The Home Delivered Meal Service provides meals that meet the 1/3 RDA requirements to people in their homes. 

        Foods to be delivered shall be packaged individually in separate leak-proof containers which have sufficient insulation to prevent heat loss by the hot foods and heat gain by the cold foods.

    ® The temperature of hot foods must at no time drop below 140 degrees from the point of preparation, through delivery and during meal service

    ® The temperature of cold foods must remain below 45 degrees at all times

    ® Frozen meals may be delivered reheated, cold (to be heated in the participant’s home) or frozen. To prevent bacteria growth, foods must maintain safe food temperatures as noted for hot and cold foods. If frozen, food temperature must be –10 degrees Fahrenheit to 0 degrees Fahrenheit during transportation and delivery

    ® Food containers must be constructed in a manner which provides for the separation of hot, refrigerated and frozen food items during delivery

    ® To assist in maintaining proper food temperatures, hot and cold foods must be kept in separate containers from the point of preparation, through delivery and during meal service

        Containers for transporting individually packaged meals shall be of a type that can be easily cleaned and sanitized and equipped with handles and secure closures. Provisions must be made for the maintenance of proper food temperatures at all times. Routine, periodic temperature checks (at least monthly), must be completed on each meal delivery route to ensure that the first meal delivered as well as the last meal delivered both meet the standards for safe temperature

        Delivery routes shall be established and route sheets provided to all paid and volunteer personnel involved in the delivery of meals. At all times, meals shall be delivered by the most sanitary means available. Animals are not permitted in vehicles during the delivery of meals

        Each meal served shall contain at least one-third (1/3) of the current RDAs as established by the Food & Nutrition Board of the National Academy of Science-National Research Council. The menu format guidelines outlined in Attachment I are based on 1/3 of the RDAs for persons 51 years and older and current knowledge of the nutritional needs of the elderly. The menu format shall be followed when planning and submitting menus

        All menus shall be submitted on the Menu Submission Form (Attachment II) with all necessary information completed, including the signature of an approved dietician

        When combination dishes such as casseroles, soups, salads or blended fruit juices are used as part of the meal, the major ingredients and portion sizes must be indicated to aid in accurate menu evaluation. Also, menu items with inexplicit names must be described. Examples of combination dishes and menu items with inexplicit names include:

    ® Spaghetti with meat sauce (6 oz. meat sauce containing 3 oz. of ground beef, 4 oz. of tomato sauce and 1 tsp. of grated cheese);

    ® Eight (8) oz. tomato juice;

    ® One-half (1/2 cup winter mixed vegetables (broccoli, cauliflower, carrots); and

    ® Health Salad (1/2 cup of fresh spinach, two tablespoons of mandarin oranges, one teaspoon of walnuts, one teaspoon of raisins and one tablespoon of sweet and sour dressing).

Utilization of the service of a dietician

    ® A registered dietician must review and approve all menus served previous to meal service. All approved menus must be maintained by a provider for at least 2 years.

    ® All menus utilized for meals in the nutrition program shall be reviewed and determined acceptable in writing by an approved dietician. The review should include nutritional adequacy and appropriateness of food combinations.

    ® Review and approval of modified diet menus by an approved dietician is essential to ensure that such meals are nutritionally adequate, as well as responsive to the special dietary needs of the consumer.

    ® An approved dietician’s signature and registration number or indication of master’s degree shall appear on the Menu Submission Form (Attachment II) used for menu planning. This signature verifies that the menus satisfy all established standards.

    ® The approved dietician must calculate and document the amount of edible protein, Vitamin C, Vitamin A and calories of each menu, ensuring that 1/3 RDA meal requirements are met.

Provision for Special Needs

    ® Special Menus-Religious requirements or the ethnic background of the program participants may necessitate the development of special menus. Nutrition programs are encouraged to provide such menus when there are sufficient numbers of persons needing the special menus and available food service resources, including personal expertise and available foods, to make the provision of such meals possible and economically feasible.

Modified diets

    ® Modified diets shall be provided only to those participants with a current written diet prescription for those diet modifications provided by the agency. Diet prescriptions shall be signed by a physician, shall indicate the specific requirements of the diet (i.e., 1500 calorie ADA, 4 gm sodium), and shall be kept on file, reviewed and updated at least annually.

