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• DRI is the umbrella term covering four reference values: EAR, RDA, AI, and UL.
• EAR (Estimated Average Requirement) — meets the needs of 50% of a group. NOT used for menu planning. Used only as a research benchmark.
• RDA (Recommended Dietary Allowance) — meets the needs of nearly all (97–98%) healthy individuals. This IS used for menu planning in institutional settings.
• AI (Adequate Intake) — used when research is insufficient to set an RDA. Example: choline. Can be applied to both groups and individuals.
• UL (Tolerable Upper Intake Level) — maximum daily intake unlikely to cause harm. Used when evaluating supplement doses.
• For a CDM planning menus in a long-term care facility, use the RDA — not the EAR — because you want to meet the needs of virtually all residents.
• DRIs vary by age group and sex because nutrient needs differ across the lifespan.

Source: NFMNT Ch. 1 (Zikmund/Eck, ANFP); Open Oregon Nutrition Science Ch. 1D

• Dietary Guidelines for Americans 2020-2025: issued jointly by USDA and HHS; updated every 5 years by law.
• Four overarching DGA guidelines: (1) Follow a healthy dietary pattern at every life stage. (2) Customize food choices to reflect personal preferences and cultural traditions. (3) Focus on nutrient-dense foods within calorie limits. (4) Limit added sugars, saturated fat, sodium, and alcohol.
• MyPlate: USDA visual food guide in use since 2011. Half the plate = fruits and vegetables; ¼ = grains (make half whole); ¼ = protein. Dairy on the side.
• MyPlate is a general public guide — it is NOT for treating specific medical conditions or therapeutic diets.
• Sodium: limit to 2,300 mg/day (max). American Heart Association recommends an ultimate goal of ≤1,500 mg/day.
• Saturated fat limit: solid fats at room temperature (butter, lard, coconut oil). Replace with unsaturated (liquid) fats.
• USDA Dietary Patterns provide amounts at 12 calorie levels (1,000–3,200 kcal) and are used to plan menus for LTC, schools, correctional facilities.

Source: NFMNT Ch. 1 (ANFP, 2025)

• Macronutrients: Carbohydrate (4 kcal/g), Protein (4 kcal/g), Fat (9 kcal/g), Alcohol (7 kcal/g — provides calories but no nutrients).
• Carbohydrates: Primary energy source. Simple (sugars) vs. complex (starches, fiber). Fiber is NOT digested but is essential for bowel health.
• Protein: Made of amino acids. Essential amino acids must come from food (9 of them). Needed for tissue repair, immune function, enzyme production.
• Fat: Essential for fat-soluble vitamin absorption (A, D, E, K), hormone production, brain function. Unsaturated fats = heart-healthy. Saturated/trans = limit.
• Water: Often called the "forgotten nutrient." Adults need 8+ cups/day. Critical in LTC — dehydration is a major risk for elderly residents.
• Fat-soluble vitamins (stored in body): A, D, E, K — excess can be toxic (especially A and D).
• Water-soluble vitamins (not stored, excreted daily): B vitamins + Vitamin C — need daily replenishment.
• Key minerals for elderly: Calcium (bone health), Iron (anemia), Potassium (heart), Vitamin D (bone/immune), Zinc (wound healing).

Source: NFMNT Ch. 2 (ANFP); Open Oregon Nutrition Science Units 4–6

• Nutrition screening: Identifies clients at nutritional risk. CDM role = collect and report data. RDN role = assess and prescribe.
• MDS (Minimum Data Set): Standardized federally-required assessment in long-term care (CMS). Triggers care planning including nutrition.
• MNA (Mini Nutritional Assessment): Validated tool for screening malnutrition risk in elderly — commonly used in LTC.
• BMI categories: Underweight <18.5 | Normal 18.5–24.9 | Overweight 25.0–29.9 | Obese ≥30.0 (CDC definitions used in NFMNT).
• % Weight change: Significant unintentional weight loss = ≥5% in 30 days or ≥10% in 180 days. Must be documented and reported.
• Lab values: Albumin (3.5–5 g/dL, chronic protein marker); Prealbumin (15–36 mg/dL, acute/sensitive indicator); Hemoglobin (men 13.5–17.5 g/dL; women 12.0–15.5 g/dL).
• Anthropometric data: Height, weight, BMI, mid-arm circumference, calf circumference, skinfold thickness.
• HIPAA: All client nutritional and health information is confidential. Share only with IDT members involved in the client's direct care.

