Training: Dietary Needs, Menu Planning, Food Preparation and Food Sanitation
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As a caregiver in the CBRF, it is important that you have a basic knowledge and understanding of:
1. The resident’s dietary needs.
2. Planning menus for the residents.
3. Preparing the resident’s food.
4. Sanitation for the residents and staff.
THE STATE OF WISCONSIN’S REGULATIONS REGARDING DIETARY NEEDS, MENU PLANNING, FOOD PREPARATION AND SANITATION.
The State of Wisconsin’s Department of Health Services (DHS) has set up specific regulations/rules for Community Based Residential Facilities (CBRF’s).
These are known as: THE WISCONSIN ADMINISTRATIVE CODE DHS 83.22(4) Dietary Training
All employees performing dietary duties shall complete dietary training within 90 days after assuming these job
duties. Specific training topics shall include: determining nutritional needs, menu planning, food preparation,
and food sanitation.
DHS 83.41 Food Service
(1) GENERAL REQUIREMENTS
a. Food supply.
1. The CBRF shall maintain a food supply that is adequate to meet the needs of the residents.
2. Food shall be obtained from acceptable sources.
b. Equipment. The CBRF shall store equipment and utensils in a clean manner and shall maintain all
utensils and equipment in good repair.
1. Whether washed by hand or mechanical means, all equipment and utensils shall be cleaned
using separate steps for pre-washing, washing, rinsing and sanitizing. Residential dishwashers
may be used in kitchens serving 20 or fewer residents. Kitchens serving 21 or more residents
shall have a commercial type dishwasher for washing and sanitizing equipment and utensils in
accordance with standard practices described in the Wisconsin food code.
2. A 3-compartment sink for washing, rinsing and sanitizing utensils, with drain boards at each end
is required for all large facilities with a central kitchen. Washing, rinsing and sanitizing
procedures shall be in accordance with standard practices described in the Wisconsin food code.
In addition, a single compartment sink or overhead spray wash located adjacent to the soiled
drain board is required for pre-washing.
WHAT COUNTS AS SERVING
A “serving” may not always be a typical “helping” of what you eat. Here are some examples of servings.
TYPES OF FOODS EXAMPLES OF ONE SERVING
Fats, Oils, Sweets Use most sparingly as this group contains the highest amounts of
Meat, Poultry, Fish Recommended, 2-3 servings. 2-3 oz. of cooked
Dry Beans, Eggs, and lean meat, poultry, or fish; ½ cup cooked dry
Nuts beans; 1 egg, or 2 Tbsp. peanut butter= 1 oz. meat.
HOW MUCH IS AN OUNCE OF MEAT?
Here is a guide as to how much meat, chicken, fish, or cheese
weigh by comparing sizes to the following objects:
1 oz. – a matchbox
3 oz. = a deck of cards
8 oz. = a paperback book
Milk, Yogurt, and Cheese Recommended, 2-3 servings. 1 cup milk or yogurt.
1-1/2 oz. natural cheese; 2 oz. processed cheese.
Vegetables Recommended, 3-5 servings. 1 cup raw leafy vegetables; ½ cup
other vegetables, cooked or chopped raw; ¾ cup vegetable juice.
Fruits Recommended 2-4 servings. 1 medium apple, banana, or orange;
½ cup cooked, or canned fruit; ¾ cup fruit juice.
Bread, Cereal, Rice and Pasta Recommended, 6-11 servings. 1 slice bread; 1 oz. ready-to-eat
cereal; ½ cup cooked cereal, rice or pasta; 3 or 4 small crackers.
1. The CBRF shall provide each resident with palatable food that meets the recommended dietary
allowance based on current dietary guidelines for Americans and any special dietary needs of
2. The CBRF shall provide a therapeutic diet as ordered by a resident’s physician.
Note: To obtain information on the Dietary Guidelines for Americans, see www.usda.gov/cnpp.
