The Virginia Department of Social Services (DSS) has issued a technical assistance (TA) on how providers should handle supplemental feedings. The guidance provides clarification on prescriber-ordered supplemental feedings versus those used for occasional or personal use by residents.  

This information will be included in the “Technical Assistance for Standards for Licensed Assisted Living Facilities” guidance document when the updates are posted to the DSS website. 

DSS encourages you to share the TA with staff responsible for these services.  You may contact your licensing inspector with any questions.

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TA 22VAC40-72-650 Storage of Medications/Supplemental Feedings 

Question: Is it the intent of this standard that all supplemental feedings be stored and accounted for in the same way as prescribed medications, dietary supplements and over-the-counter medications?

Answer: In those cases where the prescriber issues a valid order for a particular supplemental feeding (such as Ensure®, Boost®, Sustacal® and similar drinks, shakes, puddings, powders and frozen concoctions which are marketed as sources of complete, balanced nutrition) at specified times for identified reasons, the supplement should be listed on the MAR, treatment record or supplemental feeding record according to facility policy.  If managed by anyone other than the medication staff, the ISP should identify the specific position such as direct care or dietary staff and treatment sheets or supplemental feeding sheets should reflect date and time supplied and % consumed by the resident.  Except in those cases where the resident needs assistance and/or supervision with the consumption (which should be reflected on the ISP), it is not necessary for the staff person to stay with the resident until the supplemental feeding is consumed.

Supplemental feedings prescribed for and purchased by or for a specific resident must be labeled with that resident’s name.  They can be stored, according to facility policy, in the medication room, the dietary department, or other secure location accessible to the staff responsible for supplying the supplement to the resident.  Supplements should be chilled or refrigerated according to manufacturer’s label.

In those facilities that are purchasing and maintaining a supply of supplemental feedings for occasional use with residents who are on regular or liberal diets as tolerated and respond favorably to the occasional shake, pudding cup, etc. when they do not want a full meal, supplies would usually be maintained in the kitchen or dietary department and would not necessarily be labeled for specific residents.  Depending upon the design of the facility, it would be reasonable to find a small supply of these feedings in the medicine room or cart or some other central location if the kitchen is closed and the supply is inaccessible to direct care staff at the end of the day. 

Residents who are not on dietary restrictions prescribed by attending physicians and who purchase these supplements for personal use may store these in their rooms if they choose to do so.