(a) Menus must:
  (1) meet the nutritional needs of residents in accordance with established national guidelines;
  (2) be prepared at least one week in advance;
  (3) be written for each type of diet ordered in the facility, in accordance with the facility's diet manual;
  (4) be written or completely evaluated for nutritional adequacy by the facility's qualified dietitian;
  (5) vary from week to week, taking the general age-group of residents into consideration;
  (6) be followed unless substitutions are documented as required in subsection (d) of this section;
  (7) reflect, based on a facility's reasonable effort, the religious, cultural, and ethnic needs of the resident population, as well as input received from residents and resident groups; and
  (8) be updated periodically.
(b) A qualified dietitian may accept diet orders and changes from the physician.
(c) The facility must ensure that a current diet manual, approved by the qualified dietitian, is readily available to dietary service personnel and the supervisor of nursing service. To be current, the diet manual must be no more than five years old.
(d) The facility must retain records of menus served, including substitutions, and food purchased for 30 days. A list of residents receiving special diets and a record of their diets must be kept in the dietary area for at least 30 days.
(e) The facility must post the current week's menu:
  (1) in the dietary department, including therapeutic diet menus, so employees responsible for purchasing, preparing, and serving foods can use it; and
  (2) in a convenient location so the residents may see it.
(f) The dietary department must keep a seven-day supply of staple foods and a two-day supply of perishable foods at all times. The facility is allowed the flexibility to use food on hand to make substitutions at any interval as long as comparable nutritional value is maintained. Any substitution of menu items must be recorded on the day of use.
(g) Accommodation of a resident's needs. The facility must provide:
  (1) table service for all who can and will eat at the table, including a resident who uses a wheelchair;
  (2) firm supports, such as over-bed tables, for serving trays to a resident who is bedfast;
  (3) sturdy tray stands of proper height to a resident able to be out of bed for the resident's meals;
  (4) special eating equipment and utensils for a resident who needs them and appropriate assistance to ensure that the resident can use the assistive devices when consuming meals and snacks; and
  (5) prompt assistance for a resident who needs help eating.
(h) An identification system, such as tray cards, must be available to ensure that all diets are served in accordance with physician's orders.
(i) Nothing in this section limits a resident's right to make personal dietary choices.

Source Note: The provisions of this §554.1107 adopted to be effective May 1, 1995, 20 TexReg 2393; amended to be effective March 24, 2020, 45 TexReg 2025; transferred effective January 15, 2021, as published in the Texas Register December 11, 2020, 45 TexReg 8871