SOP 409.04.09: Modified Diets/Special Feeding

|GEORGIA DEPARTMENT OF CORRECTIONS
Standard Operating Procedures|Col2|Col3|
|---|---|---|
|Policy Name: Modified Diets/Special Feeding|Policy Name: Modified Diets/Special Feeding|Policy Name: Modified Diets/Special Feeding|
|Policy Number:409.04.09|Effective Date:6/7/2022|Page Number: 1 of 10|
|Authority:
Commissioner
|Originating Division:
Executive Division (Georgia
Correctional Industries - Food
and Farm Services)|Access Listing:
Level II: Required Offender
Access|

I. Introduction and Summary:

A. It is the policy of the Food and Farm Service’s Subdivision to provide Georgia

Department of Corrections (GDC) State Prisons and Centers, which operate
kitchens for preparation of the GDC Master Menu, with procedures for providing
Modified Diets and accommodating offenders with special feeding needs. This
policy shall establish and outline standard procedures for the following:

1. Ordering of Therapeutic Diets by GDC Health Services;

2. Recording the refusal of Therapeutic Diets;

3. Preparation and delivery of Therapeutic Diets;

4. Delivery and receipt of late meals; and

5. Providing a system for the delivery of physician-ordered between meal

feedings.

B. Exceptions may be made for contracted food service operations.

II. Authority:

A. O.C.G.A §42-2-11;

B. GDC Standard Operating Procedure (SOP): 507.04.29 Therapeutic Diets; and

C. ACA Standards: 2-CO-4C-01, 5-ACI-5C-05, 5-ACI-5C-06, and 5-ACI-5C-08.

III. Definitions:

A. Modified Diets - A diet that includes a meal plan differing from the regular GDC

Master Menu.

|GEORGIA DEPARTMENT OF CORRECTIONS
Standard Operating Procedures|Col2|Col3|
|---|---|---|
|Policy Name: Modified Diets/Special Feeding|Policy Name: Modified Diets/Special Feeding|Policy Name: Modified Diets/Special Feeding|
|Policy Number:409.04.09|Effective Date:6/7/2022|Page Number: 2 of 10|
|Authority:
Commissioner
|Originating Division:
Executive Division (Georgia
Correctional Industries - Food
and Farm Services)|Access Listing:
Level II: Required Offender
Access|

B. Master Diet Roster - A list of all offenders who must receive medically

prescribed meals and snacks. This list is created electronically and printed at each
facility.

C. Calorie Restricted Diets - A modified diet that provides a specific caloric value

and automatically includes an HS snack and third meal on weekends and
holidays. This includes Diabetic, Hypoglycemic, and Weight Reduction diets.

D. Therapeutic Diets - A diet based on the dietary restrictions incurred as a result

of a medical need (i.e., diabetes) per SOP 507.04.29, Therapeutic Diets.

IV. Statement of Policy and Applicable Procedures:

A. Master Diet Roster:

1. All diets and snacks prescribed by medical shall be entered into an offender

management system approved for medical use by GDC. The length of time
the offender is to remain on the diet must be included by Medical Services.

2. A Master Diet Roster will be printed by the Food Service Director or

designee daily and shall include the following information (Refer to
Attachment 2, Master Diet Roster):

a. Last and first name of the offender with their corresponding ID number;

b. The current diet and expiration date of the diet order; and

c. Date in which the roster is in effect.

3. The medical department will manage diet orders at all facilities and will input

any new diets into SCRIBE on a daily basis.

|GEORGIA DEPARTMENT OF CORRECTIONS
Standard Operating Procedures|Col2|Col3|
|---|---|---|
|Policy Name: Modified Diets/Special Feeding|Policy Name: Modified Diets/Special Feeding|Policy Name: Modified Diets/Special Feeding|
|Policy Number:409.04.09|Effective Date:6/7/2022|Page Number: 3 of 10|
|Authority:
Commissioner
|Originating Division:
Executive Division (Georgia
Correctional Industries - Food
and Farm Services)|Access Listing:
Level II: Required Offender
Access|

4. The Food Service Department will be notified when Modified Diets are

necessary according to the following schedule:

a. By 5 p.m. the previous day in which the Breakfast Meal shall be served;

b. By 10 a.m. the same day in which the Lunch Meal shall be served; and

c. By 3 p.m. the same day in which the Dinner Meal shall be served.