Source: NFMNT Ch. 7 (ANFP); Open Oregon Unit 7

• Nutrition interview: Ask about food allergies, food preferences, cultural/religious practices, appetite changes, chewing/swallowing difficulties.
• Gather info from multiple sources: resident, family, caregivers, medical records, IDT (interdisciplinary team).
• Recognize nonverbal cues: facial expressions, body language, posture can indicate pain, discomfort, or reluctance to eat.
• Client rights: Every resident has the right to refuse food, refuse a diet, or request substitute foods — even if medically suboptimal. Document all refusals.
• Liberalized diet: Per ANFP and CMS, unnecessary dietary restrictions should be removed when the risk is low and quality of life is improved. Residents may prefer their cultural comfort foods even if not "medically ideal."
• Cultural competency: Identify food customs based on race, culture, religion, age. African American dietary traditions (soul food) are valid and should be incorporated, not dismissed.
• Documentation: Use accurate, objective, timely entries in medical/health records. Follow facility policy on abbreviations. Documentation protects both the resident and the CDM.
• SOAP notes: Subjective (client reports), Objective (measurable data), Assessment (interpretation), Plan (action).

Source: NFMNT Ch. 8, 9, 10 (ANFP)

• CDM role with diet orders: The CDM implements and monitors diet orders. The physician orders; the RDN assesses and recommends. The CDM NEVER independently changes a diet order.
• Diabetic/Consistent Carb (CCH) diet: 45–60g carbohydrate per meal. Consistent timing. Avoid concentrated sweets and sugar-sweetened beverages. Monitor for hypo/hyperglycemia symptoms.
• Renal diet (CKD): Restrict potassium, phosphorus, sodium. Limit protein unless on dialysis (dialysis patients need MORE protein). Limit fluids in later stages.
• High potassium foods to AVOID on renal diet: bananas, oranges, potatoes, tomatoes, avocado, dairy.
• Cardiac/Low-sodium diet: <2,000 mg sodium/day. Limit saturated fat, trans fat, cholesterol. Encourage fruits, vegetables, whole grains, lean proteins.
• Dysphagia diets — IDDSI Framework: Level 7 = Regular; Level 6 = Soft & Bite-Sized; Level 5 = Minced & Moist; Level 4 = Pureed; Level 3 = Liquidized; Levels 0–2 = Drink consistency levels. IDDSI replaced National Dysphagia Diet in 2017.
• Enteral nutrition (tube feeding): Used when GI tract is functional but oral intake is inadequate. Types: nasogastric (NG), gastrostomy (PEG), jejunostomy. Methods: bolus, intermittent, continuous.
• Parenteral nutrition (TPN): IV nutrition when GI tract is non-functional. CDM monitors lab values and intake/output under RDN/physician direction.
• Clear liquid diet: Broth, gelatin, apple juice, clear beverages. Used post-surgery or for bowel prep.
• Full liquid diet: All clear liquids plus milk, cream soups, ice cream, puddings.

Source: NFMNT Ch. 12, 13 (ANFP, Zikmund)

• CDM applies evidence-based guidelines when implementing the nutrition care plan.
• Assess nutrient content of foods served; use nutrient analysis software to verify menus meet resident needs.
• Identify resources for care: IDT members, speech therapy (for dysphagia), occupational therapy (adaptive equipment), social work.
• Reviewing effectiveness: Monitor weight trends, intake percentages, lab values, wound healing, resident satisfaction.
• Plate waste studies: Measure food left uneaten — indicator of acceptability and adequacy.
• Meal rounds: CDM walks the dining room during meals to observe tray accuracy, assistance needs, and food acceptance.
• Protein needs: 0.8 g/kg for healthy adults; 1.0–1.2 g/kg for stable elderly; 1.2–1.5 g/kg for mild-moderate stress; 1.5–2.0 g/kg for wound healing, infection, surgery.
• Calorie needs: 25–35 kcal/kg/day for most adults. Obese or underweight residents need individualized calculation by RDN.

