Sec.17b-423-5. Community services policy manual - Title III-C nutrition services

(a) Purpose

An Area Agency on Aging shall award nutrition service funds received under Title III of the Older Americans Act to provide meals, nutrition screening and nutrition education, to older persons. In addition, these funds may be used to provide outreach, nutrition assessment, nutrition counseling, and other related services to older persons. In making these awards, the Area Agency on Aging shall assure that based on an assessment of need by the Area Agency on Aging and nutrition service providers, congregate meals, home delivered meals, nutrition screening and nutrition education are all provided in the PSA. The Area Agency on Aging shall develop a formula providing for equitable distribution of nutrition funds throughout the PSA.

(b) Selection of Nutrition providers

(1) General Rule

An Area Agency on Aging may make awards for congregate meals, home delivered meals, nutrition education, nutrition screening, nutrition assessment and counseling, and related nutritional services to a provider or providers that furnish any or all types of services. Such a provider shall meet the requirements of this section.

(2) Process for Selecting Nutrition providers

(A) Area Agency on Aging Award Process

An Area Agency on Aging shall award nutrition funds through a competitive grant or contract process.

Whenever there is no evidence of improved quality of services or cost effectiveness on the part of another bidder, an existing provider of services who receives funds under Title III of the Older Americans Act of 1965 as amended shall be given preference.

An Area Agency on Aging shall award Title III, Part C funds to organizations which are able to provide nutritional services efficiently and reasonably.

(B) Assurances of Maintenance of Effort and Non-Supplanting of Funds

The Area Agency on Aging shall have furnished assurances to maintain efforts to solicit voluntary support and not to use funds received under this part to supplant funds from non-Federal sources.

(c) Bid Procedures For Contracts With Caterers

(1) Procedure for Solicitation of Bids

The procedure for solicitation of bids shall be as follows:

(A) Bids shall be solicited on an annual basis, unless caterer is operating on a multi-year contract. In the case of a multi-year contract, additional bids should be solicited for maximum increases for the year(s) after the first year.

(B) The Area Agency on Aging shall assure that nutrition projects coordinate their bids or develop a combined bid to seek most favorable price and quality.

(2) Bid Specifications

(A) Bid Specifications shall include the requirement that the caterer either (i) obtains a Performance Bond in an amount and in form satisfactory to the Elderly Nutrition Project (ENP), the Area Agency on Aging and the Department or (ii) enters into an agreement for damages. The following is an example of a contractual default clause:

Default/Damages

"In the event of breach or default by bidder in performance of the contract, ENP may act immediately to provide replacement services and if so shall notify bidder. In the event replacement services are provided, bidder shall be liable to ENP for damages in an amount measured by the difference between the cost of services under the bidder's contract and the higher cost, if any, of providing similar requirement replacement services."

One of the following methods, as appropriate, should be utilized to define the period for which damages would be sought by ENP:

(i) If the contract contains a provision authorizing the caterer to give notice of its intention to terminate the contract, then the above damage clause shall contain the following additional sentence: "Damages shall be collected for the period from the time of default by caterer for the ensuing days" (The blank being the length of notice).

(ii) If the contract contains no such notice provision, or if the remaining term of the contract is less than any such notice term, then the damages shall be for the remainder of the contract term.

Bid specifications and Contracts may, at the option of ENP, contain the following paragraphs:

"The parties further agree that ENP may withhold any funds due to the bidder in the hands of ENP at the time of default or breach, which funds may be used by ENP to offset damages. The parties further agree that ENP may retain not to exceed $ (as determined by ENP otherwise due to bidder for services hereunder, for this purpose.

"The parties further agree that, in the event that ENP is unable to provide replacement services, damages shall be as determined by a court of law, or as otherwise agreed to by the parties, and that the amount retained by ENP as herein above set forth, may be retained by ENP until that time."

(B) Bid specifications shall include but are not limited to menu policies, delivery time, and food temperature maintenance requirements.

(C) The bid specification may request a working plan from the caterer on how they would set up their program to include anticipated staffing, employee requirement, and sanitation policies, use of standardized recipes, transport equipment and other relevant factors.

(D) If the contract contains a provision authorizing the caterer to give notice of their intention to terminate the contract, the notice term shall not be less than sixty (60) days.

(3) Options Available to Soliciting Party

After bids have been opened and reviewed, three options are open to the soliciting party:

(A) A bid can be accepted. After the bids have been received, the parties cannot negotiate price or specifications, or in any way alter the bids. The bids shall be accepted as they are submitted.

Any otherwise conforming bid may be amended by the bidder or soliciting party to correct computational errors which do not affect the cost or quality of services; such amendment shall be prior to acceptance.