    ® Since the nutrition program is designed to meet only a portion of one’s daily nutritional needs, diet counseling is an important adjunct to the provision of modified diets.

    ® It is generally recommended that diet modifications are limited to the following:

    ® 1200-1800 calorie diets (diabetic and calorie restricted diet prescriptions);

    ® Moderate sodium restricted diets (two or four grams); and

    ® Low fat and/or low cholesterol diets.

Food Supplies

        Nutrition service providers must procure foods from sources that comply with all laws relating to food and food labeling. Canned foods must be free from rust, leaks and dents on the rim or side seams of the cans. All food must be safe for human consumption, clean, wholesome and free of spoilage, adulterations, filth or contamination. Perishable foods shall be projected against spoilage by use of proper handling and storage prior to and following purchase.

        No foods previously served can be used in the preparation of other foods, offered for sale or given away.

        No food prepared in a private home or processed in a place other than a food processing establishment shall be used in the preparation of foods, unless the preparation and processing facility is regulated by an appropriate official agency. Home canned or prepared foods may not be used.

        Donated raw foods limited to whole fresh fruits and vegetables may be accepted for use by the agency only if the foods equal the standards of quality, sanitation and safety which apply to foods that are purchased commercially. Donated raw foods to be used by a food service program must be inspected and approved by the program director and/or dietician prior to being accepted for use.

        All products used and served shall be made from pasteurized milk. Fluid milk must meet grade A quality standards as established by law. Dry milk products shall be made from pasteurized milk and may be reconstituted for use in desserts or for cooking and baking purposes.

        Only clean whole eggs, with shell intact and without cracks, or pasteurized liquid, frozen or dried eggs or pasteurized dry egg products shall be used. The exception is that hard-cooked, peeled eggs and commercially prepared and packaged eggs may be used in the food service operations. All eggs and egg products shall be considered as potentially hazardous foods; they shall be refrigerated at 45 degrees Fahrenheit or below, or thoroughly cooked by a method providing the necessary time and temperature combination to control salmonella enteritidis.

        In the case of emergencies, such as fire, flood, power outage or similar event that might result in the contamination of food or might prevent potentially hazardous food from being held at required temperatures, the person in charge shall withhold any affected food from distribution to consumers.

        Condiments provided for table service shall be individually portioned, served in pour-type dispensers or served in a manner that would prohibit contamination.

        All foods, while being stored, prepared, displayed, served or transported, shall be protected from contamination, including dust, insects or unclean utensils and equipment.

        Food in food storage areas shall be stored above the floor in a manner that permits cleaning of the area.

        Food, whether raw or prepared, if removed from the container in which it was obtained, shall be stored in a clean, covered container. The container cover shall be impervious and nonabsorbent. All containers of food products must be labeled as to contents and date of preparation so food identity cannot be mistaken.

        Food, containers of food and single service utensils shall not be stored under exposed or unprotected sewer or water pipes.

        No packaged food shall be stored on non-drained ice.

        Food handlers’ costs, shoes, clothing, handbags or packages shall not be stored in the food preparation area.

        There shall be present in food service establishments only those poisonous or toxic materials necessary for maintaining the establishment, cleaning and sanitizing equipment and utensils and controlling insects and rodents.

        Containers of poisonous or toxic materials shall be prominently and distinctly labeled according to law for easy identification of contents.

        All poisonous or toxic materials shall be stored in cabinets or in similar physically separate places used for no other purpose. To preclude contamination, poisonous or toxic materials shall not be stored above food, food equipment, utensils or single-service articles, except that this requirement does not prohibit the convenient availability or detergents or sanitizers at utensil or dishwashing stations.

        Bactericides and cleaning compounds shall not be stored in the same cabinet or area of the room with insecticides, rodenticides or other poisonous materials.

        Cold storage shall be provided at temperatures no higher than 45 degrees Fahrenheit. An accurate thermometer should be available at the warmest location within the storage area, and shall be located where it can be readily observed for reading.

        Sufficient adequate hot and cold storage facilities shall be provided for storage and transportation or potentially hazardous foods in order to maintain proper temperature, 45 degrees Fahrenheit or below for cold foods, and 140 degrees Fahrenheit or above for hot foods. These temperatures must be maintained for all potentially hazardous foods at all times, except during necessary periods of preparation. Hot and cold storage facilities shall be provided with a numerical scale indicating the thermometer is accurate to +3 degrees Fahrenheit.

