The California Department of Health issued an All Facilities Letter to clarify federal and state requirements for dietetic service operations staffing and supervision in nursing homes and other healthcare facilities. The letter emphasizes the need for a full-time registered dietitian to be responsible for food service operations or, if the dietitian is less than full-time, a director of dietary to supervise with oversight by the dietitian. Facilities must comply with California laws regarding qualification requirements, and dietary service supervisors must have completed formal training from a state-approved program. The Department of Health Services does not have the authority to waive regulations, but it offers "Program Flexibility" on a case-by-case basis for facilities that propose alternative ways of meeting regulations. Facilities must submit a written request with supporting information to the appropriate Licensing and Certification District Office for review and determination. Non-compliance with these requirements may result in penalties or other consequences for the facility.

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