(B) Any of the bids can be rejected with justification. Bids can be rejected if they are too high, if they do not meet specifications, or if they are incomplete.

(C) All bids can be rejected. If all bids received are unacceptable for any of the reasons cited above, the project can resolicit bids.

(4) Review of Approved Bids by the Department

AAA approved bid packages shall be submitted to the Department for review.

Proposed contracts with profit-making organizations shall require final approval from the Department. All bid packages shall include:

(A) A copy of the letter of solicitation for bids.

(B) A copy of advertisements of bids showing names of newspapers and dates published.

(C) A list of names and addresses of caterers the project contacted directly.

(D) A copy of the total bid packet sent to caterers, including the sample menu and bid specifications.

(E) A list of organizations who declined to bid and their reason if known.

(F) A copy of each detailed bid quotation.

(G) A description of the bid opening - date, location, persons in attendance, and organizations they represent.

(H) A description of criteria used for evaluation of bids and bidders and the rank given to each criterion.

(I) A description of involvement of the Project Council and grantee agency's governing body in evaluation of bids and selection decision.

(J) The name and address of selected bidder.

Note: If the lowest bid had not been chosen, specific, strong justification for choosing a higher bid shall be provided.

(K) A completed copy of the "Caterer's Assurance for USDA Cash Reimbursement". The level of USDA Cash Reimbursement is left blank until reimbursement level is known.

(L) A copy of the contract to be signed with caterer.

(d) Operating Requirement for nutrition service providers

(1) Staffing

(A) Adequate Number to Operate Program

Nutrition service providers shall employ adequate numbers of qualified staff to assure satisfactory conduct of the service in keeping with the provisions of this Manual.

(B) Employment Preference give to 60+

Preference should be given to employing persons age 60 and over.

(C) Consideration given to Employing Minorities

Consideration should be given to employing minority individuals at least in proportion to the numbers of minority older persons represented among the service area's populations.

(D) Nutritionist Staff Requirement

Each service provider that receives Title III-C funds shall be established and administered with advice of a nutritionist. In addition the nutritionist shall be responsible for menu development, nutrition screening and education, monitoring of food preparation and in-service training of food service personnel and volunteers. The nutritionist shall meet the following minimum qualifications:

Shall have two years of recent relevant full time work experience preferably in geriatric nutrition food service management or community nutrition, in addition to one of the following criteria:

(i) Registered Dietitian, or

(ii) State certified dietitian/nutritionist, or

(iii) Bachelor's Degree from an accredited four year institution with a major in foods and nutrition, institutional food management, community nutrition dietetics or related field.

One year of the work experience requirement may be waived with possession of Registered Dietitian status, and/or Master's degree from an accredited institution in nutrition, dietetics, institutional food management, public health, business administration or relate field.

(E) Nutrition Assistant

A Nutrition Assistant, under the supervision of the Nutritionist on staff or Nutrition Consultant on contract, may also provide nutrition education and conduct eligibility and nutritional screening interviews. The Nutrition Assistant shall meet the following minimum qualifications:

(i) Diet Technician, Registered; or,

(ii) Associate degree or equivalent from an accredited program with a major in foods and nutrition, community nutrition, dietetics or related field.

(2) Congregate Meals

(A) Requirement that the Area Agency on Aging approve all New, Reopened, or Relocated Meal Sites Prior to Opening.

The Area Agency on Aging shall approve all new, reopened or relocated sites prior to opening. This applies to temporary as well as permanent locations. The following shall be considered when granting approval:

(i) In the case of closing the site: the reason and procedures used to notify the participants and public;

(ii) In site relocation: the reasons and procedures to assure continued participation at the new location;

(iii) In a new or reopened site: location and assurances that it meets local and state fire, safety, sanitation and building requirements.

(B) Congregate Nutrition Provider Requirements

Each congregate nutrition service provider shall:

(i) Provide at least one hot or other appropriate meal in a congregate setting at least once a day, five or more days per week;

(ii) Locate congregate nutrition services as close as possible to, and where feasible and appropriate, within walking distance of the majority of eligible older persons, especially those in the greatest social and economic need;

(iii) When necessary (in case of illness, injury, etc.) make home delivered meals available to congregate mealsite participants;

(iv) Serve a minimum of 98% of all meals to eligible participants and their spouses;

(v) Develop procedures for responding to emergency situations for all congregate sites and provide ongoing training on emergency procedures to all site managers and other site staff;

(vi) Where feasible, seek out and be involved in local group purchasing efforts.

