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Dietary Services - Dietitians and Staff

Description of Federal Requirements
Comparison of State Requirements
Table Comparing States
Complete Transcript of State Requirements on Dietitians & Staff (PDF)


Federal Regulations & Related F-tags for 483.40 Applicable Federal Regulation
(a) Staffing | F361
(b) Sufficient Staff | F362


  • 483.35 Dietary Services
  • Subpart D - Requirements That Must be Met by States and State Agencies: Nurse Aide Training and Competency Evaluation, and Paid Feeding Assistants
  • Description of Federal Requirements    (TOP)    (NEXT)

    The facility must provide a resident with a nourishing, palatable, well-balanced diet that meets the daily nutritional and special dietary needs of each resident.

    (a)    Staffing. The facility must employ a qualified dietician either full-time, part-time, or on a consultant basis.

    (1)   If a qualified dietitian is not employed full-time, the facility must designate a person to serve as the director of food service who receives frequently scheduled consultation from a qualified dietitian.

    (2)   A qualified dietitian is one who is qualified based upon either registration by the Commission on Dietetic Registration of the American Dietetic Association, or on the basis of education, training, or experience in identification of dietary needs, planning, and implementation of dietary programs.

    (b)  Sufficient staff. The facility must employ sufficient support personnel competent to carry out the functions of the dietary service.

    Comparison of State Requirements    (TOP)    (NEXT)

    NOTE:  The examples below may not list all States with similar language; always check your state for specifics.

    Most states address the licensing requirements for the dietician. It is interesting to note that the Federal regulations define a qualified dietitian as one who is qualified based on registration, education, training or experience. It is surprising that a person could be qualified based on experience. Many states go far beyond that basic requirement, requiring a dietician to be licensed in that particular state. If a dietician is not employed by a facility the Federal regulation requires frequently scheduled consultation from a qualified dietician. The word frequent is somewhat subjective. Some states regulate required hours that a consulting dietician must consult with a facility. Staff hygiene guidelines are addressed in many states.

    Dietitian and Dietetic Supervisor [TOP]    (TOP)    (NEXT)

    In Alaska, a full-time dietetic service supervisor to supervise the dietetic services and a consulting registered dietitian are required for the dietary department. A dietetic service supervisor means a person is (1) a graduate of a dietetic technician or dietetic manager training program or is (2) a graduate of a course approved by the department that provided 90 or more hours of classroom instruction in food service supervision and has a minimum of 2 years experience as a supervisor in health care institutions with consultation from a dietitian: and has training or experience in food service supervision and management in a military service equivalent in content to the programs in (1) or (2). In Arkansas the supervisor shall complete 15 hours of continuing education courses a year while in Idaho, supervisors are encourage to participate in food service workshops, correspondence courses and other training sessions whenever they are available. In California, the dietetic supervisor may also cook, provided sufficient time is allowed for managerial responsibilities.

    Hours Required of Consulting Dietitian [TOP]    (TOP)    (NEXT)

    In Alaska, the dietician must be available not less than once every three-months, in Arizona, the requirement is as often as necessary to meet the nutritional needs of the residents. In Georgia, the requirement is not less than 8 hours per month. In Hawaii, consultation shall be given in the facility at the rate of 4 hours per every 25 patients per month and not less than 6 hours per month. In Illinois, a minimum of 8 hours of consulting time per month is required for facilities with 50 or fewer residents. An additional 5 minutes of consulting time per month shall be provided per resident over 50 residents, based on the average daily census for the previous year. In Indiana, the number of consultant dietitian hours shall be commensurate with number of residents, complexity of resident services, and qualifications of food service director with at least the following number of hours being provided:

    (1) Four (4) hours every two (2) weeks for a facility of sixty (60) residents or less.

    (2) Five (5) hours every two (2) weeks for a facility of sixty-one (61) to ninety (90) residents. 

    (3) Six (6) hours every two (2) weeks for a facility of ninety-one (91) to one hundred twenty (120) residents.

    (4) Seven (7) hours every two (2) weeks for a facility of one hundred twenty-one (121) to one hundred fifty (150) residents.

    (5) Eight (8) hours every two (2) weeks for a facility of one hundred fifty-one (151) residents or more.

