| (a) A center must adopt and enforce written policy
and procedures to ensure that a minor, while at the center, receives:
(1) a nourishing, well-balanced diet as recommended
by the American Academy of Pediatrics or Food and Nutrition Board
of the National Research Council, National Academy of Sciences; or
(2) a diet ordered by a minor's prescribing physician.
(b) If a minor's meals and snacks are supplied by an
adult minor or a minor's parent, the center's written policy and procedures
must:
(1) include a written signed agreement between the
center and the adult minor or minor's parent that includes:
(A) a statement that the adult minor or minor's parent
is responsible for providing the appropriate meals and snacks for
the minor in accordance with this section;
(B) the responsibilities of the center and the responsibilities
of the adult minor or minor's parent concerning the provision of meals
and snacks; and
(C) actions that may be taken by the center if the
adult minor or minor's parent fails to provide meals and snacks for
the minor as agreed;
(2) describe the actions that will occur if an adult
minor or minor's parent fails to provide the minor's meals and snacks
or fails to provide meals and snacks in accordance with the minor's
prescribed diet, which must include that the center ensures that the
minor receives the meals and snacks as required in this section while
at the center; and
(3) ensure an adult minor or minor's parent receives
nutritional counseling as described in §15.5101 of this division
(relating to Nutritional Counseling).
(c) If the center provides meals and snacks directly
or under contract, the center must employ or contract with a dietitian
as described in §15.411(b) of this subchapter (relating to Rehabilitative
and Ancillary Professional Staff and Qualifications).
(1) The dietitian is responsible for the overall operation
of the dietary service.
(2) The dietitian must participate in regular conferences
with the administrator and nursing director to provide information
about approaches to identified nutritional problems.
(3) The dietitian must participate in the development
of dietary support staff policies.
(4) The center must employ sufficient dietary support
staff who meet the qualifications to carry out the functions of the
dietary service.
(5) The dietitian must ensure that a minor has a diet:
(A) that meets the daily nutritional and special dietary
needs of a minor, based upon the acuity and clinical needs of a minor;
or
(B) as prescribed by a minor's prescribing physician.
(6) The dietitian is required to review a minor's plan
of care for any known food allergy and special diet ordered by a
minor's prescribing physician as often as necessary for changes to
a minor's dietary needs.
(d) If a center provides meals and snacks directly
or under contract:
(1) a dietitian must develop a menu that:
(A) is prepared at least one week in advance;
(B) is written for each type of diet; and
(C) varies from week to week, taking the general age-group
of minors into consideration;
(2) the center must post the current week's menu in
a conspicuous location so an adult minor and a minor's parent may
see it; and
(3) the center must retain menus for 30 days.
(e) If a center provides meals and snacks directly,
the center must retain records of menus served and food purchased
for 30 days. The center must keep a list of minors receiving special
diets and a record of the diets in the minors' medical records for
at least 30 days.
(f) The center must:
(1) provide tables that allow minors to eat together
when possible;
(2) provide assistance to minors, as needed;
(3) serve food on appropriate tableware; and
(4) ensure clean napkins, bibs, dishes, and utensils
are available for each use.
(g) A center must coordinate with an adult minor or
a minor's parent to ensure special eating equipment and utensils
are available for a minor at the center if needed.
(h) An identification system, such as tray cards, must
be available to ensure that all food is served in accordance with
a minor's diet.
(i) A center must monitor and record food intake of
all minors as follows.
(1) Deviations from normal food and fluid intake must
be recorded in a minor's medical record.
(2) In-between meal snacks, and supplementary feedings,
either as a part of the overall plan of care or as ordered by a minor's
prescribing physician, including special diets, must be documented
using professional practice standards.
(j) The center must serve a minor meals and snacks
as specified in this section and as outlined in a minor's plan of
care.
(1) If breakfast is served, a morning snack is not
required.
(2) Notwithstanding the provisions of this section,
a minor must not go more than three hours without a meal or snack
being offered, unless a minor is sleeping.
(3) The center must offer at least one snack to a minor
who is served at the center for less than four hours.
(4) The center must offer one meal, or one meal and
one snack, equal to one third of a minor's daily food needs to a minor
who is served at the center for four to seven hours.
(5) The center must offer two meals and one snack,
or two snacks and one meal, equal to one half of a minor's daily
food needs to a minor who is served at the center for more than seven
hours.
(6) The center must ensure that a supply of drinking
water is always available to each minor and is served at every snack,
mealtime, and after active play.
(k) The center must:
(1) purchase food from sources approved or considered
satisfactory by federal, state, and local authorities;
(2) store, prepare, and serve food under sanitary conditions,
as required by the Department of State Health Services food service
sanitation requirements; and
(3) dispose of garbage and refuse properly.
(l) The center must provide safe and proper storage
and service of a minor's meals and snacks provided by an adult minor
and minor's parent.
(m) Dietary service staff must be in good health and
practice hygienic food-handling techniques. Staff with symptoms of
communicable diseases or open, infected wounds may not work at the
center until the center receives written documentation from a health
care professional that the staff member is released to return to work
or, the signs and symptoms which relate to the communicable disease
are no longer evident.
(n) Dietary service staff must wear clean, washable
garments, wear hair coverings or clean caps, and have clean hands
and fingernails.
(o) Routine health examinations must meet all local,
state, and federal codes for food service staff.
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| Source Note: The provisions of this §550.511 adopted to be effective September 1, 2014, 39 TexReg 6569; transferred effective May 1, 2019, as published in the Texas Register April 12, 2019, 44 TexReg 1875 |