Source: NFMNT Ch. 11 (ANFP)

• Cycle menu: Rotating menu repeated on a set schedule (e.g., 4-week cycle). Reduces planning labor, ensures variety, supports purchasing efficiency.
• Selective menu: Residents choose from 2+ options at each meal. CMS now encourages selective menus in LTC as a resident rights issue.
• Nonselective menu: No choice. Less preferred in LTC. Still acceptable in some settings (schools, corrections).
• Menu planning must consider: therapeutic diet modifications, texture modifications, cultural/religious preferences, resident preferences, budget, seasonal availability, nutrient content.
• Nutritional resources used in planning: DRIs/RDAs, USDA dietary patterns, diet manuals, facility policy, CMS F-tag requirements.
• Nutrient analysis: Use computer software to verify menus meet nutritional standards. Check for adequacy of protein, calcium, vitamin D, fiber, sodium levels.
• Standardized recipes are essential for nutrient analysis accuracy — must use tested, documented recipes.
• Cultural/regional/seasonal considerations: Menus should incorporate foods familiar to resident population. African American residents may prefer collard greens, sweet potatoes, cornbread — these should be included when possible.

Source: FSM Ch. 2 (Legvold, Salisbury, Perl — ANFP)

• Standardized recipe elements: Recipe name, yield (total quantity produced), serving size, number of servings, ingredients (with exact weights/measures), preparation method, cooking time/temperature, equipment needed, nutrient content per serving.
• Standardized recipes ensure: consistency of product, portion control, cost control, accurate nutritional information, and food safety (HACCP integration).
• Recipe conversion factor (RCF): Used to scale recipes up or down.
• Yield percentage: Accounts for prep loss (trimming, cooking shrinkage).
• Recipe cost calculation: Sum cost of each ingredient at the quantity used; divide by number of servings = cost per serving.

Source: FSM Ch. 2 (ANFP)

• Production schedule: Written plan specifying what to prepare, how much, who is responsible, and when. Reduces over/underproduction and waste.
• Batch cooking: Cook in smaller quantities close to serving time for better quality and food safety. Avoids holding food in danger zone.
• Forecasting: Predict meal counts based on census, historical data, day of week, season, special events. Reduces waste and cost.
• Tally sheet / diet census: Lists each resident's name, room, and current diet order. Updated daily or with each change. Critical for tray accuracy.
• Thawing methods (safe only): (1) Refrigerator — safest, plan ahead; (2) Cold running water ≤70°F, cook immediately; (3) Microwave — cook immediately; (4) As part of the cooking process. NEVER thaw at room temperature.
• Food quality standards: appearance (color, shape), temperature (hot foods hot, cold foods cold), acceptance (resident likes it), portion size (matches menu/diet order).
• Plate waste study: Weighs leftover food to measure acceptance and identify menu items needing revision.
• Tray accuracy audits: Check trays before delivery against the diet card — verify diet type, texture, portion, allergies, preferences.

Source: FSM Ch. 3 (ANFP)

• FIFO (First In, First Out): Older products used before newer ones. Label all items with date received. Stock rotation prevents spoilage and waste.
• Par level: Minimum on-hand quantity before reorder is triggered. Set based on usage rate + delivery schedule + safety stock.
• Perpetual inventory: Continuous real-time record of stock (add deliveries, subtract usage). Most accurate method.
• Physical inventory: Manual count of all items on hand. Done periodically (weekly, monthly) to verify perpetual records.
• Receiving: Check temperature of refrigerated/frozen items on delivery. Reject if out of range. Verify quantity and quality match purchase order. Check for signs of contamination or damage.
• Storage temperatures: Refrigerator ≤41°F | Freezer ≤0°F | Dry storage 50–70°F, low humidity.
• Dry storage: 6 inches off the floor (minimum), away from walls, away from cleaning chemicals.
• Raw meat storage order (top to bottom): Ready-to-eat foods (top) → Whole fish → Whole beef/pork → Ground meats → Poultry (bottom). Based on required cooking temperature — lowest temp on top, highest on bottom.
• Approved food sources: Purchase from USDA-inspected or state-inspected suppliers. Shellfish must have tags. Eggs must be grade inspected.