    In New Jersey, the dietitian shall spend an average of 15 minutes per resident each month providing dietary services in the facility, which requires one full-time equivalent dietitian for every 693 residents. Oregon requires the facility shall have on-site consultation provided at least monthly. In Pennsylvania, if consultant dietary services are used, the consultant’s visits shall be at appropriate times and of sufficient duration and frequency to provide continuing liaison with medical and nursing staff, advice to the administrator, resident counseling, guidance to the supervisor and staff of the dietary services, approval of menus, and participation in development or revision of dietary policies and procedures and in planning and conducting in-service education and programs. In Texas, the facility must ensure monthly dietary consultant hours as follows: 60 residents or under – 8 hours and for each additional 30 residents and additional 4 hours. West Virginia requires no less than 8 hours every 30 days. In Wyoming, the consultants shall visit for at least 8 hours every other week, so that adequate time is allowed for observation of more than 1 meal per visit or, for at least 4 hours every week so that adequate time is allowed to observe the preparation and serving of food at meal time. The weekly visits shall be scheduled to allow for observation of different meals.

    Staffing Requirements    (TOP)    (NEXT)

    Arkansas includes a formula for determining dietary staffing as follows: Number (#) for minutes per meal times (x) three (3) equals (=) number of minutes per day, number of minutes per day times (x) number of patients divided by (/) 60 equals (=) number of hours required by day. The number of employees will be rounded off to the nearest whole number. If deficiencies are found that directly relate to shortage of personnel, additional personnel will be required.

    Staff Hygiene    (TOP)    (NEXT)

    In Arkansas, all food service employees shall wear appropriate light colored clothing including hairnet and shall keep themselves and their clothing clean. They must have an approved health card. Food employees shall not be assigned duties outside dietetic services. The public, personnel, or patients shall not be permitted to eat or drink in the kitchen dishwashing area or storeroom. Only dietetic services and administrative personnel shall be allowed in the kitchen. Only dietetic services personnel shall be allowed to portion out food for patients or personnel. [NH Regs Plus Comment: Resident involvement in the kitchen is an important part of the household and Green House concept.]

    In California, beards and mustaches which are not closely cropped and neatly trimmed shall be covered. In Colorado, staff involved in preparing and serving food shall not wear nail polish and false nails. Florida’s comprehensive rules cover all dietary entities in the state. Requirements for staff include: (2) Cleanliness – The outer clothing of all employees shall be clean. Employees shall maintain a high degree of personal cleanliness during all periods of duty. (a) Hairnets, headbands, caps or other effective hair restraints shall be worn to keep hair from food and food-contact surfaces.

    (b) Keep their fingernails trimmed, filed, and maintained so the edges and surfaces are cleanable and not rough. Fingernails exceeding one-eighth inch beyond the nail bed shall not be considered trimmed. (c) Not wear fingernail polish or artificial fingernails when working with exposed food or unwrapped utensils unless wearing intact gloves in good repair. In Idaho, a. the food service department shall be staffed and operated at least twelve (12) hours each day. b. Work and duty schedules shall be available in the dietary department for all food service positions. c. If food service workers are assigned duties outside of the dietary department, these duties shall not interfere with sanitation, safety or time required for dietary work assignments. d. No person who has worked in any other area of the facility shall assist with the preparation or serving of food inside of the kitchen without first putting on a clean uniform or gown and a hairnet or cap. Hands must be thoroughly washed. e. Dietary personnel engaged in food preparation shall not feed patients/residents in the dining room.  In Indiana, the facility shall not assign personnel duties simultaneously in the kitchen and laundry, housekeeping, or nursing service except in an emergency situation. In Maryland, the kitchen may not be used for any purpose other than the preparation of food. In Minnesota, all employees must consume food only in areas designated for employee dining. In Montana, persons unnecessary to the food establishment operation may not be allowed in the food preparation, food storage, or ware-washing areas, except as allowed by the person in charge if steps are taken to ensure that exposed food, clean equipment, utensils and linens; and unwrapped single-service and single-use articles are protected from contamination. In Rhode Island, those employees involved in direct preparation of food shall not be involved in resident care. Housekeeping and nursing personnel may assist in food distribution, but not food preparation. [NH Regs Plus Comment: Many of these state regulations related to hygiene are obstacles to the household or Green House model and the universal worker in general.]

    Dietary Policy and Procedure Manual    (TOP)    (NEXT)

     Maine requires the following items be included in the dietetic services procedure manual:  organization and dietetic services offered; personnel management; staffing and budgeting; orientation and in-service education; menu planning; therapeutic diets; resident clinical nutritional care; purchasing, receiving, and storing of food and supplies; food preparation and service; meal and nourishment service; safety, sanitation, and infection control; time parameters for storage of opened or leftover foods; and disaster feeding plan. In Rhode Island, policies and procedures shall be established for the dietetic service, pertaining to but not limited to the following: a) responsibilities and functions of personnel; b) standards for nutritional care in accordance with reference 12; c) alterations or modifications to diet orders or schedules; d) food purchasing storage, preparation and service; e) safety and sanitation relative to personnel and equipment in accordance with reference 10; and f) ancillary dietary services, including food storage and preparation in satellite kitchens and vending operations in accordance with reference 10; and

    g) a plan to include alternate methods and procedures for food preparation and service, including provisions for potable water, to be used in emergencies.

