General Requirements. Unless otherwise indicated, all general requirements apply to both new construction and an existing nursing home. Food Service Department. The size and location of the food service area shall comply with COMAR 10.15.03. A catered or satellite system shall be covered by a contract approved by the Department. The vendor providing the food shall have a valid food service permit. Outside Service Entrance. A convenient outside service entrance shall exist to facilitate receiving food supplies and the disposal of waste. Restriction — Entry to Kitchen or Serving Pantry. A toilet room or sleeping room may not open directly into any kitchen or serving pantry. Limitations on Use of Kitchen. The kitchen may not be used as a passageway. It shall be used for no other purpose than activities connected with food service. Janitor Closet or Service Area. Janitor Closet — New Construction. A janitor closet or service alcove for the exclusive use of food service areas shall be provided in, or adjacent to, the dietetic service department. The janitor closet or service alcove shall be: Equipped with: A utility sink; Storage shelves; and A rack for hanging brooms and mops; and Connected to mechanically operated exhaust ventilation. The plumbing fixture for the utility sink within a janitor’s closet shall be provided with an approved back-flow prevention device. Space. There shall be sufficient floor space in the food service department to permit all activities to function efficiently without overcrowding or increasing the risk for cross-contamination of food or equipment from soiled surfaces. Minimum Space Requirements — New Construction. Space — Existing Nursing Home. A nursing home that holds full licensure as of the adoption date of these regulations shall be considered to have an adequate size dietetic service department. Renovations of all kitchens shall be approved by the Department, which will consider modification of the minimum space requirement based on space available, costs, and type of service. Aisle space between working areas shall be at least 3 feet, and aisle space for main traffic shall be at least 5 feet wide. Ceiling height shall be at least 9 feet. If the licensed capacity of a nursing home is increased, or if meals are provided to anyone outside of the nursing home from the food service area of the nursing home, the nursing home shall provide an additional food service area in accordance with this chapter. The additional food service area required when meals are provided to anyone outside of the nursing home is to be calculated by using the total number of individuals to whom meals are provided. The kitchen space requirement as described in this regulation does not apply to occasional special functions such as picnics or dinners for residents, volunteers, families, or community groups as long as the nursing home certifies to the Department that providing meals for a special function will not adversely affect or detract from the timely provision of meals to the nursing home’s residents. Floor Pantries — New Construction. There shall be at least one food service floor pantry per nursing care unit. This area shall be of sufficient size to accommodate the equipment required for food preparation and service. The equipment provided in food service floor pantries shall comply with the requirements of the local health department. A food service floor pantry shall include the following: Refrigerator; Cabinets for dry storage and supplies; Work space; Sink for purposes other than hand-washing; Hand-washing sink with soap dispenser and disposable paper towel dispenser; and Except for trays that are assembled in the main kitchen and then distributed to the nursing care units, equipment to hold hot food if bulk foods are plated and served to the residents on the nursing care unit. A food service floor pantry shall include the following additional equipment: Toaster; Ice-making machine or ice-storage container; Work space for tray preparation; Equipment to deliver completed trays; Three-compartment sanitizing sink or dishwasher; Cabinet for dry storage, supplies, and kitchenware; and Storage for trays, tableware, flatware, and utensils. Equipment for Food Preparation and Distributions. Adequate equipment for preparation, serving, and distribution of food shall be provided. A dumbwaiter, elevator, or ramp shall be provided in a nursing home of more than one story where more than eight residents above or below the kitchen level receive bedside tray service. Equipment to protect food from dust or contamination and to maintain food at proper temperature shall be provided to transport food to the residents. Dry Food Storage. Food Storage Space. Adequate space shall be provided to store food supplies. The amount of storage space needed to store food depends on the frequency of deliveries. It is recommended that 2 square feet per resident be provided and that the dry food storage area be located within easy access to the receiving area and the kitchen. The storeroom shall be cool and well-ventilated. All food supplies shall be stored off the floor and away from the wall to allow for cleaning. Refrigerated Storage. Adequate refrigerated storage, refrigerators, and frozen food storage cabinets shall be provided and regulated to maintain temperatures prescribed in COMAR 10.15.03. Food in storage shall be arranged so that new food items are stored behind old food items. The oldest foods shall be used first, known as the first in, first out method. Mobile Food Carts. All policies and procedures for the mobile food cart shall be approved by the Department and the nursing home’s local health department before implementation. Policies and procedures shall address, at a minimum the following: Identify how many staff members will assist with serving food items, pushing the mobile cart, and delivering meals to the residents; Ensure proper food protection on three sides to protect the food; Maintain proper temperature control, hot food at a minimum of 135°F and cold food maintained at a maximum of 41°F; Record of temperatures before serving meals on each individual unit; Ensure proper food temperatures; and Hand washing. The hand washing policy and procedures referenced in §L(2)(f) of this regulation shall include the following: Use of a hand sanitizer in lieu of proper hand washing is not permitted; Bare hands may not have direct contact with ready-to-eat food; Hand washing shall be done before starting meal service on each individual unit; When and at what location hand washing will be done; Hand washing may not be done in resident rooms; Access to a hand washing sink may not require the opening of a door; The hand washing sink shall be in a central, unobstructed location; Mobile hand sinks are acceptable as long as a written procedure to meet sanitation requirements is developed; The hand sink shall be supplied with hot and cold water under pressure; The unit shall be supplied with adequate waste containers to hold dirty water until dumping is done; and The written procedure shall include the disposal of the dirty water.