(vii) Make nutrition education available to mealsite participants at a minimum of once each quarter. Each Area Agency on Aging shall submit nutrition education plans for approval to, the Department or Area Agency on Aging nutritionist one month prior to the start of each program year.

Nutrition education sessions shall be conducted by the nutritionist, other health professionals with adequate background and training in nutrition, or nutrition assistant.

Nutrition education subjects shall be based on the needs of the participants. Nutrition information and visual educational materials shall be available to the participants on a continuing basis.

(C) Congregate Nutrition Site Requirements

Each congregate nutrition site shall:

(i) Have a designated site manager who is responsible for activities at the site.

Where Title III-C funds are utilized, they can pay for a maximum of 5 hours per mealtime if an average of 25 or more participants are served; and, for a maximum of 3 hours per mealtime if fewer than an average of 25 participants are served. If home delivered meals are prepared at a site serving fewer than 25 participants, Title III-C funds can pay for a maximum of 5 hours if a waiver is received from the Area Agency on Aging.

(ii) Where possible, local support should be sought for mealsite operations.

(iii) Serve an average of at least 25 participants per mealtime unless a waiver is received from the Area Agency on Aging. If fewer than 25 participants are served, consideration shall be given to providing meals in single serving units;

(iv) Be located in a facility which meets the accessibility requirements of the Americans With Disabilities Act of 1990 or, if not accessible, be located in an ENP catchment area. (An ENP catchment area is an area within the Project Service area containing at least one accessible site. Transportation shall be available to and from the site designated as accessible from all points in the catchment area);

(v) Be located in a facility where all eligible individuals will feel comfortable visiting. Site selection shall take into consideration the type and location of the facility so as not to offend the cultural and ethnic preference of the eligible individuals in the service area;

(vi) Meet all Local and State fire, health, safety and building codes;

(vii) Be open for at least three hours per mealtime unless a waiver is received from the Area Agency on Aging;

(viii) Be neat, clean and have adequate lighting, ventilation, and temperature control.

(ix) Establish written food handling procedures and provide site staff and volunteers with ongoing training and monitoring;

(x) Serve meals at a pre-established time each day.

(xi) Serve all hot food within 2 hours from the time food preparations ends unless a waiver is received from the Area Agency on Aging. Maintain hot foods at a temperature above 140°F. and cold foods at below 45°F (41°F after October 1, 1997) from the time preparation ends until the food is served to a participant. Reheat to 165°F hot foods received at 130°F to 140°F. Refuse or discard hot foods received at less than 130°F and potentially hazardous cold foods received at more than 50°F, and have available shelf stable or other suitable substitute foods as replacement.

(xii) Be equipped with the proper utensils to ensure portion control;

(xiii) Have an established procedure for closing the mealsite in inclement weather, and for informing the participants about the closing.

(3) Home Delivered Meals

Each home delivered meals provider shall:

(A) Assess the needs of, and complete the elderly nutrition assessment form (W689) for intakes on all eligible home delivered meals applicants annually or more often as necessary. (See 17b-423-5(g) (2) for definition of eligibility.) Individuals whose names have been on a waiting list for longer than six months shall be re-screened.

(B) Establish target groups for receipt of home delivered meals;

(C) Provide a nutritious home delivered meal at least once a day, 5 days a week.

Meals may be hot, cold, frozen, dried, or canned foods with a satisfactory storage life;

(D) With the consent of the older person, or his/her representative, bring to the attention of appropriate officials for follow up conditions or circumstances which place the older person or the household in imminent danger;

(E) Make arrangements for the availability of meals to older persons in weather related emergencies;

(F) Assist participants in taking advantage of benefits under other programs;

(G) Deliver meals to participants' homes within 2 hours after completion of preparation, unless a waiver is received from the Area Agency on Aging. The temperature shall be maintained above 140°F for hot foods, below 45°F (41°F after October 1, 1997) for cold foods and at 10°F for frozen meals from the time food preparation ends until the food is delivered to the participant's home.

(H) Offer nutrition education to home bound clients or their caretakers at least twice per year. One session should be a discussion with client or caretaker, unless refused by client or caretaker or deemed unproductive by the provider on a case by case basis.

(I) Appropriately instruct clients or their caretakers on the following safe practices for handling delivered food, as they may apply:

(i) To eat hot food within 1 hour of delivery.

(ii) To eat cold foods immediately or place them in the refrigerator.

(iii) To eat fast chilled meals within 3 days of delivery and to store them at 41°F or less.

(iv) To eat frozen meals within 1 month of delivery and to store them at 10°F or less.

(v) To have an accurate thermometer in their refrigerator if they store fast chilled meals, and one in their freezer if they store frozen meals.

