Food and drink are fundamental to quality care. Their impact on both physical and emotional wellbeing cannot be underestimated. Food and drink can really make the difference between poor and excellent care. They are central to what we do and who we are and they must, therefore, be at the very heart of any care service.
The link between nutritional intake and health and wellbeing is widely reported and accepted. It’s a basic principle that is readily understood and championed when it comes to paediatric services. But, sadly, it’s often an area still ignored or misunderstood in the provision of care services for adults, particularly for the older, disabled or frail.
Nutrition and mealtimes are arguably even more important for older, vulnerable adults in receipt of care services. Physically, the right nutritional intake is vital to recover from myriad age-related conditions or critical incidents and to maintain general wellbeing. From a social and emotional perspective, mealtimes are often the highlight of the day and a boost to morale.
For those living in the community, mealtimes are the point at which their social isolation ceases, and for those in other care settings, it’s the chance to sit down and talk to others.
If a mealtime is enjoyable then ultimately, the nutritional care will be excellent, as an enjoyable meal recognises the essentials of what people need and want, and how, where and with whom they want it.
The Care Quality Commission (CQC) rightly includes food and drink provision within its fundamental standards and scrutinises practices during inspection. The question is, how many care providers fully understand what CQC requires of them? How many have the right information and tools to fulfil their responsibility to service users and ensure they are delivering the best nutritional care, with dignity, in line with CQC’s expectations?
The CQC fundamental standards
CQC’s fundamental standards are quite simply standards below which care must never fall.
The standards are designed to help providers of health and social care services comply with regulations, set out the requirements for meeting the nutritional and hydration needs of service users, and also ensure that they provide safe, effective, caring, responsive and well-led quality care.
The regulations are the Health and Social Care Act 2008 (Regulated Activities) Regulation 14 Outcome 5: Meeting Nutritional Needs and the National Institute for Health and Care Excellence (NICE) Nutritional Support in Adults (QS24).
An inspector calls…
CQC inspectors assess services against Key Lines of Enquiries (KLOEs) and providers are expected to supply evidence that people’s care treatment and support achieves good outcomes and promotes a good quality of life.
They must also show that people are supported to live their lives in the way they choose and experience the best possible health and wellbeing.
When it comes to food and nutrition, the KLOE is: How are people supported to drink and eat enough and maintain a balanced diet?
CQC inspectors will be looking for evidence that shows:
- How people are supported to:
– have enough to eat and drink.
– have a balanced diet that promotes eating for good health.
– participate in decisions about what they eat and drink.
- That meals are appropriately spaced, but that the provision is flexible to meet people’s needs.
- How the service identifies the eating and drinking risks for those with complex needs.
- How people’s nutritional needs, including those relating to culture and religion, are identified, monitored and managed.
Inspectors will use a range of information gathered from a variety of sources to assess provision.
They will review records and talk to people, including professionals, service users, carers and families, to determine the following:
- If the dining experience and mealtimes are an enjoyable and sociable experience.
- The quality of the food and drink provided.
- Whether staff support effectively.
- Whether needs and preferences are met throughout the day (and night where applicable).
Support for care providers
The National Association of Care Catering’s (NACC) primary objective is to raise standards of catering across the care sector by supporting caterers and providers with the relevant information, guidance and best practice examples needed to fulfil their roles and responsibilities properly.
Everyone has the right to receive good food and drink that reflects their individual nutritional, cultural, physical and emotional needs. Care providers want to be able to achieve this. To this aim, The NACC has produced a guidance document, How to provide good nutritional care and comply with CQC’s fundamental standards to help providers to drive improvements in their nutritional care and secure Good or Outstanding CQC ratings. Having the right information, tools and systems in place means that care providers can be confident that they are consistently meeting all necessary standards in relation to nutrition, hydration and mealtimes.
A comprehensive toolkit
The NACC’s guidance document clearly explains what the CQC fundamental standards are and what CQC inspectors are looking for when it comes to food and drink in both residential and domiciliary care settings.
It outlines the policies, procedures and records required by a service to meet the KLOE: How are people supported to eat and drink enough and maintain a balanced diet? Other closely linked KLOEs are also highlighted, so they can also be appropriately considered.
Key policy and records centre around the Nutritional Care Policy (including hydration), which should be relevant to the care service provided, reflect the 10 Key Characteristics of Good Nutritional Care, consider the needs of service users, and lay out a clear set of values that include involvement, dignity, independence, respect, equality and self-help.
Essential components of the Nutritional Care Policy are:
- Individual Nutritional Component of Care Plan.
- Nutritional Screening Action Plan.
- Hydration Action Plan.
- Catering procedures, including food safety.
- Mealtime procedures and protocols.
- Staffing and training policy.
- How people are involved in service delivery.
For each outcome required to meet the aforementioned KLOE, the NACC has created template charts for recording recommended evidence of compliance, in the form of information, observations and statements, that an inspector would be looking for. The charts can be personalised to each care provider, as appropriate.
Observations and information can be gathered by talking to people receiving a service, staff, friends and other professionals involved in the care provision. By regularly updating the records, a clear picture of the service and its history can be created. These useful charts can be presented to inspectors to help them judge the service’s rating during inspection.
Practical and relevant support
The guidance also includes further practical action plans, monitoring charts and record templates to ensure the needs of individual service users are recognised, met and regularly monitored.
With documents tailored for domiciliary care, reablement and Shared Lives services and for residential and nursing care, the NACC covers:
- Action Plan for Residential/Nursing Care.
- Eating and Drinking Guideline Questions.
- Nutritional Screening Questions.
- Recording of ‘MUST’ or Nutritional Screening Questions.
- Nutritional Screening Action Plans for Reablement and Shared Lives.
- ‘My Food Preferences’ record sheet.
- Guidance for Healthier Eating.
- Guidance for Fortified Foods.
- Daily Food and Fluid Intake Sheet.
- Nutritional Care Risk Assessment – Activity Template.
- Nutritional Care Risk Assessment – Dysphagia example.
- Residential/Nursing Care Action Plan.
Example audit tools are also included for use by managers to ensure that Nutritional Screening Action Plans are being correctly implemented.
Simplifying the process
Quite often, the language used by regulatory bodies, such as CQC, can bamboozle. The NACC has, therefore, also included a very useful glossary that demystifies the jargon and makes sure all care providers and caterers understand the information being presented to them.
Other websites and organisations that also offer guidance around nutrition, hydration and mealtimes are signposted, providing a wide-ranging support system.
The NACC’s guidance provides a valuable and practical comprehensive resource for care services to help comply with CQC’s fundamental standards and achieve Good or Outstanding ratings. However, it’s not just restricted to those operating under England’s regulatory framework. The information and tools within the document are relevant for all care providers. It is for everyone who wants to ensure that mealtimes are an important part of their care service and uphold the cultural and communal significance of food, as well as providing a balanced nutritional intake.
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