5. Diet revisions made by telephone must be entered into SCRIBE within

twenty-four (24) hours.

6. The Master Diet Roster will be used to verify the delivery, receipt and/or

refusal of diet trays for all offenders. The Diet Roster should be initialed at
each meal by the Food Services Director or designee when a modified diet
tray is received by an offender. Refusal of a diet tray or failure of an offender
to pick up his/her tray must also be documented on the Master Diet Roster.

a. The initialed Diet Roster is used to put non-compliance data into the

approved operating system. The Food Service Director or designee is
responsible for entering information pertaining to non-compliance. A
weekly non-compliance report is printed by Food Service and sent to the
Medical Department for review.

B. Guidelines for Recording Refusal of Therapeutic Diets:

1. When an offender refuses to adhere to a Therapeutic Diet prescribed by

Medical Services, the offender will be required to sign Attachment 2,
Modified Diet Waiver Form.

|GEORGIA DEPARTMENT OF CORRECTIONS
Standard Operating Procedures|Col2|Col3|
|---|---|---|
|Policy Name: Modified Diets/Special Feeding|Policy Name: Modified Diets/Special Feeding|Policy Name: Modified Diets/Special Feeding|
|Policy Number:409.04.09|Effective Date:6/7/2022|Page Number: 4 of 10|
|Authority:
Commissioner
|Originating Division:
Executive Division (Georgia
Correctional Industries - Food
and Farm Services)|Access Listing:
Level II: Required Offender
Access|

2. The Modified Diet Form will be filed in the offender's Medical Chart. If the

offender refuses to sign the form, documentation of refusal will be written on
the Modified Diet Form or in the Medical Chart.

3. The Master Diet Roster will be used to verify refusal of diet trays for all

offenders receiving a Therapeutic Diet.

a. Each week, two (2) copies of the noncompliance report from the previous

week will be generated using the approved computer system. One copy
will be sent to Medical Services for review.

b. Offenders who fail to pick up a prescribed diet six (6) times in one week

or fifteen (15) times or more in a month will be counseled by Medical
Services regarding their dietary noncompliance and the importance of
their diets. Offenders who continue to be non-compliant will have their
names submitted for review to the Medical Director requesting
permission to continue or discontinue the diet.

c. Consideration of medical condition, therapeutic benefit of the diet, and

degree of noncompliance will be involved in the decision to continue or
discontinue all diets.

d. All discontinued Modified Diets must be updated by medical services in

the approved offender management system

e. Any offender who is removed from the Master Diet Roster due to

non-compliance may not be placed back on a modified diet for sixty (60)
days.

C. Preparation and Delivery of Modified Diets:

1. All Modified Diets will conform as closely as possible to the regular menu,

|GEORGIA DEPARTMENT OF CORRECTIONS
Standard Operating Procedures|Col2|Col3|
|---|---|---|
|Policy Name: Modified Diets/Special Feeding|Policy Name: Modified Diets/Special Feeding|Policy Name: Modified Diets/Special Feeding|
|Policy Number:409.04.09|Effective Date:6/7/2022|Page Number: 5 of 10|
|Authority:
Commissioner
|Originating Division:
Executive Division (Georgia
Correctional Industries - Food
and Farm Services)|Access Listing:
Level II: Required Offender
Access|

however, variations in portion size and substitutions from the regular menu
may be made for special diets. Additional information on substitutions is
available by contacting the Food and Farm Central Office Registered
Dietitian.

2. Each facility preparing Modified Diets is required to follow the GDC

Therapeutic Plating Guide distributed by Food and Farm Services Central
Office Registered Dietitian. The Therapeutic Plating Guide will be available
on the serving line of the diet preparation area and followed when plating diet
trays.

3. The Food and Farm Central Office Registered Dietitian must be contacted for

recommendations if medical services request a diet not listed on the
Therapeutic Plating Guide. Recommendations shall be provided in writing.

D. Late Meals:

1. Late meals will be provided for the following offenders:

a. Offenders returning from medical appointments at ASMP or a local

hospital;

b. Offenders attending the clinic in their institution;

c. Offenders requiring laboratory tests or workups; and

d. New offender transfers to the medical facility at ASMP.