Source: FSM Ch. 11 (ANFP)

• HACCP = Hazard Analysis Critical Control Points. A systematic, preventive food safety system. Mandated in many foodservice operations.
• Principle 1: Hazard Analysis — Identify biological, chemical, and physical hazards at each step of food preparation.
• Principle 2: Identify CCPs — A CCP is any step where a hazard can be prevented, eliminated, or reduced to safe levels. Example: cooking to proper temperature is a CCP.
• Principle 3: Establish Critical Limits — The measurable boundary a CCP must not exceed. Example: chicken must reach 165°F internal temperature.
• Principle 4: Monitor CCPs — Take measurements at each CCP. Use calibrated thermometers. Record temperatures in a log.
• Principle 5: Corrective Actions — What to do when a critical limit is not met. Example: If chicken did not reach 165°F, continue cooking or discard.
• Principle 6: Verification — Confirm HACCP system is working. Review records, observe practices, calibrate equipment.
• Principle 7: Record Keeping — Maintain written documentation of the HACCP system, monitoring logs, and corrective actions. Required for CMS surveys.
• Temperature Danger Zone: 41°F–135°F. Never leave TCS food in this range more than 4 hours (cumulative).

Source: FSM Ch. 12 (ANFP)

• Verify quality: correct diet type, accurate portion size, appropriate food temperature, correct texture modification, allergen safety.
• Tray line audit: supervisory check of trays before delivery. Compare to diet card/tray ticket for each resident.
• Assure compliance: meals served must match what is posted on the menu and the resident's diet order.
• QAPI (Quality Assurance & Performance Improvement): Required by CMS for long-term care. Includes quality assurance (prevent problems) and performance improvement (fix problems).
• Quality indicators for foodservice: tray accuracy rate, meal satisfaction scores, weight loss incidents, foodborne illness incidents, plate waste percentages.
• PDCA cycle: Plan → Do → Check → Act. The standard QI framework. When a problem is identified, plan a fix, implement it, measure results, then adjust.
• Food acceptance surveys: Standardized tools that collect resident feedback on meal quality, temperature, variety, and service.

Source: FSM Ch. 5 (ANFP)

• FTE (Full-Time Equivalent): 1 FTE = 40 hours/week. Use to calculate total labor needs.
• Meals per labor hour (MPLH): Measures productivity. Higher MPLH = more efficient. Target varies by facility type (healthcare LTC typically 4–6 MPLH).
• Productive hours: actual hours worked. Non-productive: vacation, sick, holiday, orientation time. Budget must account for both.
• Overtime: FLSA requires time-and-a-half for hours over 40 per workweek. Manage scheduling to minimize overtime costs.
• Cross-training: Employees trained in multiple positions. Increases scheduling flexibility and reduces call-out impact.
• Work schedules must consider: census fluctuations, meal service times, employee availability, budget constraints, union contracts if applicable.
• Track absences and tardiness in personnel files — required for documentation and progressive discipline.

Source: FSM Ch. 8 (ANFP)

• Job description: Written document with job title, reports-to, qualifications, essential functions, physical requirements. Basis for hiring and performance evaluation.
• Job specification: Minimum qualifications (education, experience, certifications) needed for the position.
• Orientation: Initial training for new employees. Covers facility policies, job duties, safety procedures, HIPAA, food safety basics, dress code.
• In-service training: Ongoing education for current employees. Required in LTC (OSHA, CMS requirements). Topics: food safety updates, allergen training, emergency procedures.
• Training verification: Document that all training was completed. Keep records in personnel files. Required for CMS survey.
• Interview compliance: Cannot ask about age, marital status, religion, national origin, disability status, or pregnancy in interviews (ADA, Title VII, ADEA protections).
• DE&I (Diversity, Equity & Inclusion): All hiring and employment decisions must be free from discrimination. CMS requires compliance with fair employment laws.

