Food safety

Your Guide to Nursing Home Kitchen Regulations for Food Safety Success

Discover the ins and outs of nursing home kitchen regulations in this in-depth guide.

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Discover the ins and outs of nursing home kitchen regulations in this in-depth guide.

"Nursing home kitchens in 'horrible' condition endanger the elderly, advocates say."

This is not the type of headline you want associated with your nursing home facility. Ever. News stories like that are the very reason nursing home kitchen regulations exist in the first place.

Just think of the elderly loved ones in your life who are or may need to be in a nursing home one day...

Seeing a headline like the NBC one above would make you feel uncomfortable, concerned, untrusting, and angry. You'd likely empathize with and want to advocate for your loved one.

As a nursing home kitchen staff member — whether you're a cook, kitchen or dietary manager, or supervisor — you appreciate weight of these regulations more than the average person, and know just how important they are for keeping elderly residents safe.

That's half the battle. The other half is ensuring that you and your team comply with the nursing home kitchen regulation, which you'll be even more confident in by the end of this article.

Key points covered:

  1. 33% of nursing homes violated federal requirements to store, prepare, and serve food safely. Unsafe food handling was the third most frequently cited violation.
  2. Nursing home kitchens should implement systems to ensure food safety, starting with the 4 C's: cleaning, cooking, cross-contamination prevention, and chilling.
  3. Nursing home facilities need to designate a food and nutrition services director if they don't have a clinically qualified dietician or professional.
  4. Only ever source food for nursing homes that have been approved at the local, state, or federal levels.
  5. If visitors bring residents food from an outside establishment, make sure that they adhered to your facility's specific policy. Don't forget to obtain a copy of the outside food establishment's last approved inspection.
  6. FoodDocs is a smart food safety monitoring software that nursing homes can use to fully customize kitchen tasks, easily verify that they've been completed, and even add educative instructions to train your team and ensure compliance.


Understanding the importance of nursing home kitchen regulations

Before jumping into the regulatory details of nursing home kitchens and food, let's set the stage with some food-related nursing home statistics courtesy of Long Term Care Community Coalition's LTC Journal:

  • Nursing homes reported 230 foodborne illness outbreaks, resulting in 54 deaths, 532 hospitalizations, and 7,648 sickened people over a two-decade period.
  • The 3rd most frequently cited violation was unsafe food handling. In fact, 33% of nursing homes violated federal requirements to store, prepare, and serve food safely.
  • 1/3 of nursing homes over the last eight years have been cited at least twice for the same food violation.

(Note: The board at FairWarning, an investigative news organization with an emphasis on public health, dissolved the charitable nonprofit in February 2021.)

Those eye-opening nursing home stats go to show why nursing homes and the teams running them must hold themselves to such high standards. They're arguably working with the most vulnerable and at-risk population, which is why they need to more effectively and consistently uphold nursing home food regulations.

Senior woman with caregiver or healthcare worker indoors, preparing food.

4 Key food safety measures in nursing home kitchens

Following simple yet critical food safety practices goes a long way to keep nursing home kitchens safe and protect the residents they serve safe. Inspired by the 4 C's of food safety, nursing home kitchens should implement systems to ensure:

1. Thorough cleaning

Compared to assisted living and independent living, nursing home residents require higher degrees of medical attention across the board. Especially with activities such as taking baths or showers, getting dressed, taking medications and, of course, feeding. All the more reason to stay on top of regular cleaning procedures.

In the context of nursing home kitchens, cleaning applies to:

  • Sanitizing food contact surfaces to eliminate the risk of microbiological hazards that dust, for example, can cause. This includes floors, countertops, windows, walls, and hood fans to name a few.
  • Cleaning raw materials that are produced in-house or shipped to your nursing home facility. For example, cleaning excess soil or debris on root crops.
  • Washing high-usage pieces of kitchen equipment like utensils, meat slicers and grinders, and blenders. You can even download this free meat slicer cleaning poster and put it up in your nursing home kitchen.
  • Maintaining employee personal hygiene through frequent handwashing, clean kitchen uniforms and towels, trimmed fingernails, as well as neatly tied or covered hair. (If you haven't already, place this helpful handwashing poster above every sink in your nursing home kitchen area.

2. Proper cooking

A benefit of working in a nursing home kitchen is that your numbers, dining requirements, and dietary care plans are consistent. Kitchen staff know what to expect. Even the guest visiting are usually accounted for, which means cooks can stay alert and focused on proper cooking.