    Table Comparing States        (TOP)

    Note: If the States in this table are not hyper-linked, their provisions do not appear to address the topic, and therefore, do not alter the Federal Regulatory scope.  The Table summarizes content on Dietitians and Staff by State (with a link to each State's specific language).  Link to a downloadable PDF document containing all State requirements on Dietitians and Staff.

    483.35 Dietary Services

    Dietitians and Staff
    State Goes beyond Federal Regulations? Subjects Addressed: How State Differs From or Expands On Federal Regulations
    Alabama Yes State license requirement for dietitian.
    Alaska Yes Dietician requirements; record keeping.
    Arizona Yes Dietician requirements.
    Arkansas Yes Staffing; hygiene of staff; method of determining dietary staff needs; percentage of time of supervisor.
    California Yes Dietitian service staff; clothing for staff; personal hygiene.
    Colorado Yes Number of staff; policies; no nail polish or false nails.
    Connecticut Yes Employ sufficient personnel.
    Delaware No Delaware regulations do not contain specific content for Dieticians and Staff.
    District of Columbia Yes Personnel; procedure when infection is suspected; manager certification.
    Florida Yes Personnel; procedure when infection is suspected; manager certification; dietary tasks performed under supervision of licensed nurse.
    Georgia Yes Federal regulations.
    Hawaii Yes Consultation; training; in-service.
    Idaho Yes Supervisor responsibilities; qualifications; staff only work in dietary or put on clean uniform or gown.
    Illinois Yes Director of food services; duties; consultation; sufficient personnel.
    Indiana Yes Qualifications of dietitian; hours required; duties.
    Iowa Yes Job description; written policies; staffing; in service.
    Kansas Yes Kansas state requirements; temporary license; qualifications; application process; sponsorship; reinstatement of license.
    Kentucky Yes Qualifications of dietitian; sufficient staff.
    Louisiana Yes Dietary manager definition; dietary staff hygienic practices; dietary staff storage of personal items.
    Maine Yes Policies and procedures manual; health and hygiene; staffing; food service supervisor; administration.
    Maryland Yes Supervision; dietetic services; consultation; staffing; coordination of nursing & dietetic services.
    Massachusetts Yes Dietary service requirements; supervisor; records; minimum sanitation standards for food services personnel.
    Michigan Yes Dietary services qualification.
    Minnesota Yes Dietary staff requirements; direction of dietary department; food poisoning and disease reporting; direction of dietary department.
    Mississippi Yes Direction and supervision; food service personnel; dietician.
    Missouri Yes Food services reviewed by consultant at least quarterly.
    Montana No Montana regulations do not contain specific content for Dieticians and Staff.
    Nebraska Yes Dietary staffing; food service director; qualifications of dietician; responsibilities.
    Nevada Yes Dietician requirements; duties.
    New Hampshire Yes Training program.
    New Jersey Yes Dietician requirements; dietician shall spend an average of 15 minutes per resident each month providing dietary services; advisory dietary services.
    New Mexico Yes Staff; hygiene of staff.
    New York Yes Dietician qualifications; sufficient staff.
    North Carolina Yes Director of food service; sufficient staff; handbook.
    North Dakota Yes Dietician requirements.
    Ohio Yes Dietician; monitoring and assessing; tube feeding.
    Oklahoma Yes Clinical records; nutritional assessment; nutritionist or dietitian.
    Oregon Yes Staffing; qualifications of supervisor or dietician; orientation; staffing.
    Pennsylvania Yes Manual; personnel hygiene; overall supervisory responsibility.
    Rhode Island Yes Responsibilities of dietician; staff duties.
    South Carolina Yes Worker hygiene; personnel; dietician duties and requirements.
    South Dakota Yes Dietician; written dietetic policies; nutritional assessment.
    Tennessee Yes Designate a person as director; qualifications; education programs including orientation.
    Texas Yes Staffing; director of food service requirements; consultant requirements; clinical records; staff hygiene.
    Utah Yes Dietician requirements.
    Vermont Yes Dietician requirements.
    Virginia Yes Staff responsible for full time management and supervision of dietary service; duties.
    Washington Yes Nutrition assessment; liaison with medical and nursing staff and administrator; in-service training; dietician; qualifications.
    West Virginia Yes Dietician qualifications; sufficient staff.
    Wisconsin Yes Director of food services; qualifications; hygiene of staff.
    Wyoming Yes Consultant dietitian hour requirements; responsibilities of supervisor.

    Complete Transcript of State Requirements on Dietitians and Staff    (TOP)