Source: FSM Ch. 6, 7 (ANFP)

• Performance appraisal: Formal evaluation of employee performance against job standards. Should be objective, specific, documented, and timely.
• Avoid evaluation errors: Halo effect (one good trait colors all ratings), recency bias (only recent events matter), central tendency (rating everyone average).
• Progressive discipline: Step 1 = Verbal warning (documented); Step 2 = Written warning; Step 3 = Suspension; Step 4 = Termination. Gives employees opportunity to correct behavior.
• Termination criteria: Must be documented, non-discriminatory, and consistent with facility policy. Consult HR and legal counsel before terminating.
• Promotion criteria: Based on performance, qualifications, and job requirements. Must be applied consistently and equitably.

Source: FSM Ch. 8 (ANFP)

• FLSA (Fair Labor Standards Act): Sets federal minimum wage, overtime (1.5x pay for >40 hrs/week), child labor rules. Applies to all employees.
• Title VII (Civil Rights Act of 1964): Prohibits employment discrimination based on race, color, religion, sex, or national origin. Applies to employers with 15+ employees.
• ADA (Americans with Disabilities Act): Requires reasonable accommodations for qualified employees/applicants with disabilities. Also covers residents (access to meals, adaptive equipment).
• FMLA (Family & Medical Leave Act): Up to 12 weeks unpaid leave per year for qualifying medical/family reasons. Employee must have worked 12 months and 1,250 hours. Job protected.
• ADEA (Age Discrimination in Employment Act): Protects workers 40 and older from age-based discrimination.
• USERRA: Protects veterans' employment rights during and after military service.
• OSHA: Workplace safety. CDM must provide safety training, maintain SDS (Safety Data Sheets) for chemicals, report serious injuries. PPE requirements.
• Union contracts: If facility has a union, employment decisions must comply with the collective bargaining agreement (CBA).

Source: FSM Ch. 8 (ANFP)

• IDT (Interdisciplinary Team): CDM participates in care conferences with nursing, RDN, occupational therapy, speech therapy, social work, activities, physician. CDM contributes dietary/nutrition data.
• Active listening: Maintain eye contact, avoid interrupting, paraphrase to confirm understanding, ask clarifying questions.
• Conflict resolution: Address early, focus on the issue (not the person), remain objective, seek win-win solutions, document outcomes.
• Chain of command: Follow organizational hierarchy. Report issues through proper channels (supervisor → department head → administration).
• Department meetings: Agenda should be shared in advance. Minutes must be documented and retained. A way to communicate policy changes, address concerns, provide training updates.
• Regulatory surveys: CDM must participate in CMS surveys. Be prepared to present training records, temperature logs, HACCP documentation, menus, and diet card accuracy.
• Professional code of ethics: CDM, CFPPs must maintain confidentiality, avoid conflicts of interest, treat all clients with dignity and respect, maintain competency through continuing education.

Source: FSM Ch. 9 (ANFP)

• Temperature Danger Zone (TDZ): 41°F–135°F. Bacteria multiply rapidly. Minimize time in TDZ — 4 hours maximum cumulative.
• Refrigerator holding: ≤41°F
• Freezer storage: ≤0°F (-18°C)
• Hot holding: ≥135°F
• Poultry (whole, ground, stuffed): 165°F for 15 seconds
• Ground beef, ground pork, sausages: 155°F for 17 seconds
• Whole cuts of beef, pork, lamb, veal, fish, seafood: 145°F for 15 seconds
• Roasts (beef, pork, veal, lamb): 145°F for 4 minutes
• Eggs (for immediate service): 145°F
• Reheating for hot holding (leftovers): 165°F within 2 hours
• Cooling: 135°F → 70°F within 2 hours; then 70°F → 41°F within next 4 hours (6 hours total maximum).
• Cooling methods: ice bath, ice paddles, shallow pans (2 inches deep), blast chiller, placing in walk-in cooler uncovered.

Source: FSM Ch. 12; FDA Food Code 2022 (fda.gov)

• The 9 Major Allergens (per FALCPA & FASTER Act): 1. Milk, 2. Eggs, 3. Fish, 4. Shellfish, 5. Tree Nuts, 6. Peanuts, 7. Wheat, 8. Soybeans, 9. Sesame (added Jan 2023 under FASTER Act).
• Cross-contact: Transfer of an allergen from one food to another. Cannot be eliminated by cooking. Example: using the same spoon in peanut butter, then in applesauce.
• Cross-contact ≠ cross-contamination: Cross-contamination involves pathogens; cross-contact involves allergens. Both are dangerous but require different management strategies.
• Allergen management: Train all staff, color-code utensils, use dedicated equipment, label menus, maintain allergen documentation for each resident.
• Anaphylaxis signs: sudden hives, throat tightening, difficulty breathing, rapid heartbeat, drop in blood pressure. This is a life-threatening emergency — call 911 immediately.
• CDM must have a crisis management plan for allergic reactions and foodborne illness outbreaks — FSM Ch. 12 requirement.
• Resident allergen information must appear on the tray ticket/diet card for every meal and be verified at tray assembly.

