Sure-Fire MethodS

Feeding Individuals Receiving Behavioral Health Care

ehavioral health care organizations that provide nutrition services are responsible for ensuring that food is safely prepared and distributed and

that they are adhering to individual nutritional requirements. Joint Commission Care, Treatment, and Services (CTS) Standard CTS.04.03.33 requires that organizations providing food services have a process for preparing and/or distributing food and nutrition products (see “Related Requirements” on page 3 for the entire standard). In 2014 this was one of the most challenging standards for organizations accredited under The Joint Commission’s Behavioral Health Care Accreditation Program, with 17% of organizations surveyed found to be noncompliant.

According to Merlin Wessels, LCSW, associate director, Standards Interpretation Group, The Joint Commission, one of the biggest reasons behavioral health care organizations are being cited for noncompliance with Standard CTS.04.03.33 is that they fail to watch for expiration dates and dispose of food when it is expired. “Food that is opened but not consumed within that sitting is often not marked with a new expiration date,” Wessels says. “After the food has been opened, the expiration date becomes significantly less. It could be a matter of just a few days, depending on what type of food it is.”

Many organizations are also not adequately monitoring temperatures for foods

Organizations that provide nutritional services must ensure that food provided to individuals served has not expired and is properly stored and prepared.

Related Requirements

Standard CTS.04.03.33

For organizations providing food services: The organization has a process for preparing and/or distributing food and nutrition products.

Elements of Performance for CTS.04.03.33

For organizations providing food services: Food and nutrition products are provided to the individual served as appropriate to the care, treatment, or services being provided.
For organizations providing food services: Food and nutrition products are prepared under proper conditions of sanitation, temperature, light, moisture, ventilation, and security.
For organizations providing food services: Food and nutrition products are stored under proper conditions of sanitation, temperature, light, moisture, ventilation, and security.
For organizations providing food services: Cultural, religious, and ethnic food preferences of the individual served are honored when possible, unless contraindicated.
For organizations providing food services: Staff assist the individual served who requires help eating.
For organizations providing food services: Special diets and altered diet schedules are accommodated.
For organizations providing food services: Meals and snacks are served at times that are normal and appropriate for the age of the individual served.
For organizations providing food services: The organization assigns responsibility for preparing, storing, distributing, and administering food and nutrition therapy products.
For organizations providing food services: The dining areas used by individuals served are adequately supervised.

that need to be refrigerated or frozen, and some are not meeting special dietary needs or cultural preferences.

Wessels provides the following five strategies to help organizations to better comply with Standard CTS.04.03.33:

1

Develop a defined process for monitoring expiration dates. “The process should include rotating food so the older food can be used before the expiration date is up,” says Wessels. “When food is opened, it needs to be marked with a new expiration date, and someone needs to consistently monitor all nutrition products to make sure they’re being used or disposed of before they expire.”

2

Invest in a minimum/maximum thermometer with an alarm for refrigerators and freezers. “In a 24/7 setting, staff will be able to hear the alarm and take immediate action,” Wessels says. “In settings in which staff leaves the building on weekends or holidays, when they return to work, someone needs to be in charge of checking to see that the temperature stayed within the minimum/maximum range.”

3

Educate staff. “One of the things staff needs to know is how to set the appropriate temperature ranges on the alarm,” says Wessels. “They should also have

an understanding of proper sanitation and storage techniques. And if you’re in a setting in which clients

are learning to cook, staff should be trained in and consistently adhere to safety rules.” Tracy Collander, LCSW, executive director of Behavioral Health Care Accreditation, The Joint Commission, explains, “Clients should be managed by staff to adhere to safety rules while cooking, and staff need to oversee clients’ adherence to public health regulations while learning to cook.”

4

Incorporate nutrition screening into the pre- admission assessment. “Ask about cultural or religious preferences and dietary restrictions before you admit someone,” Wessels says. “If you can’t meet their needs, let the person know up front so they can decide if they’re willing to accept what you are able to offer or if another place might be a better fit for them.”

5

Make sure staff is adhering to public health regulations. “You need to make sure that your prep area is sanitary and that food is being stored properly in sealed containers,” says Wessels. “Review public health regulations, which are determined by local jurisdiction, to make sure you’re in compliance.” TS