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{{org_field_name}}

Registration Number: {{org_field_registration_no}}

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Meeting Nutritional and Hydration Needs Policy

1. Purpose

This policy ensures that {{org_field_name}} provides sufficient, nutritious and enjoyable food and drink to sustain each resident’s life and good health, reduce the risks of malnutrition and dehydration, and support wellbeing and quality of life. Food and drink are provided safely, with appropriate assistance and regard for dignity, choice, independence and clinical need.

This policy explains how nutritional and hydration needs are assessed, planned, met, monitored and reviewed. It covers personalised menus, malnutrition and dehydration screening, allergies, swallowing risks, modified-texture diets, assistance with eating and drinking, escalation and multidisciplinary working. It supports compliance with CQC Regulation 14 and related safety requirements.

{{org_field_name}} provides food and drink that is safe, suitable, culturally appropriate and responsive to each resident’s preferences, beliefs, allergies, intolerances and assessed needs. Reasonable adjustments are made so residents can make informed choices and eat and drink as independently as possible.

2. Scope

This policy applies to all individuals involved in meal provision, preparation, and service, including kitchen staff, care staff, registered nurses, and allied health professionals. It also applies to external catering providers if meals are outsourced.

In addition, this policy applies to all people we support, including those who:

• Are independent in eating and drinking but require a structured meal plan to meet their dietary needs.
• Require assistance, encouragement, or adaptive equipment to eat and drink safely.
• Have complex dietary requirements due to medical conditions such as diabetes, dysphagia, or food allergies.
• Are at risk of malnutrition or dehydration, requiring monitoring and intervention.

Every staff member must understand and adhere to this policy to ensure that individuals receive appropriate, high-quality, and safe nutritional care.

3. Legal and Regulatory Framework

This policy is aligned with the latest legal and regulatory requirements, ensuring compliance with:

• Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 – Regulation 14 requires providers to meet a resident’s nutritional and hydration needs, including providing suitable and nutritious food and hydration in sufficient quantities, supporting safe consumption and obtaining professional advice where required.
• Care Act 2014 – The statutory wellbeing duty is placed principally on local authorities. {{org_field_name}} supports the outcomes in assessed care and support plans and works with commissioners and professionals where nutrition or hydration needs change.
• Mental Capacity Act 2005 – Capacity is presumed and assessed for the specific decision when required. Decisions for a resident who lacks capacity must follow the best-interests process and use the least restrictive option.
• Equality Act 2010, which requires that all dietary needs, including those arising from religious, cultural, and ethical beliefs, are accommodated without discrimination.
• Food Safety Act 1990, Food Safety and Hygiene (England) Regulations 2013 and food information requirements – Food must be produced, handled and served safely, with accurate allergen information and controls to prevent allergen cross-contact.

Compliance with these requirements supports safe, person-centred nutrition and hydration and does not override a resident’s capacitous decision, including a decision that involves risk.

4. Meeting Nutritional and Hydration Needs

4.1 Assessing Nutritional and Hydration Needs

A trained and competent member of staff completes a nutrition and hydration assessment before or on admission and reviews it at planned intervals and whenever needs change. The assessment covers weight history, appetite, usual intake, hydration, medical conditions, medicines, allergies and intolerances, oral health, ability to obtain and consume food and drink, swallowing, communication, cognition, dexterity, preferences and beliefs.

Validated screening, such as the Malnutrition Universal Screening Tool (MUST), is completed and repeated at a frequency determined by the score and care plan. Weight and body mass index are used where appropriate; where these cannot be measured reliably, approved alternatives and clinical judgement are documented. Screening for dehydration and swallowing or choking risk is also completed when indicated.

Where risk is identified, the care plan records measurable actions, food fortification or oral nutrition support where advised, fluid goals where clinically appropriate, monitoring frequency, required assistance, positioning and any prescribed International Dysphagia Diet Standardisation Initiative (IDDSI) food or drink level. Responsibilities and escalation thresholds are clear.

Staff recognise and report indicators including unplanned weight loss, reduced intake, swallowing difficulty, coughing or a wet voice when eating or drinking, recurrent chest infection, constipation, dry mouth, confusion, weakness and reduced urine output. Urgent symptoms or a rapid deterioration are escalated immediately; other concerns are referred promptly to the GP, dietitian, speech and language therapist, dentist or other relevant professional.

4.2 Person-Centred Meal Planning

Menus are developed with residents and catering staff, with dietetic or other clinical input where required. Choices reflect personal preferences, cultural and religious requirements, ethical choices, allergies, intolerances and assessed therapeutic needs. Residents receive accessible information about available choices and allergen content.

A varied menu cycle provides balanced, appealing options and suitable alternatives at each meal. Therapeutic diets are used only where clinically indicated and are reviewed so that unnecessary restriction does not reduce enjoyment or intake. Snacks and drinks are available between meals and at night.

Meals are prepared and served safely using suitable ingredients. Kitchen and care staff use accurate, up-to-date diet information and an effective system for identifying each resident’s required meal. Portion size, presentation, fortification and texture are adjusted in line with the care plan, without mixing or substituting modified diets unless assessed as safe.

4.3 Ensuring Adequate Hydration

Proper hydration is essential to maintaining good health, cognitive function, and the prevention of complications such as urinary tract infections (UTIs), constipation, and confusion.