Source: FSM Ch. 12 (ANFP); FDA FASTER Act 2023

• Salmonella: Raw poultry, eggs, raw produce. Symptoms: diarrhea, fever, cramps 12–72 hrs after exposure. Cook poultry to 165°F.
• E. coli O157:H7: Ground beef, leafy greens, raw milk. Can cause bloody diarrhea and hemolytic uremic syndrome (kidney failure). Cook ground beef to 155°F.
• Listeria monocytogenes: Deli meats, soft cheeses, RTE foods, smoked fish. Dangerous for elderly and immunocompromised. Can grow at refrigerator temps.
• Norovirus: Highly contagious. Fecal-oral route, contaminated surfaces. Exclude ill employees for 48 hours after symptoms resolve.
• Clostridium perfringens: "Cafeteria germ." Improperly cooled/reheated meats and gravies. Spore-forming (survives heat). Prevent by proper cooling and reheating.
• Hepatitis A: Fecal-oral route. Contaminated produce, RTE foods. Prevent with strict handwashing and employee health screening.
• Shigella: Fecal-oral, contaminated produce. Very low infectious dose.
• FDA Big 6 (must exclude from work / report to regulatory authority): Norovirus, Nontyphoidal Salmonella, Salmonella Typhi, Shiga toxin-producing E. coli (STEC), Hepatitis A, Shigella.
• TCS (Temperature Control for Safety) foods: Cooked meats, poultry, fish, eggs, dairy, cooked rice/pasta, cut melons, cut tomatoes, leafy greens, tofu, cooked beans. These require time/temperature control.

Source: FSM Ch. 12 (ANFP); FDA Food Code 2022

• Proper handwashing: Use soap + warm water, scrub for at least 20 seconds, rinse, dry with single-use towel. Sing "Happy Birthday" twice as a timer.
• Must wash hands: after restroom, after handling raw meat, after touching face/hair/phone, after taking out garbage, after handling chemicals, before putting on gloves.
• Hand sanitizer does NOT replace handwashing — especially ineffective against Norovirus and C. difficile (C. diff). Only handwashing removes these.
• Gloves: Single-use, change when switching tasks, after contamination, after 4 continuous hours, or when taking a break.
• PPE required: Hair restraints (hats, nets, beard guards) for all food handlers. Aprons should be removed before restroom use.
• Cuts/wounds: Cover with waterproof bandage AND wear single-use glove over the affected hand. Report to supervisor.
• Employee illness exclusion criteria (FDA Food Code): Exclude employees who have vomiting, diarrhea, jaundice, sore throat with fever, or confirmed infection with Big 6 pathogen.
• Employees with Big 6 illness: Must be excluded from work AND excluded from food handling. Notify regulatory authority for Typhi, STEC, Hep A, Shigella.

Source: FSM Ch. 10 (ANFP); FDA Food Code 2022

• Cleaning vs. Sanitizing: Cleaning = remove soil/debris (soap + physical scrubbing). Sanitizing = reduce pathogens to safe levels (heat or chemical). Must clean BEFORE sanitizing — sanitizers can't penetrate soil.
• Sanitizing methods: Chemical (chlorine, quaternary ammonium, iodine) or Heat (water ≥171°F for mechanical dishwashing).
• Master cleaning schedule: Written schedule specifying what to clean, how, with what product, how often, and who is responsible. Required for CMS surveys.
• SDS (Safety Data Sheets): Required by OSHA for all hazardous chemicals used in the facility. Must be accessible to all employees. Contains: chemical name, hazards, safe handling, first aid, storage, disposal info.
• HAZCOM (Hazard Communication Standard): OSHA requirement that employers train employees about chemical hazards. Employees must be trained before using any chemical.
• IPM (Integrated Pest Management): Systematic approach to preventing pests. Regular inspections, seal entry points, eliminate food/water sources, use least-toxic pesticides only when needed, document all pest activity and treatments.
• Equipment maintenance: Routine inspections, calibrate thermometers regularly, repair or replace faulty equipment promptly. Document all maintenance.
• Fire safety: Know location of fire extinguishers (PASS: Pull, Aim, Squeeze, Sweep). Types: Class K for kitchen grease fires.