A modified or special diet and dietary supplements shall be provided as ordered by a resident’s physician or a
NUTRITIONAL CONCERNS FOR THE ALZHEIMER’S/DEMENTIA RESIDENT
1. Disorientation at mealtime.
2. Inability to grasp eating utensils and use them (spilling of food and liquid).
3. Forgetting to use utensils.
4. Catastrophic reactions at mealtime.
5. Decreased appetite or refusal to eat.
6. Difficulty chewing or no dentures.
7. Stuffing too much in the mouth at one time
8. Persistent craving for food.
9. Not opening the mouth to receive food.
10. Not initiating chewing with food in the mouth.
11. Food collecting in the mouth.
12. Choking on food, liquid or saliva/
13. Loss of coordination of hand-to-mouth.
Dysphagia is when a resident has problems with chewing or swallowing foods, beverages or medications.
Dysphagia is not a disease but a symptom of a condition that affects the swallowing process.
The occurrence of Dysphagia in the United States is on the rise, primarily in geriatric and pediatric patients.
Identifying Swallowing Problems
General warning signs of dysphagia include:
1. Coughing before, during or after swallowing food, liquids or medications.
2. Need to swallow 3 or 4 times with each mouthful of food.
3. Frequent throat clearing.
4. Hoarse, wet, breathy voice or garbled breathing.
5. Feeling of something caught or sticking in the throat.
6. Drooling or loss of food from mouth.
7. Pocketing of food in the mouth.
If you notice these symptoms, the resident should be evaluated by their physician.
Aspiration (taking foreign material into the lung…ex.; food, liquids, etc.) is a very serious health risk for the
resident with dysphagia. Signs of aspiration pneumonia include elevated temperature, weight loss, coughing,
labored breathing, and fatigue. It is also possible for foreign materials to enter the lungs without triggering a
cough, which is referred to as silent aspiration.
Chokes on food Position the resident in the chair up to the table for meals.
Hips and ankles need to form a 90 degree angle with feet flat on floor.
The distance from the plate to mouth should be 12 inches.
Avoid foods that are tough and hard to chew.
If meat is ground or food crumbles easily, mix with gravy, sauces, or soup to moisten and hold food together.
If foods must be pureed, food should be mashed potato or applesauce consistency.
Thin purees may cause more problems and may be inadequate in nutrients.
Reduce the risk of aspiration with these procedures:
– Allow 30-45 minutes for residents to eat.
– Serve food hot or cold to help resident identify that there is food in the mouth.
– Have resident concentrate on eating/avoid distractions while resident eats.
– Offer small amounts at a time.
– Have resident lower chin to chest for each swallow, then lift head and clear throat after each swallow.
– Keep resident upright 30 minutes after eating.
Chokes on liquids
Avoid use of a straw, as it rushes liquids to back of the mouth before swallowing can safely occur.
Avoid tilting head back. Use “nosey cup” so resident can drink beverage without tilting head back.
Avoid thin liquids.
Try naturally thick liquids such as tomato juice, fruit nectars, milk shakes and eggnogs.
Thickening agents may be prescribed to thicken thin liquids.
Has increased mucus/phlegm Increase fluid intake.
Phlegm becomes thinner, less sticky, and easier to cough up when an adequate amount of fluid is consumed.
Avoid reducing milk consumption. Milk has not been shown to increase phlegm.
Reduce or thin phlegm/mucus with one of the following alternatives:
– Grapefruit, pineapple, or cranberry juice.
– Carbonated beverages.
– Chew on papain tablets (enzyme found in papayas).
– Increase the moisture in the air with a vaporizer or humidifier.
Has increased food material
Verbally ask residents to use their finger or tongue to clear or remove
caught in mouth from their mouth.
If food pockets to one side of the mouth, ask the resident to place or chew
food on the opposite side.
Offer liquids after each solid to clear food in mouth.
Clear the mouth completely and complete oral cares following the meal.
1. The CBRF shall provide meals that are routinely served family or restaurant style, unless
contraindicated in a resident’s individual service plan or for short-term medical needs.
2. The CBRF shall provide at least 3 meals a day, unless otherwise arranged according to the
program statement or the resident’s individual service plan. A nutritious snack shall be offered
in the evening or more often as consistent with the resident’s dietary needs.
3. If a resident is away from the CBRF during the time a meal is served, the CBRF shall offer food
to the resident on the resident’s return.
1. The CBRF shall make reasonable adjustments to the menu for individual resident’s food likes,
habits, customs, conditions and appetites.
2. The CBRF shall prepare weekly written menus and shall make menus available to residents.
Deviations from the planned menu shall be documented on the menu.
