1. Principles

The service must include people’s nutrition and hydration needs when making an initial assessment of their care, treatment and support needs and in the ongoing review of these. The assessment and review should include risks related to people’s nutritional and hydration needs.

The following principles relate to the nutritional needs of adults who use the service:

  • adults should be protected from the risks of inadequate nutrition and dehydration due to the involvement of the service and monitoring by staff;
  • staff should ensure that any diverse needs relating to food and drink (including any reasonable requirements arising from their religious or cultural background) are provided to them;
  • staff should ensure the food and drink the adult has is nutritionally balanced and supports their health;
  • where required, staff provide appropriate support to enable the adult to be able to consume sufficient diet and fluid intake.

The service must meet people’s nutrition or hydration needs wherever an overnight stay is provided as part of the regulated activity, or where nutrition or hydration are provided as part of the arrangements made for the person using the service.

The service must follow people’s consent wishes if they refuse nutrition and hydration, unless a best interests decision has been made under the Mental Capacity Act 2005 (see Mental Capacity). Other forms of authority such as advance decisions should also be taken into account.

The service may vary the way they apply this regulation to take account of people’s assessed needs and wishes. This includes adults requiring palliative care for example, or are at the end of their life.

2. Nutritional Needs

2.1 Assessment and review

Nutrition and hydration assessments must be carried out by people with the required skills and knowledge. The assessments should follow nationally recognised guidance and identify, as a minimum:

  • requirements to sustain life, support the agreed care and treatment, and support ongoing good health;
  • dietary intolerances, allergies, medication contraindications;
  • how to support people’s good health including the level of support needed, timing of meals, and the provision of appropriate and sufficient quantities of food and drink.

Nutrition and hydration needs should be regularly reviewed during the course of care and treatment and any changes in people’s needs should be responded to in good time.

A variety of nutritious, appetising food should be available to meet people’s needs and be served at an appropriate temperature. When the person lacks capacity, they must have prompts, encouragement and help to eat as appropriate.

Where a person is assessed as needing a specific diet, this must be provided in line with that assessment. Nutritional and hydration intake should be monitored and recorded to prevent unnecessary dehydration, weight loss or weight gain. Action must be taken without delay to address any concerns.

Staff must follow the most up to date nutrition and hydration assessment for each person and take appropriate action if people are not eating and drinking in line with their assessed needs.

Staff should know how to determine whether specialist nutritional advice is required and how to access and follow it.

Water must be available and accessible to people at all times. Other drinks should be made available periodically throughout the day and night and people should be encouraged and supported to drink.

Arrangements should be made for people to receive their meals at a different time if they are absent or asleep when their meals are served.

Snacks or other food should be available between meals for those who prefer to eat little and often.

2.2 Parental nutrition

The service must have systems to make sure that people using the service receive any prescribed parenteral nutrition and dietary supplements at the specified times.

Parenteral nutrition and dietary supplements must only be administered by appropriately qualified, skilled, competent and experienced staff.

2.3 Preferences and choices

People should be able to make choices about their diet.

People’s religious and cultural needs must be identified in their nutrition and hydration assessment, and these needs must be met. If there are any clinical contraindications or risks posed because of any of these requirements, these should be discussed with the person, to allow them to make informed choices about their requirements.

When a person has specific dietary requirements relating to moral or ethical beliefs, such as vegetarianism, these requirements must be fully considered and met. Every effort should be made to meet people’s preferences, including preference about what time meals are served, where they are served and the quantity.

All choices and preferences should be documented in the adult’s case file.

2.4 Support with eating and drinking

People’s food must be placed within their reach and presented in a way that is easy to eat, such as liquidised or finger foods where appropriate.

Food must be served and maintained at the right temperature for the whole mealtime.

People should be encouraged to eat and drink independently. They should receive appropriate support, which may include encouragement as well as physical support, when they need it.

People must have appropriate equipment or tools to help them eat and drink independently.

Each person who requires support should have enough time to enable them to take adequate nutrition and hydration to sustain life and good health.

2.5 Concerns about an adult’s intake of food and drink

Where a member of staff has concerns about an adult’s food and drink intake, they should discuss it in the first instance with their line manager. This concern should be communicated to the GP or the multi-disciplinary team.

This should result in the situation being discussed by a nominated practitioner with the adult and / or their carer, and action taken as appropriate.

All information relating to the concerns and action taken should be documented in the adult’s case file.

3. Staff Training

Staff should receive training on the importance of adequate intake of food and drink. They should also receive training on handling food were appropriate.

Staff working with adults with swallowing difficulties should first complete an agreed first aid course including how to manage dysphagia.

Staff should also be trained in what action should be taken if they are concerned about an adult’s food and drink intake (see Section 2.5, Concerns about an adult’s intake of food and drink above).