(e) Food Procurement, Food and Nutrition requirements for Nutrition Service Providers

(1) Food Procurement

(A) USDA Food Assistance

(i) The Department has an agreement with the USDA State Distributing Agency to assure the availability of food, cash, or a combination of food and cash to nutrition service providers.

(ii) Those nutrition service providers receiving cash instead of food from USDA shall spend the USDA cash only for U.S. agricultural commodities and other food.

(iii) In the case of the caterer using commodity foods: The caterer shall allow to the elderly nutrition project a credit equal to the value of the USDA Commodities that are furnished to the caterer for use in the program.

(iv) In the use of USDA Commodities, sufficient precautions should be taken to transport and store commodities to preserve their quality and prevent theft.

(B) Food Stamp Program

Nutrition service providers shall assist participants in taking advantage of benefits available to them under the food stamp program.

(2) Food Requirements

(A) For Purchasing, Preparing and Delivering Meals

In purchasing food, and in preparing and delivering meals, the nutrition service providers shall follow appropriate procedures to preserve nutritional value and food safety.

(B) Provision of Special Menus

Nutrition service providers shall provide special menus, where feasible and appropriate, to meet the particular dietary needs arising from the health requirements, religious requirements, or ethnic backgrounds of eligible individuals. In determining feasibility and appropriateness, a provider shall use at least the following criteria:

(i) Whether there are sufficient numbers of persons who need the special menus to make their provision practical; and

(ii) Whether the food and skills necessary to prepare the special menus are available in the planning and service area;

(C) Availability of Appropriate Food Containers and Utensils

Nutrition service providers shall use, upon request, appropriate food containers and utensils for blind and handicapped participants.

(3) Food Quality and Safety

(A) Standards of Quality, Sanitation and Safety

(i) All personnel and facilities involved in producing or dispensing foods or beverages for the elderly, including caterers, shall comply with State of Connecticut Public Health Regulations 19-13-B42 and B48, as amended.

(ii) Meals shall be delivered to a congregate site or home delivered meal recipient within two hours after completion of preparation unless a waiver is received from the Area Agency on Aging. The temperature shall be maintained above 140°F for hot foods, below 45°F (41°F after October 1, 1997) for cold foods and at 10°F or below for frozen meals from the time preparation ends until the food is delivered (whether to the participant's home or to the congregate site). The Area Agency on Aging may grant a waiver for the 2 hours and extend the delivery time if proper equipment is used and if the ENP will agree to conduct regularly scheduled monitoring to assure that proper food temperatures and food quality are maintained throughout the delivery process (from the time food preparation ends until the food is delivered, whether to the congregate site or to the participant's home). The total time of rethermalization, delivery and holding of potentially hazardous hot food, shall not exceed 4 hours. In issuing the waiver, consideration shall be given to progress made toward reducing the total time to two hours or less.

(III) Meal sites storing quick-chilled food shall protect it from contamination (and oxygen where practical) and store it at 35°F or less. The total time between initial cooking and eating of quick-chilled food shall be no longer than 5 days unless extended by written authorization from the Department.

(B) Requirement to Use Only Commercially Processed Foods

No food prepared, frozen or canned in the home may be used in meals provided by projects financed through Title III. Only commercially processed canned and frozen food may be used.

(C) Items Prohibited from Purchase with Title III, Part C.

Nutrition service providers may not purchase vitamins and/or mineral supplements, nor alcoholic beverages, with funds under Title III, Part C.

(D) ENP Reporting Procedures Regarding Food Borne Illness

The ENP shall report immediately the occurrence, or suspicion of, any incidence of food borne illness to the proper public health authorities, to the Area Agency on Aging, and to the Department.

(E) Cooling Rate and Storage Requirements for Kitchens

Potentially hazardous food shall be served within 4 hours of cooking or meet cooling rate and length of storage requirements specified in writing by the department and use a batch coding system specifying an "eat by" date.

(F) Record of Recent Health Inspection

A recent (within 180 days) health inspection report having a score of 90 or above with no unresolved 4 point items shall be kept on file.

(4) Nutrition Standards

(A) Nutritional Value of Menus

The nutritional value of menus shall be confirmed either by

(i) nutritional analysis,

(ii) conformance to a department approved meal pattern,

(iii) selection from a list of department approved menus with accompanying recipes, or

(iv) an individually prescribed menu.

If the value of menus is confirmed by nutritional analysis, each regular meal shall provide all essential food components in amounts specified in writing by the department. If two meals are served per day, food components may be averaged over two meals; if three meals are served, over three meals. Fat and fat soluble vitamins may be averaged over one week.