HOW TO CREATIVELY PLAN YOUR MENU
- Select meat or entrée for the entire cycle or length of time for which menus are being planned:
- Show style of baking, stuffed, barbecued, breaded, etc.
- Most expensive is entrée, balance high/low price
- Meatless-veg. lasagna, cottage cheese fruit plate, etc.
- Plan a soup or sandwich as entrees, at same time, if they are to be offered as a main dish:
- Selective menu option: cream soup vs. stock soup. Choose starch such as potato, rice or pasta.
- Select vegetable, salad (cabbage, lettuce) cooked, cold.
- Choose bread, vary with bun, roll, bread, and biscuit, hot and cold.
- Plan the dessert, heavy pie with a lite meal or lite dessert such as sherbet, fruit, and cookies with a heavy
For Breakfast: Establish a standard so that you can easily plan the rest of the meals for the day:
- Eggs every day
- More protein at lunch
- Cereal every day
- Extra starch at lunch
7. Evaluate the completed meal for garnish, criteria, and after the meal is consumed, for resident
For example: Selective menu, salad bar, ice cream bar, choice of soup or juice.
8. Beverages: Coffee, milk, tea, juice, fruit punch.
ADDITIONAL PLANNING IDEAS FOR MEALS/MENUS
– Heavy foods with light foods.
– Light dessert with a heavy entrée.
– Lasagna with sorbet instead of pie.
Plan for the Resident’s acceptance of the Menus
– Know your resident
– Reassess the food preferences of the resident.
– Ask the resident for input.
– Annually- Resident or guardian shall be offered the opportunity to complete a written or oral
evaluation within 30 days of the resident’s evaluation.
Materials needed to plan your menus
3. Menu forms and previous menus that the residents have liked.
4. Suggestions from resident and their families.
SANITATION AND SAFETY
1. Each employee who prepares or serves food shall be free from open, infected wounds and from
communicable disease and shall maintain clean and safe work habits.
2. The CBRF shall provide hand-washing facilities in the kitchen for use by food handlers.
Use of a common towel is prohibited.
Whether food is prepared at the CBRF or off-site the CBRF shall store, prepare,
distribute and serve food under sanitary conditions for the prevention of food borne illnesses,
including food prepared off-site, according to all of the following:
1. The CBRF shall refrigerate all foods requiring refrigeration at or below 40F. Food shall be covered and stored in a sanitary manner.
2. The CBRF shall maintain freezing unites at 0F or below. Frozen foods shall be packaged, labeled and dated.
3. The CBRF shall hold hot foods at 140F or above and shall hold cold foods at 40F or below until serving.
c. Reporting The CBRF is required under s. DHS 145.04 to report suspected incidents of food borne
disease to the local public health officer.
1. Supplies of perishable foods for at least a 24-hour period and of nonperishable foods for at least a 3 day
period, shall be on the premises. When meals are prepared off the premises of the facility, the facility
shall have a one day supply of nonperishable food in the facility for emergency purposes, and shall
provide nutritious snack foods and a refrigerator and cabinet space in the facility accessible to residents
for storage of snacks.
2. Only fluid milk which meets the grade A milk standards shall be used for beverage purposes.
3. Powdered milk may only be used for cooking purposes and shall be brought to a temperature of at least
165F during the cooking process.
4. Eggs and egg mixtures shall be refrigerated at all times.
5. No hermetically (airtight) sealed food which has been processed in a place other than the premises of the
CBRF or a commercial food processing establishment may be used.
6. Food shall be stored, prepared, distributed and served under sanitary conditions which prevent
contamination or spoilage.
7. Food in cans that are dented on the seam or on the top of the can or are bulging or leaking or have any
contaminants on them, and dry food in packages that are crushed, punctured or have any contaminants
on them shall now be allowed on the premises of the CBRF and shall not be served to the residents.
8. When unlabeled canned goods are purchased, the cans shall either remain the in the processing
company’s marked box until the food in them is prepared for serving, or each can shall be labeled to
identify its content and the date of purchase.
9. Any canned food, dry food or processed food for which the expiration date on the processing company’s
container has expired, shall not be kept on the premises of the CBRF and shall not be served to
1. All food and drink shall be stored to be protected from dust, insects, vermin, rodents, unnecessary
handling, overhead leakage, condensation, sewage waste, water backflow or other contamination. No
food or drink may be stored on the floor.