Residents have regular access to drinks they enjoy throughout the day and night. Drinks are placed within reach and suitable cups, prompts and assistance are provided. Fluid targets are individualised where clinically indicated, taking account of conditions that may require restriction or closer monitoring.

A resident with suspected dysphagia is referred promptly for appropriate assessment. Thickened drinks or texture-modified food are provided only in accordance with current professional instructions, using the specified IDDSI level, preparation method and equipment. Staff do not use imprecise descriptions such as ‘soft diet’ where an IDDSI level is required.

Food and fluid intake is recorded only where the assessment or care plan identifies a need. Records are completed accurately and reviewed against the resident’s individual targets. Poor intake, repeated refusal, vomiting, diarrhoea, swallowing concerns or signs of dehydration are escalated within the timescale stated in the care plan and sooner where clinically urgent.

4.4 Supporting Individuals with Eating and Drinking

Staff who assist with eating and drinking are trained and assessed as competent. They confirm the correct meal, IDDSI level and assistance plan, support safe positioning, allow sufficient time, observe for difficulty and know how to respond to choking or aspiration concerns. Adaptive crockery, cutlery and other equipment are provided where assessed as beneficial.

Assistance is discreet, unhurried and responsive to the resident’s communication and consent. Small portions, energy-dense food, fortified meals, finger foods and oral nutritional supplements may be used according to the care plan; supplements are not used as a substitute for meals without appropriate clinical advice. Pain, ill-fitting dentures, dry mouth, nausea and other barriers to intake are addressed.

Residents living with dementia or other cognitive impairment receive consistent prompts, familiar foods, visual choices and an environment that reduces distraction or distress. Staff monitor whether the resident recognises food and drink, can use utensils and remains able to eat and drink safely.

4.5 Encouraging a Positive Mealtime Experience

At {{org_field_name}}, mealtimes are seen as an important social and cultural activity. To enhance the dining experience, meals are served in a pleasant, comfortable, and well-lit environment, with opportunities for communal dining where preferred.

Individuals who choose to eat alone are also fully supported, with meals delivered in a way that maintains dignity and personal choice.

To encourage engagement, menu choices are clearly explained, and individuals are given the opportunity to express their preferences and feedback.

4.6 Dysphagia, Choking and Modified Diets

Dysphagia and choking risks are assessed individually. Current speech and language therapy instructions are incorporated into the care plan, kitchen information and handover records without delay. Food and drink are prepared, labelled, checked and served at the prescribed IDDSI level, and residents are positioned and supervised as directed.

Staff stop assistance and follow the emergency procedure if choking occurs. Coughing, a wet or gurgly voice, breathlessness, food pocketing, prolonged mealtimes or recurrent chest infections are reported and reviewed. After any choking or aspiration event, immediate care, clinical assessment, incident reporting and care-plan review are completed as appropriate.

4.7 Allergies, Food Safety and Oral Health

Known allergies and intolerances are recorded consistently in the care plan, kitchen system and other relevant records. Staff verify the resident and meal before service, provide accurate allergen information and prevent cross-contact during storage, preparation, cooking and service. Suspected allergic reactions are treated as emergencies in accordance with the resident’s plan.

Food is stored, prepared, cooked, cooled, reheated and served in accordance with food-safety procedures. Temperature, cleaning and traceability records are maintained as required, and external caterers must provide equivalent assurance, including accurate ingredient and allergen information.

Oral health is assessed and supported because pain, infection, dry mouth, poor dentition and ill-fitting dentures can affect intake and swallowing. Residents receive assistance with oral care and prompt access to dental or medical advice when concerns arise.

4.8 Refusal, Capacity and Clinically Assisted Nutrition and Hydration

A resident with capacity may refuse food, drink, supplements or a recommended diet after receiving accessible information about the likely consequences. Staff respect the decision, record it, continue to offer appropriate alternatives and escalate significant risk. Capacity is assessed only where there is reason to doubt it and is specific to the decision and time.

Where a resident lacks capacity, decisions follow the Mental Capacity Act 2005 best-interests process and consider wishes, beliefs, values, advance decisions and any valid health and welfare lasting power of attorney. Decisions about clinically assisted nutrition or hydration, including at the end of life, are made with the responsible clinical team and documented clearly; staff do not commence, stop or alter such treatment outside their competence or authority.

5. Monitoring and Compliance

To monitor compliance with CQC Regulation 14 and the effectiveness of individual care, we:

• Audit menus, mealtime practice, food safety, allergen controls, modified diets, care plans, referrals and the availability of drinks and snacks.
• Monitor weight, MUST scores, intake and hydration at the frequency specified by each resident’s assessment and care plan, increasing monitoring when risk rises.
• Maintain accurate records of assessments, consent, professional instructions, food and fluid intake where required, actions taken and outcomes.
• Provide induction, role-specific training and competency assessment covering nutrition, hydration, allergies, food safety, dysphagia, IDDSI, choking response, assistance and escalation.

Managers review audit findings, incidents, complaints, weight loss, dehydration, choking events and hospital admissions to identify trends and complete improvement actions. Records are available to the CQC and other authorised bodies when lawfully required.

6. Policy Review

This policy is reviewed at least annually and earlier when legislation, CQC requirements, national guidance, safety alerts or organisational needs change.

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Responsible Person: {{org_field_registered_manager_first_name}} {{org_field_registered_manager_last_name}}
Reviewed on: {{last_update_date}}
Next Review Date: {{next_review_date}}
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