2. Medical Services will order any late meals required from the Food Service

Department by telephone. The offender's name, I.D. number, and type of diet
will be provided by Medical Services. The meal will be prepared and
delivered to the appropriate nursing unit by a Food Service employee.

|GEORGIA DEPARTMENT OF CORRECTIONS
Standard Operating Procedures|Col2|Col3|
|---|---|---|
|Policy Name: Modified Diets/Special Feeding|Policy Name: Modified Diets/Special Feeding|Policy Name: Modified Diets/Special Feeding|
|Policy Number:409.04.09|Effective Date:6/7/2022|Page Number: 6 of 10|
|Authority:
Commissioner
|Originating Division:
Executive Division (Georgia
Correctional Industries - Food
and Farm Services)|Access Listing:
Level II: Required Offender
Access|

3. The facility will order any late meals required from the Food Service

Department by telephone for an offender in the general population. The
offender's name, I.D. number, and type of diet will be provided by Security.

4. Documentation of modified diet and regular late meals will be recorded on

the Late Meal Record form by Food Service. Receipt of late meals in the
Medical Section will be recorded in the offender's medical record and receipt
of these meals in the general population will be recorded by Security on
Attachment 1, Late Tray Record Receipt.

5. Late meals requested after meal service will consist of foods that may be held

under refrigeration. Food and Farm Services Central Office Registered
Dietitian shall provide contents of late meals for offenders on a modified
(special) diet. For regular diets, these meals consist of:

a. 2 sandwiches (4 slices of bread with 2 oz. of luncheon meat and 2 slice of

cheese or 4 slices of bread with 2 oz. peanut butter);

b. ½ cup canned fruit or 1 piece of fresh fruit; and

c. 1 carton of milk.

E. Between Meal Feedings:

1. Between meal feedings will be provided to offenders when ordered by an

advanced clinical provider and/or dentist. All between meal feedings shall be
entered into the offender management system.

2. Expiration dates shall be entered with each diet snack order and shall not

exceed ninety (90) days.

|GEORGIA DEPARTMENT OF CORRECTIONS
Standard Operating Procedures|Col2|Col3|
|---|---|---|
|Policy Name: Modified Diets/Special Feeding|Policy Name: Modified Diets/Special Feeding|Policy Name: Modified Diets/Special Feeding|
|Policy Number:409.04.09|Effective Date:6/7/2022|Page Number: 7 of 10|
|Authority:
Commissioner
|Originating Division:
Executive Division (Georgia
Correctional Industries - Food
and Farm Services)|Access Listing:
Level II: Required Offender
Access|

3. The desired time for between meal feedings will be specified, such as A.M.

(8:30 a.m.), P.M. (2:00 p.m.), HS (hour before sleep), etc.

4. In-between meal feedings and HS snacks must be ordered as part of the diet

pattern and do not automatically apply unless a Calorie Restricted Diet has
been ordered. HS snacks and 3 meals x 7 days will be automatically provided
for Calorie Restricted Diets. 3 meals x 7 days will also be provided
automatically to offenders who receive the Low Protein diet. Offenders on
any other diet will not receive 3 meals on weekends unless specifically
ordered by a physician. Renal diet orders are only available at certain
facilities. Refer to SOP 507.04.29, Therapeutic Diets.

a. Regular Snacks: ½ sandwich will consist of 1 slice of bread with one 1

oz. of luncheon meat and 1 slice of cheese or 1 slice of bread with ½ oz.
of peanut butter. 1 sandwich will consist of 2 slices of bread with 1 oz. of
meat and 1 slice of cheese or 1 oz. of peanut butter.

1) A.M. Snack: ½ sandwich and 1 cup low-fat milk;

2) P.M. Snack: ½ sandwich and 1 cup low-fat milk;

3) HS Snack: 1 cup Cereal and 1 cup low-fat milk; and

4) 3 meals x 7 days: 1 sandwich, 1 fruit, and 1 cup low-fat milk.

b. Calorie Restricted Diet Snacks conform to diet pattern and is included to

provide the total calories allotted for the day. If additional between meal
feedings other than 3 meals x 7 days or HS snack is desired by the
physician, it must be ordered separately.