        Warm foods shall be transferred into cold storage in shallow, approved containers for rapid cooling. Adequate air circulation should be maintained between food items stored.

        Frozen foods shall be kept frozen at a temperature of 0 degrees Fahrenheit or colder. Once frozen foods are thawed, they should not be refrozen. Frozen foods shall be thawed by the following means:

    ® As part of the cooking process;

    ® In the refrigerator at a temperature of 45 degrees Fahrenheit or below;

    ® Under running water (70 degrees Fahrenheit or below); and

    ® By microwave thawing.

        The dry foods storeroom shall be dry, cool, dark and free from insects and rodents. It shall be clean and orderly and have adequate ventilation to maintain storage temperatures at a level from 40 degrees Fahrenheit to 70 degrees Fahrenheit.

        All foods shall be prepared to retain maximum nutritive value, color, flavor and texture.

        Potentially hazardous foods requiring cooking shall be cooked to heat all parts of the food to a temperature of at least 140 degrees Fahrenheit except that: pork roasts and all pork products shall be prepared to the well-done state and at an internal temperature of 150 degrees Fahrenheit; and stuffed meats and poultry shall be cooked to a minimum internal temperature of 165 degrees Fahrenheit, with no interruption in the cooking process.

        Potentially hazardous foods that have been cooked and refrigerated shall be reheated rapidly to 165 degrees Fahrenheit or higher before being served or placed in a hot food serving facility. Steam tables, bainmaries, warmers or similar hot food holding devices are prohibited for rapid reheating of potentially hazardous foods.

        The freezing of foods in large quantities requires correct food handling techniques to conserve food values and prevent food-borne illness. When freezing large quantities of foods, the following procedures should apply:

® Begin food preparation with high quality raw materials that are free from spoilage, structural damage and microbiologic contamination. This is necessary to obtain a "quality" frozen product.

® Schedule food production so quantities produced do not exceed the recommended load capacity of the freeze or chill unit. The time period during storage of the "warm" food product in a refrigerator will produce temperature ranges conducive to microbiologic growth. Freezers should be capable of freezing food in a short time, preferably within one-half hour.

® All food products to be chilled must be cooked to an internal temperature of 165 degrees Fahrenheit or above to sufficiently eliminate microbiological contaminants and active food enzymes, both of which will cause product deterioration during storage. Upon freezing, the center of the food should be brought to a temperature of 0 degrees Fahrenheit as quickly as possible.

® Prior to the freezing process, temperatures must be maintained at 140 degrees Fahrenheit or above to achieve optimum sanitary conditions.

® The food product should be portioned into sanitary, moisture-proof loosely covered containers. After cooling, all containers shall be sealed with tight-fitting lids or over-wrapping materials. This is necessary to prevent product contamination, oxidation and dehydration during processing and storage. Containers should be labeled as to content and date of preparation.

® Materials for food containers should be good conductors of heat and cold, and approved for use by the AAA’s Dietician or Nutrition Project Director. Products must be portioned into containers that will permit rapid freezing. Large cuts of meat and poultry should be cut into small pieces. During freezing, a minimum

of one-inch free spacing is required above and below pan to produce surfaces for air circulation. Failure to follow these parameters will increase the total time required to freeze or chill the product.

® Freezer temperatures should be 0 degrees Fahrenheit or below to assure quality and safety control.

Reheat previously prepared frozen foods to at least 165 degrees Fahrenheit and hold prepared food no longer than necessary so the quality of foods can be maintained.

        Potentially hazardous foods, such as custards and cream fillings should be prepared and immediately refrigerated at 45 degrees Fahrenheit or below. These foods should never be stored at room temperatures.

        Suitable serving utensils such as prongs, ladles or spoons should be used when preparing and serving foods so that manual contact is minimal.

        Metal stem-type numerically scaled indicating thermometers, accurate to +2 degrees Fahrenheit, shall be provided and used to assure the attainment and maintenance of proper internal cooking, holding or refrigeration temperatures of all potentially hazardous foods.

Transportation of Food

        During transportation, food and food utensils should be kept in covered containers so they are protected from contamination.

        No person with any disease in communicable form shall work in any food service establishment, in any capacity, in which there is a likelihood that the person would contaminate food or food contact surfaces.

        When suspicion arises as to the possibility of transmission of infection from any food service worker, the provider shall require any or all of the following:

     ® Immediate exclusion from the food service facility.