More rigorous dietary standards may be used at the discretion of the nutritionist to improve nutrition, flavor, appearance, texture or smell.

(B) Fruit Requirement

Fruit (including fruit juices) shall be served at least three times every six meals with fresh fruit served at least once subject to seasonal quality.

(5) Menu and Recipe Requirements

(A) Menus

Menus shall specify amount of each item to be prepared and served, and shall reference all recipes used in the preparation of mixed dishes.

(B) Recipes

Tested quality recipes, adjusted to yield the numbers of servings needed, shall be used. Each recipe should specify cooking, cooling and storage procedures as well as exact ingredient amounts and preparation instructions, to assure the production of a uniform, high quality and safe food or dish.

(C) Certification Required

Menus shall be certified in writing by the nutritionist as providing at least one-third of the current recommended dietary allowances (RDA's) of The National Academy of Sciences for energy, protein, vitamins and essential minerals, and as conforming to theDietary Guidelines for Americans. Menus shall be submitted to the Department or Area Agency on Aging nutritionist at least two weeks prior to use for review of nutritional adequacy.

(D) Certification of Individually Prescribed and Therapeutic Menus

Individually prescribed menus, including menus for each type of therapeutic diet, shall be certified by a registered dietitian of the American Dietetic Association.

(E) Record Keeping

Recipes and certified menus shall be kept on file at the nutrition provider's office for a minimum of two years following the year during which they were in use.

(6) Funding restricted for foods not conforming to menu

No funds authorized under this section shall be used to pay for foods served that fail to conform to the menu, without approval by the nutritionist.

(7) Leftover Food

Only the following may be taken from the meal site and at the discretion of the manager: fruit, baked goods and other foods in individually sealed units that have been protected from contamination and held at 45°F (41°F beginning October 1, 1997) or less. All other food shall be offered as a second serving or discarded. Potentially hazardous food offered as a second serving shall be protected from contamination and held at 140°F or more if hot, and at 45°F (41°F beginning October 1, 1997) or less if cold.

(f) Coordination with other providers/educators in the PSA

Title III nutrition services may be coordinated with other preventive medicine, health maintenance and in-home service providers; with the University of Connecticut Cooperative Extension and other nutrition and physical fitness educators; and, with providers of elderly services in the PSA. Coordination may involve joint planning and resource sharing.

(g) Eligibility

(1) Congregate Nutrition Services

(A) Program Participants

Persons eligible to participate in this program include: a participating person age 60 or older, and the spouse of the person regardless of age; and handicapped or disabled individuals who have not attained 60 years of age, but who reside in housing facilities occupied primarily by the elderly at which congregate nutrition services are provided.

(B) Volunteers/Individuals with Disabilities

Each Area Agency on Aging shall establish procedures that will allow nutrition projects the option to offer a meal, on the same basis as meals are provided to elderly participants, to individuals providing volunteer services during meal hours, and to individuals with disabilities who reside at home with and accompany older eligible individuals.

(2) Home Delivered Meals

Persons eligible to participate in this program include: a person age 60 or older who is homebound because of illness, or incapacitating disability, or who is otherwise isolated; and the spouse of the older person, regardless of age, if, according to the criteria established by the Area Agency on Aging, receipt of the meal is in the best interest of the older person; and a non-elderly disabled person who is a member of the household of an elderly home-delivered meals recipient.

(3) Assessment of Need

The Area Agency on Aging shall assess the level of need for congregate and home delivered meals within the planning and service area.

(h) Contributions for Nutrition Services

(1) Mandated Uses of Contributions

Nutrition services contributions shall be used to increase the number of meals served by a project, to facilitate access to such meals, and to provide other supportive services directly relate to nutrition services.

(2) Area Agency on Aging Policy on Contributions

Each Area Agency on Aging shall develop clear written policies for use by its service providers regarding contributions for services received through the program. These policies shall include:

(A) A statement stressing that no older person shall be denied service for failure or refusal to contribute to the cost of the meal.

(B) Meal fee policies for non-participants.

(C) A procedure which ensures the confidentiality of individuals' contributions.

This may include highly specific steps such as placement of a contribution box or collection of envelopes. The procedure determined by the Area Agency on Aging should avoid giving participants the impression that there is a fee for nutrition services.

(D) Procedures to safeguard and account for all contributions; which should include the counting of donations by at least two people, and the regular deposit of contributions.

(3) Cost of meals for Non-Participants

The cost of meals to non-participants shall, at a minimum, include the following costs: raw food, labor, transportation of food, utilities, cost of disposables.

(Adopted February 26, 1992; Amended June 2, 1992; Transferred and AmendedOctober 7, 1997)