Cooking reduces the initial microbial load of foods to safe and edible levels by killing target pathogens. Ensure kitchen staff does this consistently by:

  • Reaching correct internal temperatures: measure this with a clean, professional grade thermometer to ensure that the nursing home food is evenly cooked and free of cold spots.
  • Following prescribed cook times: in addition to meeting the right internal food temperature, this is the safest way to ensure you're consistently cooking certain foods properly combined with internal food temperatures.
  • Serving hot food: Whether your nursing home plates meals individually or serves food in buffet-style hot plates, serving food hot prevents the development of pathogenic microorganisms. It goes without saying that if you're serving an evening meal shortly after it's cooked, you must keep the food temperature at least 63°C (145°F).
  • Reheating leftovers: Previous handling and time play a crucial role in deciding when you should or should not keep let alone reheat leftover food. If you're nursing home food has been exposed to unsafe temperatures or the temperature danger zone (40°F to 140°F (5°C to 60°C) for more than two hours, discard them. With the leftovers you do keep, ensure kitchen staff reheats them again to 74°C (165°F).

Cooking temperature log

Digitalize your cooking temperature log with FoodDocs.

3. Temperature control (i.e., chilling)

Chilling will keep food safety hazards at bay for both raw and cooked foods because it slows down pathogen reproduction. Cold food safety practices that nursing home kitchen staff need to consider are:

  • Chilling raw materials (e.g., uncooked meat) if they're not going to immediately use them.
  • Cooling leftovers that weren't served to residents with a two-stage cooling method to avoid having them food spend time in or even near the temperature danger zone.
  • Setting refrigerator temperatures between 0°C or 5°C (32°F and 41°F) for an effective chilling process.

Additional information to help with temperature control:

4. Prevention of cross-contamination

One of the quickest ways that pathogens and foodborne illnesses spread is through cross contamination. This typically happens in one of three ways: food to food, equipment to food, and people to food.

If your nursing home kitchen staff are not adhering to the safe food handling practices above, the chances of cross-contamination are high.

Thankfully, there are practical things the whole nursing home kitchen team can do to prevent cross-contamination:

  • Wash your hands between handling different raw food (e.g., after touching raw meat, wash your hands before handling vegetables).
  • Ensure nursing home kitchen staff use clean uniforms, protective gear like hairnets and disposable gloves, utensils and other cooking materials that come in contact with food; ensure everything dirty gets placed properly in the laundry hamper, dish pit, etc.
  • As hard as it might be to be down a cook when a dining room full of hungry nursing home residents needs to eat, emphasize the importance of staying home when sick. While other kitchen staff may get sick, the elderly residents are highly susceptible to illnesses, too, which can spread to their food.
  • Use specific chopping boards for specific foods and adequately clean nursing home kitchen surfaces during the preparation of foods.
  • And what the year 2020 re-taught everyone, wash your hands properly.


How to operate a nursing home kitchen that's in compliance with federal and state regulations

The Centers for Medicare and Medicaid Services (CMS) State Operations Manual is 863 pages. That's a whole lot of pages and we're aware there's only so much time in a day. However, we encourage to check it out for yourself.

In the following section, you'll find the most important aspects of the CMS State Operations Manual that that relate to nursing home kitchen regulations. The following paragraphs will not explore the intricacies of meeting every residents’ individual food preferences, accommodating nutritional needs, or how to support their nutritional well-being while respecting an individual’s right to make choices about his or her diet. We cover those things and more in CMS dietary regulations for nursing homes.

Our goal is to present the guidelines in a simplified way and provide practical information that will help alleviate some of your day-to-day stress.

Training and Education for Nursing Home Kitchen Staff

Section 483.60(a)(2) Staffing

If the nursing home does not have a qualified dietician or professional who isn't clinically qualified, the facility needs to designate someone to serve as a director of food and nutrition services. A few people could qualify for this position, including someone who:

  • Is a certified dietary manager
  • Is a certified food service manager
  • Has an equivalent food service management and safety certification
  • Has a food service or hospitality management degree at an associate's level or higher
  • Has two or more years of experience as a director of food and nutrition services at a nursing facility
  • Has completed a completed food safety and management course that covers topics such as food purchasing and receiving, sanitation procedures, and foodborne illnesses (by no later than October 1, 2023)

Procuring and Serving Food in Nursing Homes

Section 483.60(i) Food safety requirements

The nursing home facility must:

  • Procure food from sources that the local, state, or federal authorities approve or consider satisfactory. It's important to note that facilities can still produce food in an on-site garden and residents can still consume food procured outside of their nursing home of residence, so long as they adhere to the policies and guidelines.
  • Use professional food safety standards to guide their storage, preparation, and distribution of food. This will help enable nursing homes to prevent foodborne illness and maintain safety especially in periods of change (e.g., changing from buffet style dining to portable steam tables).
  • Dispose of garbage and refuse properly. This includes using containers that don't leak and properly contain waste products, garbage storage areas that prevent pests, and proper coverage or waste when moving it from one location to another. Using a pest management system template can simplify this process for you.
  • Have and make clear policies around storing and bringing food from outside sources (e.g., family and friends). Improper storage, handling, and consumption can result in the resident falling ill. Melissa Vaccaro, MS, CHO, CP-FS is the co-author of the SURE Complete HACCP Food Safety Series. On this topic, Vaccaro says:

"When writing SOPs for this scenario, remember that the facility did not make this food, nor did it transport this food to the facility for the resident; therefore, the facility’s primary concern should be to not only protect the resident, but to safeguard other residents from potential contamination as well. Setting ‘rules’ in a residential care setting such as a nursing home can be tricky, as we don’t want to stifle the free will and rights of residents, but we do want to protect them from potential harm when we can."

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Monitoring and Inspections

Section 483.60(i)-(2) Definitions

Safe food receiving and storage procedures are paramount. Food service staff must:

  • Inspect food items for safe transport and quality, and store them appropriately.
  • Cover, label, and date all Potentially Hazardous Food (PHF) or Time/Temperature Control for Safety (TCS) Food, as well as keep track of when to discard of them respectively.
  • Maintain the working condition of refrigerators and freezers, ensuring that they're keeping foods at or below 5°C (41°F).
  • If, for example, a visitor brings a resident food from an outside establishment, make sure that the visitor adhered to your facility's specific policy. You must also obtain a copy of the last approved inspection for the facility from which the visitor brought food.

A note on state-specific laws: While this article doesn't cover specific state requirements, there are similarities across the board. But be sure to inquire about state-specific food safety regulatory laws to keep your facility operating legally.

How FoodDocs improves your nursing home kitchen's food safety compliance

As a nursing home, your food safety standards are far stricter — and rightly so. You continue to support a highly vulnerable and susceptible demographic.

FoodDocs understands this and has created a powerful smart food safety monitoring software. It allows you to:

  • Fully customize your food safety monitoring tasks
  • Easily verify tasks that have been completed by kitchen staff
  • Add educative instructions to train your team and ensure compliance

Example from the FoodDocs app about how you can customize monitoring tasks.

Food System Safety Set Up with a web and mobile app in FoodDocs.

You can do all that (and more!) through a smart food safety system created by experts.

Say goodbye to sheets of paper, lost pens, and clunky clipboards.

Say hello to a sleek, easy-to-use app that will put +20% more time back in your day so you can focus on what matters most — providing high-quality care for your nursing home residents.


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Frequently Asked Questions (FAQs)


Can you reheat food in a nursing home?

Yes, you can reheat food in a nursing home. Just make sure that kitchen staff reheats them again to 74°C (165°F). Discard the leftovers if they've been exposed for more than two hours to unsafe temperatures or the temperature danger zone (40°F to 140°F (5°C to 60°C) for more than two hours, discard them.

What should you not serve at an assisted living facility?

It's advised that nursing homes not serve the following foods to their residents:

  • Meats, poultry, fishRaw or undercooked meat, poultry, fish, or seafood
  • Milk, milk products, and juices that are raw or unpasteurized
  • Cookie dough, cake batter, salad dressings like Caesar, and protein milkshakes (i.e., anything that includes raw or partially cooked eggs)
  • Luncheon meats and hot dogs (unless kitchen staff reheat them to at least 165°F)
  • Brie, Ricotta, Chevre, Camembert, and other soft cheeses (unless you've confirmed that they were made with pasteurized milk)
  • Uncooked sprouts (e.g., alfalfa, radish, clover, bean)

What food is good for nursing homes?

Nursing homes should include protein-rich meals on their menus. They promote the creation and maintenance of muscle mass, stronger immunity, and improved heart function. This is not an exhaustive list, but foods you should include are:

  • Beans
  • Eggs
  • Fish
  • Grilled chicken
  • Nuts
  • Sausages
  • Steaks These food items help seniors maintain muscle mass, increased immune functions, and better cardiovascular function.

What are the considerations when preparing food for a nursing home resident?

Some of the most important things kitchen staff should not do while handling, preparing, and cooking food are:

  • Eat or drink on the line
  • Smoke
  • Chew gum
  • Come to work sick

Some of the most important things kitchen staff should do while handling, preparing, and cooking food are:

  • Wear clean uniforms and proper hair coverings
  • Properly wash hands before, between, and after different kitchen activities

Is it acceptable to serve a rare hamburger in a nursing home?

Nursing home kitchens should never serve rare hamburger due to the high risk of causing foodborne illness. Because nursing home residents can have compromised immune systems, they may not be able to survive a bout of food poisoning caused by harmful bacteria like E. coli.


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