2. All foods requiring refrigeration shall be refrigerated at or below 41F.
Food shall be covered and stored in an orderly manner.
3. Freezing units shall be maintained at 0F or below and foods to be stored in a freezer shall be wrapped,
identified and labeled with the date received.
4. Each refrigerator, walk-in cooler or other refrigeration unit shall have an accurate thermometer inside
1. Food shall be properly protected from contamination while being prepared and served and food shall be
prepared as close to serving time as possible.
2. Raw fruits and vegetables, and poultry shall be washed thoroughly.
3. Hot foods shall be kept at 135o
F or above and cold foods at 41o
F or below until serving. Reusable
leftovers shall be refrigerated promptly.
4. Food preparation surfaces shall be maintained in a sanitary condition.
5. Prepare foods shall not be cut on the same surfaces as are used for raw food preparation, unless those
surfaces are washed between operations.
6. The kitchen or food preparation areas shall not open into resident rooms, toilet rooms, or laundry areas.
7. The kitchen shall be located on the premises, or a sanitary method of transportation for food shall be
8. Food preparation areas not located on the premises which are used to prepare meals for the CBRF
residents, and the persons preparing the food, shall meet all applicable requirements under this section.
9. Food returned from resident plates shall be discarded.
a. Clean and safe work habits shall be maintained by all personnel who prepare or serve food.
b. Personnel showing evidence of open, infected wounds, or communicable diseases transmitted by
food handling, to include diarrhea and jaundice, shall be relieved of their duties until the conditions
c. Hand washing facilities, including hot and cold running water, soap and disposable towels, shall be
provided in the kitchen for use by food handlers. Use of a common towel is prohibited.
- Work areas and equipment
a. Work areas and equipment shall be clean and orderly.
b. All cases, counters, shelves, tables, cutting blocks, refrigerating equipment, sinks, cooking and
baking equipment, mechanical dishwashing equipment and other equipment used in the preparation,
storage or serving of food shall be constructed to be easily cleaned and shall be kept in good repair.
c. Food preparation, serving and food storage areas shall not be used for transporting, washing or
rinsing soiled linens.
- All rooms in which food or drink is stored or prepared or in which utensils are washed shall have the
a. Floors that are easily cleaned and that are kept in good repair.
b. Walls and ceilings that have nonabsorbent, washable surfaces.
c. Good lighting.
- Floors of toilet rooms shall be easily cleaned and shall be kept in good repair.
Cleansers and Insecticides
1. Cleaning compounds, soaps, polishes, insecticides and toxic substances shall be labeled and shall be
stored in an area separate from that used to store food.
- All utensils shall be cleaned after each use with soap and hot water and maintained in a clean condition.
When mechanical dishwashing is used, the final rinse shall be for a period of 10 seconds or more at a
temperature in the dishwasher of at least 140F. Automatic chemical sanitizing may be substituted.
When automatic chemical sanitizing is used, one of the following maintenance procedures shall be used
and a log shall be maintained of the type of procedure used and the date it was used:
a. Preventative maintenance on the automatic chemical sanitizing system recommended by the
manufacturer, at the frequency recommended by the manufacturer, to determine effectiveness of the
b. Testing the effectiveness of the sanitizing solution as recommended by the manufacturer, using
chemical strips designed for that purpose.
- Non-disposable dishes, cups, glasses, and other utensils shall be used for all meals except for special
occasions such as picnics or parties.
- Disposable single-service utensils may not be reused.
- Utensils shall be stored in a clean, dry place, shall be covered or inverted and shall be protected from
- Common drinking glasses or cups may not be used.
Garbage and Rubbish Disposal
1. Garbage and rubbish not disposed of by mechanical means shall be kept in leak-proof, no absorbable,
tightly closed containers and removed from the CBRF daily in a manner that will not be a health hazard.
2. All containers for garbage, rubbish and recyclables shall be thoroughly cleaned as often as necessary.
3. Disposable containers and disposable liners of permanent containers shall be discarded after one use.
4. Outdoor storage of garbage and rubbish shall be in leak-proof, nonabsorbent, tightly closed containers.
1. There shall be safe, effective procedures for exclusion and extermination of insects, rodents and vermin.
DHS 83 RELATED CODES
On the following pages you will find the Department of Health Services codes (DHS 83) that are related to
Dietary Needs, Menu Planning, and Food Preparation and Sanitation unit.