® Restriction of the service to an area where there is no likelihood of such person contaminating food or food contact surfaces with pathogenic organisms or transmitting disease to other persons.

® Adequate medical examinations of the food service worker and/or associates, with such laboratory examinations as may be necessary.

          Any employee who has a discharging or infected wound, sore or lesion on hands, arms or any exposed portion of the body shall be excluded from those operations which will bring him into contact with food, beverages, utensils or equipment used in public eating or drinking places.

        All food handlers shall wear clean outer garments that will not hinder movement or be hazardous near equipment. Effective hair restraints shall be worn while working.

        The food service employee shall use tobacco only in designated areas, and not within the food preparation and serving area nor while in areas used for equipment, utensil washing or for food preparation.

        Employees shall consume food only in the designated dining room and not where contamination of food or other equipment may result.

        Employees shall keep their fingernails clean and trimmed. No fingernail polish shall be worn when engaging in food preparation. Use of rings, bracelets and jewelry shall be minimal. Hand-washing shall be completed on the hands and exposed parts of arms with soap and hot water before work, after smoking, eating, drinking and using the toilet facilities and as often as necessary to remove soil and contamination.

        All equipment shall be designed, installed and constructed not to impart odor, color or taste nor contribute to the contamination of food.

        Food contact surfaces (including glassware, china and pottery utensils) shall be easily cleanable, smooth and free from breaks, open seams, cracks, chips, pits and free of difficult to clean interior corners and crevices.

        The product surfaces of equipment, utensils and single service articles must be nontoxic and must not cause prohibited food additives to migrate into food. Utensils containing metals and/or salts or cadmium, lead and zinc must not be used.

        All utensils and food contact surfaces or equipment used in the preparation or storage of potentially hazardous foods shall be thoroughly cleaned, rinsed and sanitized prior to such use.

        Tableware shall be washed, rinsed and sanitized after each usage.

        Food contact surfaces shall be washed, rinsed and sanitized at intervals to assure that equipment is free from accumulation of dirt, dust and food particles. Moist cloths used for wiping spills shall be restricted to only that purpose and stored in a sanitizing solution between uses.

        For manual washing, rinsing and sanitizing or utensils and equipment, these procedures shall be followed:

     ® Equipment and utensils shall be pre-scraped and, when necessary, presoaked.

® Equipment and utensils shall be thoroughly washed in warm water containing a detergent solution.

     ® Equipment and utensils shall be rinsed in clean water.

® All eating equipment and utensils shall be sanitized using one of the following methods:

® immersion for at least one-half minute in clean, hot water at a temperature of at least 170 degrees Fahrenheit;

® immersion for at least one minute in a clean solution containing at least 50 parts per million of available chlorine as a hypochlorite and at a temperature of at least 75 degrees Fahrenheit;

® immersion for at least one minute in a clean solution containing at least 12.5 parts per million of available iodine and having a pH not higher than 5.0 and at a temperature of at least 75 degree Fahrenheit;

® immersion in a clean solution containing any other chemical sanitizing agent which demonstrates to be effective and nontoxic under use conditions; and

® a test kit or other device that accurately measures the parts per million concentration of a solution shall be provided and used regularly.

® For equipment too large in size to immerse, steam can be used for rinsing. Spraying can be completed with a chemical solution made two times the strength as used for immersion techniques.

® cleaning and sanitizing may be done by any machine that demonstrates that it thoroughly cleans and sanitizes equipment and utensils. Wash and rinse temperatures shall be no less than those specified by the machine manufacturer which are shown on the machine’s data plate. Also, the water should be changed periodically throughout the dishwashing process to maintain its cleaning ability.

® after sanitization, all equipment and utensils shall be air dried and shall be stored in a self-draining position. Glasses and cups shall be stored inverted. Other items should be covered or inverted, whatever practical.

® if adequate facilities for cleaning and sanitization are not available, single services articles shall be used and then discarded.

Lavatory Facilities-adequate toilet facilities shall be accessible to employees and participants at all times. All facilities shall be in clean condition and good repair. Toilet rooms shall be enclosed with self-closing solid doors. Toilet tissue shall be provided and a covered waste container shall be installed in all lavatories. Windows to the outside shall be properly screened.