c. Other Snacks - Diets such as liquid, low fat, pureed, etc., may require an

in between feeding or snack. The type of snack required must be ordered

|GEORGIA DEPARTMENT OF CORRECTIONS
Standard Operating Procedures|Col2|Col3|
|---|---|---|
|Policy Name: Modified Diets/Special Feeding|Policy Name: Modified Diets/Special Feeding|Policy Name: Modified Diets/Special Feeding|
|Policy Number:409.04.09|Effective Date:6/7/2022|Page Number: 8 of 10|
|Authority:
Commissioner
|Originating Division:
Executive Division (Georgia
Correctional Industries - Food
and Farm Services)|Access Listing:
Level II: Required Offender
Access|

in addition to these types of diets and shall include an expiration date of
no greater than ninety (90) days.

d. All between meal feedings shall be counted as pack-outs on the daily

meal count to account for food issues.

5. Delivery of these feedings will vary according to local procedure. These

feedings contain perishable foods and are to be delivered or picked up within
30 minutes of the requested feeding times. Space for documentation is
provided on the Master Diet Roster.

F. Food Allergies:

1. Practitioners should not order a food allergy diet from Food Service unless a

verifiable and documented food allergy exists and is an available diet option.

2. Food Service will only honor documented food allergies to main entrees for

offenders on regular diets.

3. Offenders with undocumented food allergies and allergies that effect menu

items other than main entrees should be counseled by Medical on avoiding
those food items.

4. Substitutions for menu items other than main entrees may be needed for

offenders on Modified Diets or with particular allergies. Food Service should
contact the Food and Farm Services Central Office Registered Dietitian for
any substitutions.

G. Ordering of Nourishments (Breakfast Beverages):

1. Beverages and nourishments will only be ordered by Medical Services when

necessary, such as when providing medications or meeting other medically

|GEORGIA DEPARTMENT OF CORRECTIONS
Standard Operating Procedures|Col2|Col3|
|---|---|---|
|Policy Name: Modified Diets/Special Feeding|Policy Name: Modified Diets/Special Feeding|Policy Name: Modified Diets/Special Feeding|
|Policy Number:409.04.09|Effective Date:6/7/2022|Page Number: 9 of 10|
|Authority:
Commissioner
|Originating Division:
Executive Division (Georgia
Correctional Industries - Food
and Farm Services)|Access Listing:
Level II: Required Offender
Access|

required needs. These will be ordered by the physician and provided by the
Food Service Department.

2. All requests for beverages and nourishments must be in writing from Medical

Services. Medical personnel must sign that they received the items ordered.
The signed request should be filed in the Food Service Department for
accounting purposes.

3. Special diet requests are to be submitted to the Food Service Department on

each Tuesday and Friday by 10:00 a.m. The Food Service Department will
deliver the order on the same day by 3:00 p.m.

4. Special diet requests will be signed by appropriate personnel upon receipt of

the beverage order. The signed request will be returned to the Food Service
Department for accounting purposes.

H. For cases in which an offender has used food service trays or utensils in a manner

that is hazardous to themselves, staff or other offenders, staff may provide
alternative ways of serving food to the offender upon the Warden’s approval.

1. Alternative serving methods include disposable plates, cups, utensils, etc.

2. If alternative procedures are needed for more than seven (7) days, Food and

Farm Services Central Office State Food Service Administrator must be
notified so that appropriate supply items can be procured.

V. Attachments:

Attachment 1: Late Tray Receipt Record
Attachment 2: Master Diet Roster
Attachment 3: Modified Diet Waiver Form

|GEORGIA DEPARTMENT OF CORRECTIONS
Standard Operating Procedures|Col2|Col3|
|---|---|---|
|Policy Name: Modified Diets/Special Feeding|Policy Name: Modified Diets/Special Feeding|Policy Name: Modified Diets/Special Feeding|
|Policy Number:409.04.09|Effective Date:6/7/2022|Page Number: 10 of 10|
|Authority:
Commissioner
|Originating Division:
Executive Division (Georgia
Correctional Industries - Food
and Farm Services)|Access Listing:
Level II: Required Offender
Access|

VI. Record Retention of Forms Relevant to this Policy:

Upon completion, Attachments 1, 2, and 3 shall be kept locally for one (1) year in
the Food Service Office, then stored locally for five (5) years in an inactive file and
destroyed.