As a caregiver, you will need to demonstrate your knowledge of these codes and be able to implement them
DHS 83.14 Licensee. (2) RESPONSIBILITIES. (j) The licensee may not permit the existence or continuation
of any condition which is or may create a substantial risk to the health, safety pr welfare of any resident.
DHS 83.15 Administrator. (3) RESPONSIBILTIES. (a) The administrator shall supervise the daily operation of
the CBRF, including but not limited to, resident care and services, personnel, finances, and physical plant. The
administrator shall provide the supervision necessary to ensure that the residents receive proper care and
treatment, that their health and safety are protected and that their rights are respected.
DHS 83.42 Resident Records. The CBRF shall maintain a record for each resident in the CBRF. Each record
shall include all of the following: (1) (i) Individual service plan and resident satisfaction evaluation.
SUGGESTIONS FOR NUTRITIONAL CONCERNS OF THE ALZHEIMER’S/DEMENTIA
RESIDENT AND STAFF APPROACHES
1. Increase the frequency of special theme events and include food.
2. Bring restaurant food/atmosphere to your CBRF.
3. Show food to the resident prior to altering (before grinding, pureeing, etc.)
4. Offer food that is easily available and “snitchable”.
5. Offer food in small portions on small plates.
6. Have a staff member walk with a wandering resident, offering them food while walking.
7. Offer unusual snacks at “not-the-usual” time of day (ex. Fried potatoes at 3pm)
8. Involve resident in preparing the dining area and food to be served (reinforce dining rituals)
9. Assist the resident in making unusual food sandwiches when a resident prefers eating this way.
10. Listen to and honor diet requests when possible.
11. Encourage diet order changes/modifications (ADA diet with Non-Diabetic snack.)
12. If resident displays hearing/vision strengths on one side…feed from that side.
13. Make the food and fun easily available to every resident in every area of the CBRF.
14. Combine the dining experience with all special events.
15. Offer as many opportunities to make choices as possible to maintain independence.
16. When conditions are justified, treat physical symptoms with natural interventions/remedies.
1. Encourage families to bring in homemade favorites for the resident when diet permits.
2. Encourage family members to share a snack with their loved ones.
3. Provide a special private area for those families who wish to share a meal with their loved one.
1. Nutri-Grain bars
2. Pretzels with/without nonalcoholic beer.
3. Soup and crackers
4. Muffins filled with nutritional additives
5. Scrambled eggs
6. Oatmeal or cream of wheat
7. Cereal and milk
8. Soft fruits
9. Cheese and crackers
10. Cubed bread and cooled fondue
11. Rice/tapioca pudding
12. Baby food served from alternate container
13. Liver sausage and crackers
14. Mashed potatoes
15. Sweet potatoes mashed and seasons with sugar and pumpkin pie spices
16. Frozen juice pops
17. Cream cheese roll-ups
18. Frozen yogurt
20. Fruit shakes
21. Milk shakes
23. Fig Newton’s
SUGGESTION AND ENVIRONMENTAL ADJUSTMENTS
- Use familiar odors to stimulate the appetite:
a. Brew coffee
b. Toast bread at the table
c. Steam fruit/spice scented potpourri
- Minimize the institutional look:
a. Decorate with wallpaper/Knick knacks appropriate to the dining area.
b. Have a quiet time before the meal begins.
c. Use tablecloths, flowers and no trays to enhance the home-like atmosphere.
- Encourage residents to dine in preferred/traditional mealtime attire.
- Provide residents with smaller, more intimate dining areas.
- Promote traditional dining routines:
a. Reading AM paper at the breakfast table.
b. Coffee before a meal.
- Offer in-house salt-free popcorn that is easily available.
- Offer a quick snack pantry that is easily available:
a. Offer choices.
b. Offer residents opportunities to stock the pantry (reinforces a former task).
SOURCE: The Helen Bader Foundation Community Based Residential Facility (CBRF) Caregiver Training Program. “Caring for the Person with Alzheimer’s Disease”
Unit 13 Dietary Needs, Menu Planning, Food Preparation and Sanitation in the CBRF.