clients eligibility for services, emergency information, and service referral information. that referral for services and emergency care information are maintained for clients. Nutrition providers are required to obtain information related to congregate clients within three days of determination of client status, obtain information related to homebound clients prior to receipt of home delivered meals except in emergency circumstances, establish recording procedures of number of eligible clients served daily promptly submission of reports, provide access to records and reports to authorized representatives. All nutrition providers must establish and maintain a project or site advisory council. The nutrition advisory council shall advise the nutrition program director on all matters relating to the delivery of nutrition services within the program area. All nutrition advisory council recommendations shall be in accord with federal and state policies and take into consideration the nutrition budget. The advisory council shall not function in a policymaking or decision-making capacity. Nutrition providers are required to obtain information regarding congregate and home delivered meal clients. Authorized representatives are to have access to client records. A Project or site advisory council is mandatory for each nutrition provider. The nutrition advisory council provides input on the nutrition programs in accordance with federal and state polices within the constraints of the budget. The advisory council is established for the purpose of advising in the nutrition program. that nutrition providers have the required client records. that a site advisory council is in existence for each nutrition provider. Verify through the review of documentation that the nutrition advisory council provides input to the progam director. Review documentation that supports that no policy or decision-making was carried out by the advisory council.

8 COMPLIANCE REQUIREMENT INTERPRETIVE GUIDELINES VERIFICATION ACTIVITIES Each nutrition provider, in conjunction with the AAA, is responsible for the development and distribution of information regarding services throughout its service area. Providers utilize all appropriate media sources to inform the public about the nutrition program for the elderly. Nutrition providers are responsible for informing the public about the services available in the areas in which they serve. Providers must comply with all policies regarding public notice and confidentiality. that media sources were utilized to inform the public of nutrition programs for the elderly. Public information activities must conform to policies concerning confidentiality and public notice. Nutrition service providers may enter into contracts or subcontracts with profit-making organizations for nutrition services only with prior approval of the AAA. Contracts are executed only for vendors who supply meals from premises that have a valid permit, license, or certificate issued by the appropriate regulatory authority. The service provider complies with all state and local laws, ordinances, and codes for establishments that are preparing, handling, and serving food to clients. The AAA ensures that Title III service providers monitors all subcontractors performance at least once annually during the contract period. Follow up visits for corrective action and quality improvement are made as needed. The AAAs have approved cooperative monitoring of a single food service vendor. The following conditions must be met for cooperative monitoring approval: The service provider agency must have monitored the subcontract at least once in accordance with Chapter 1, Section 3 of the handbook; The AAA monitoring of the service provider shall ensure compliance with Food safety and sanitation and service AAA must give prior approval to nutrition providers to enter into contracts or subcontracts with profit making organizations. Contracts are for vendors who provide meals from a properly licensed business that complies with all local, state regulations concerning the preparation, handling, and service of food to clients. Title III service providers are monitored on an annual basis during the contract year. AAA approval is required for cooperative monitoring of a food service vendor. The AAA must verify that the provider meets the qualifications for cooperative monitoring. that nutrition providers obtained prior approval from the AAA to enter into contracts or subcontracts with profitmaking food providers that are in compliance with state and local laws and other requirements for preparing, handling, and serving food to clients. Review documentation that evidences that the AAA ensures that providers are monitored at least once within the contract year. Documentation of corrective action and quality improvement is evident as necessary. that AAA has approved cooperative monitoring of a food service vendor.

9 standards. COMPLIANCE REQUIREMENT INTERPRETIVE GUIDELINES VERIFICATION ACTIVITIES Monitoring may include all aspects of kitchen management. Including but not limited to: all local and state level health department inspections, meal/menu related invoices, food staff certifications, staff in-service documentation, standardized recipes, standardized recipes to monitor for nutrient compliance; and the individual conducting the food service vendor monitoring shall have demonstrated knowledge of sanitation, food handling, food preparation, and food storage principles, preferably be a Certified Food Protection Manager or a Qualified Dietitian. The written monitoring report and any other report of the cooperative monitoring visit is provided to the AAA. Corrective action plans, if appropriate are required to ensure that deficiencies are remedied. The individual conducting the food service vendor monitoring shall have demonstrated knowledge of sanitation, food handling, food preparation, and food storage principles, preferably be a Certified Food Protection Manager or a Qualified Dietitian. 2. Written Monitoring Report: The written report documenting the monitoring visit and any other reports required by the project will be reviewed by the AAA for validation of the documented services. 3. Corrective Action Plans: The AAA monitor should ensure the accuracy of all reports and require corrective action plans, if appropriate, to ensure that deficiencies are remedied. Food service vendor monitoring is performed by a Qualified Dietitian or a Certified Food Protection Manager. The AAA reviews monitoring reports and other reports required by the project. Corrective action plans are monitored by the AAA to ensure accuracy and appropriateness, and to ensure that deficiencies are remedied. that AAA has reviewed monitoring reports and corrective action plans if necessary for service providers. Documentation evidences that qualified staff performed the monitoring.