Source: FSM Ch. 10, 13 (ANFP)

• Operating budget: Day-to-day expenses — food, labor, supplies, chemicals. Typically monthly/annual.
• Capital budget: Major equipment purchases (equipment lasting >1 year and over a set dollar threshold). Requires separate budget proposal with specifications, justification, and cost-benefit analysis.
• Food cost percentage: Most commonly used performance indicator in foodservice. Target: typically 30–40% in healthcare (varies by facility type and reimbursement structure).
• Budget variance: Actual cost vs. budgeted cost. Positive variance = under budget (good). Negative variance = over budget (bad). CDM must explain and correct negative variances.
• Per-patient day (PPD) cost: Total cost ÷ number of patient days. Used to compare costs across facilities or time periods.
• Labor cost: Typically the largest controllable expense. Manage through scheduling efficiency, overtime reduction, and cross-training.
• Productivity metrics: Minutes per meal, meals per labor hour (MPLH). Used to justify or reduce staffing levels.

Source: FSM Ch. 14 (ANFP)

• Purchase specifications: Written description of the exact product needed — grade, brand, pack size, count, quality standards. Ensures consistent purchasing.
• Group purchasing organizations (GPO): Facilities join together to negotiate lower prices through volume purchasing. Common in LTC and hospital chains.
• Bid buying: Requesting competitive price proposals from multiple vendors. Required by some regulatory bodies for government-funded facilities.
• Par stock: Predetermined minimum inventory level. When stock drops to par, reorder is triggered. Prevents both stockouts and overstocking.
• Perpetual vs. physical inventory: Perpetual = continuously updated record. Physical = manual count. Both must be reconciled regularly.
• Recalls: CDM must have a procedure to identify and remove recalled products immediately. Check USDA/FDA recall databases. Document recall response.
• Returns and rejections: Refused products must be documented with reason, vendor notified, and credit obtained.

Source: FSM Ch. 16 (ANFP)

• CMS (Centers for Medicare & Medicaid Services) oversees long-term care facilities through annual unannounced surveys.
• F-tags: Regulatory citations issued during surveys. Foodservice and nutrition F-tags: F800–F812.
• Key F-tags: F800 = Provided sufficient fluid intake; F801 = Therapeutic diet compliance; F802 = Sufficient qualified dietary staff; F803 = Menus meet nutritional needs; F808 = Food procurement from safe sources.
• CDM meets CMS staffing requirements for LTC dietary departments.
• During a survey, be prepared to show: temperature logs, HACCP records, staff training records, menus, diet cards, cleaning schedules, pest control records, equipment maintenance logs.
• Residents' rights (CMS): Right to be fully informed about nutritional status and diet. Right to refuse food. Right to have cultural food preferences honored.
• QAPI: Required by CMS in all LTC facilities. Ongoing process of identifying problems, implementing improvements, and monitoring outcomes.

Source: FSM Ch. 9; NFMNT Ch. 16 (ANFP)

• Cost control strategies: portion control, standardized recipes, waste reduction, inventory management, competitive purchasing.
• Waste study: Track and measure food waste (overproduction, plate waste, prep waste). Identify cost-saving opportunities.
• Spend-down: In some facilities, end-of-year budget surplus may be "spent down" on equipment or supplies. CDM should track and report monthly for budget accuracy.
• Retail/catering: CDM calculates food cost to set selling prices. Price must cover food cost, labor, overhead, and desired profit margin.
• Break-even point: Revenue = Total costs. Below break-even = operating at a loss.
• Petty cash: Small cash fund for minor purchases. Must be audited and reconciled regularly. All receipts documented.

Source: FSM Ch. 17 (ANFP)