(a)  A facility shall ensure that each patient is provided with a palatable diet that meets his or her daily nutritional and specialized nutritional needs.

(b)  The facility shall designate a person to be known as the director of food service who shall be responsible for the facility's dietetic service and for supervision of dietetic service personnel.

(c)  Based on a resident's assessment, the nursing home must ensure that a patient maintains nutritional status, such as body weight and protein levels, unless the patient's clinical condition demonstrates that it is not possible.

(d)  There shall be sufficient personnel employed to meet the nutritional needs of all patients in the areas of therapeutic diets, food preparation and service, principles of sanitation, and resident's preferences as related to food services.

(e)  The facility shall ensure that menus are followed which meet the nutritional needs of patients in accordance with the recommended dietary allowances of the Food and Nutrition Board of the National Research Council, National Academy of Sciences which are incorporated by reference, including subsequent amendments.  Copies of this publication may be obtained by contacting The National Academy Press, 500 Fifth St. N.W., Washington, D.C. 20001 or accessing it at  Menus shall:

(1)           be planned at least 14 days in advance,

(2)           provide for substitutes of similar nutritive value for patients who refuse food that is served, and

(3)           be provided to patients orally or written through such methods as posting and daily announcements.

(f)  Food must be prepared to conserve its nutritive value and appearance.

(g)  Food shall be served at the preferred temperature as discerned by the resident and customary practice, in a form to meet the patient's individual needs and with assistive devices as dictated by the patient's needs.  Hot foods shall leave the kitchen (or steam table) above 135 degrees F; and cold foods below 41 degrees F.  The freezer must keep frozen foods frozen solid.

(h)  If patients require assistance in eating, food shall be maintained at the appropriate temperature until assistance is provided.

(i)  All diets, including enteral and parenteral nutrition therapy, shall be as ordered by the physician or other legally authorized person, and served as ordered.

(j)  At least three meals shall be served daily to all patients in accordance with medical orders.

(k)  No more than 14 hours shall elapse between an evening meal containing a protein food and a morning meal containing a protein food.

(l)  Hour-of-sleep (hs) nourishment shall be available to patients upon request or in accordance with nutritional plans.

(m)  Between-meal fluids for hydration shall be available and offered to all patients in accordance with medical orders.

(n)  The facility shall have a current online or hard copy nutrition care manual or handbook approved by the dietitian, medical staff and the Administrator which shall be used in the planning of the regular and therapeutic diets and be accessible to all staff.

(o)  Food services shall comply with Rules Governing the Sanitation of Restaurants and Other Foodhandling Establishments (15A NCAC 18A .1300) as promulgated by the Commission for Public Health which are incorporated by reference, including subsequent amendments, assuring storage, preparation, and serving of food under sanitary conditions.  Copies of these Rules can be accessed online at


History Note:        Authority G.S. 90-368(4); 131E-104;

RRC objection due to lack of statutory authority Eff. July 13, 1995;

Eff. January 1, 1996;

Amended Eff. August 1, 2012;

Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. March 22, 2015.