(a) A limited services rural hospital (LSRH) shall have organized dietary services that are directed and staffed by adequate qualified personnel.
  (1) An LSRH that has a contract with an outside food management company or an arrangement with another hospital may meet this requirement if the food management company or other hospital:
    (A) has a dietitian who serves the LSRH on a full-time, part-time, or consultant basis;
    (B) maintains at least the minimum requirements specified in this section; and
    (C) provides for the frequent and systematic liaison with the LSRH medical staff for recommendations of dietetic policies affecting patient treatment.
  (2) The LSRH shall ensure that there are sufficient personnel to respond to the dietary needs of the patient population being served.
(b) The LSRH shall employ a full-time staff who is qualified by experience or training to serve as director of the food and dietetic service and is responsible for the daily management of the dietary services. The director shall:
  (1) comply with a job-specific position description;
  (2) clearly delineate responsibility and authority;
  (3) participate in conferences with administration and department heads;
  (4) establish, implement, and enforce policies and procedures for the overall operational components of the LSRH's dietary department that include:
    (A) integration of the food and dietetic service into the LSRH-wide quality assessment and performance improvement program and infection control program;
    (B) the frequency of meals served;
    (C) nonroutine occurrences; and
    (D) identification of patient trays; and
  (5) maintain authority and responsibility for at least the following:
    (A) providing orientation and training;
    (B) evaluating staff performance;
    (C) providing work assignments;
    (D) supervising work and food handling techniques including kitchen sanitation and acceptable hygiene practices of food service personnel;
    (E) procuring food, paper, chemical, and other supplies, including implementing a first-in first-out rotation system for all food items;
    (F) ensuring there is a four-day food supply on hand at all times;
    (G) planning the menu; and
    (H) ensuring compliance with Texas Administrative Code Title 25 Chapter 228 (relating to Retail Food Establishments).
(c) The LSRH shall employ a qualified dietitian who works full-time, part-time, or on a consultant basis. If the LSRH chooses to employ the dietician on a consultant basis, such services shall occur at least once per month for not less than eight hours. The dietitian shall:
  (1) be currently licensed under the laws of this state to use the titles of licensed dietitian or provisional licensed dietitian, or be a registered dietitian;
  (2) maintain professional practice standards;
  (3) supervise the nutritional aspects of patient care;
  (4) assess the nutritional status and nutritional regimen adequacy, as appropriate;
  (5) provide diet counseling and teaching, as appropriate;
  (6) document nutritional status and pertinent information in patient medical records, as appropriate;
  (7) approve menus; and
  (8) approve menu substitutions.
(d) The LSRH shall employ administrative and technical personnel competent in their respective duties. The administrative and technical personnel shall:
  (1) participate in established departmental or LSRH training pertinent to assigned duties;
  (2) conform to food handling techniques in accordance with subsection (b)(5)(D) of this section;
  (3) adhere to clearly defined work schedules and assignment sheets; and
  (4) comply with job-specific position descriptions.
(e) An LSRH shall ensure menus meet the needs of the patients.
(f) A physician responsible for the care of the patients shall prescribe therapeutic diets. The LSRH's dietary department shall:
  (1) establish procedures for processing therapeutic diets, including:
    (A) accurate patient identification;
    (B) transcription from nursing to dietary services;
    (C) diet planning by a dietitian;
    (D) regular review and updating of diet when necessary; and
    (E) written and verbal instruction to patient and family, which shall be in the patient's primary language, if practicable, prior to discharge;
  (2) ensure a qualified dietitian plans therapeutic diets in writing;
  (3) ensure a qualified dietitian approves menu substitutions;
  (4) document pertinent information about the patient's response to a therapeutic diet in the patient's medical record; and
  (5) evaluate therapeutic diets for nutritional adequacy.
(g) An LSRH shall meet patient nutritional needs in accordance with recognized dietary practices and in accordance with orders of a physician or appropriately credentialed practitioner responsible for the care of the patients. The LSRH shall meet the following requirements.
  (1) Menus shall provide a sufficient variety of foods served in adequate amounts at each meal according to the guidance provided in the Recommended Dietary Allowances (RDA), as published by the National Research Council.
  (2) The LSRH shall not exceed 15 hours between providing the last meal of the day (i.e., dinner) and the breakfast meal, unless a substantial snack is provided. The LSRH shall adopt, implement, and enforce a policy on the definition of "substantial" to meet each patient's varied nutritional needs.
(h) An LSRH shall have a current therapeutic diet manual approved by the dietitian and medical staff readily available to all medical, nursing, and food service personnel. The LSRH shall:
  (1) revise the therapeutic manual as needed and at least every five years;
  (2) ensure the therapeutic manual:
    (A) is appropriate for the diets routinely ordered in the LSRH;
    (B) has standards in compliance with the RDA; and
    (C) contains specific diets which are not in compliance with RDA; and
  (3) ensure staff use the therapeutic manual as a guide for ordering and serving diets.

Source Note: The provisions of this §511.53 adopted to be effective October 5, 2023, 48 TexReg 5668