Hand-washing Facilities-each food site shall have adequate and conveniently located hand-washing facilities for employees and participants. Hot and cold running water, hand soap or detergent and an appropriate hand drying device or paper towels shall be available. New sites or sites extensively altered shall have hand-washing facilities located in the food preparation area not more than 50 feet from any work area.

Garbage & Refuse-garbage and refuse shall be kept in easily cleanable, insect and rodent proof, non-absorbent pieces of equipment. All containers shall have tight fitting lids and shall be covered when not in continuous use. There shall be a sufficient number of containers to hold all garbage accumulated. Soiled containers shall be cleaned at a frequency to prevent insect and rodent attraction.

Insect & Rodent Control-effective means shall be implemented to minimize the presence of rodents and insects. The premises shall be kept in such condition as to prevent the harborage or feeding of insects or rodents.

® Floors, walls and attached equipment shall be kept clean. The floor surfaces in kitchens, food preparation areas, walk-in refrigerators and toilet rooms shall be of smooth, non-absorbent material that is easily cleanable. No carpets shall be permitted in these areas. Walls and ceilings shall be smooth, non-absorbent and easily cleanable. Permanent light fixtures shall be installed to assure safety for personnel working in the food service area. All rooms shall have sufficient ventilation to keep them free of excess heat, smoke, steam, odors and fumes. Ventilation systems, when applicable, should comply with state and local fire code requirements.

® No live birds or animals shall be permitted in any part of the food service facility. Patrol dogs accompanying security or police officers, or guide animals accompanying blind persons shall be permitted in dining area.

Lighting

® Permanently fixed artificial light sources shall be installed to provide ample light on all food preparation surfaces and at equipment or utensil-washing work areas. Adequate lighting is essential for general cleaning, identifying labels and for recognizing the condition of stored foods. Ample light, properly distributed, should assist in on-the-job safety. Minimum illumination standards are available from the Department of Environmental Resources.

® Infrared or other heat lamps shall be protected against breakage by a shield surrounding and extending beyond the bulb, leaving only the face of bulb exposed.

® Lights and fixtures over exposed food or equipment shall be of the safety type or otherwise constructed to protect food products and equipment from damage by breakage.

® plumbing shall be sized, installed and maintained in accordance with the provisions of the local plumbing code or, in the absence thereof, in such a manner as to prevent contamination of the water supply or the creating of an unsanitary condition. There shall be no cross-connection between the potable water supply and any non-potable or questionable water supply nor any source of pollution through which the potable water supply might become contaminated.

Sewage Disposal

® All sewage disposal systems shall comply with the Clean Streams Law, Act of June 22, 1937, P.L. 1987, No. 394, as amended (35 P.S. § 91.1, et seq).

Water Supply

® enough potable water for the needs of the food service establishment shall be provided from a source constructed and operated according to law. Bottled and packaged potable water shall be obtained from a source that complies with the applicable laws and is stored in a way that protects it from contamination.

® the construction of individual water supplies shall be based upon satisfactory compliance with standards set forth by the Department of Environmental Resources.

        Prompt handling and referral of food-related complaints are the foundation for the successful investigation of food-borne illness. When an illness related to food is suspected, the following procedures should immediately be implemented:

     ® assist persons in obtaining medical treatment;

® refrigerate suspected food item until the appropriate health authorities are contacted;

® inform the food caterer, local health officials or Area Agency on Aging of the suspected contaminated food;

® file a report which includes time of onset of illness, number of persons affected, name of the alleged food item, where the stricken persons ate, symptoms of illness, name of the food caterer and actions taken.

        Health officials will advise of further actions or surveillance.

        Persons providing Home Delivered Meals services must comply with all reporting requirements as specified by the AAA.

        All meals that are prepared and delivered must be of the type and quality, and at the time scheduled in conformance with the consumer’s needs and consistent with the Care Plan provided by the AAA.

        Agencies who wish to provide Home Delivered Meals services will be required to attest to having the following types of insurance in amounts consistent in the industry:

• General liability

• Automobile liability if vehicle is company owned

• Workman compensation as required by law

• Employer’s liability of accident and disease.

        All agencies that provide Home Delivered Meals services must comply with all federal, state and local laws relating to research on human subjects and consumer confidentiality.

        Agencies must provide all care managers with consent forms and approval from all appropriate review boards for those consumers who wish to be part of a research study.

Menu Pattern For Planning

Menu Submission Form