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{{org_field_name}}

Registration Number: {{org_field_registration_no}}

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Nutrition and Hydration Policy

1. Purpose

The purpose of this policy is to ensure that all individuals supported by {{org_field_name}} receive safe, nutritious, and personalised food and drink support that promotes their health, wellbeing, dignity, and independence. Proper nutrition and hydration are essential to maintaining overall health, preventing illness, managing long-term conditions, reducing hospital admissions, and supporting people to live fulfilling and active lives.

We recognise that food and nutrition are central to overall wellbeing, not only as sources of sustenance but also of enjoyment, cultural expression, social interaction, and personal dignity. Malnutrition and dehydration can seriously compromise people’s wellbeing, independence, and ability to remain safely at home. Therefore, this policy aims to embed strong nutritional care across all areas of our practice.

In enhancing this policy, we have incorporated and aligned it with:

• Health and Social Care Standards: My Support, My Life (Scottish Government, 2017) (including the eating and drinking standards).
• The Care Inspectorate “A quality framework for support services (care at home, including supported living models of support)” (May 2022), including expectations for wellbeing, planned care and support, and quality assurance.
• Care Inspectorate guidance: “Developing a care service’s food, fluid and nutritional care policy” (Publication date: March 2024) (Part 2: care at home/housing support services/nurse agencies), including expectations on assessment, escalation, training and audit.
• Public Services Reform (Scotland) Act 2010 and The Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011 (SSI 2011/210), including the duty to keep and review personal plans.
• SSSC Codes of Practice (2024) for social service workers and employers.

This policy outlines how {{org_field_name}} assesses, plans, monitors, and supports the nutritional and hydration needs of each person we support in a consistent, responsive, person-led, evidence-based, and legally compliant manner.

2. Scope

This policy applies to:

• All staff involved in the planning, preparation, and delivery of nutritional and hydration support.
• All people supported by {{org_field_name}}, including those with complex needs, cognitive impairments, swallowing difficulties, or at risk of malnutrition or dehydration.
• Family members, carers, legal representatives, and health professionals where appropriate.
• Multi-disciplinary professionals involved in the assessment and management of nutrition-related needs.

This includes care provided in people’s homes where we assist with:

• Meal preparation.
• Shopping and menu planning.
• Monitoring intake.
• Fluid intake reminders and assistance.
• Support with safe eating, drinking, and modified diets.
• Support for healthy eating and lifestyle promotion.

3. Related Policies

This policy should be read in conjunction with:

• Personal Care and Support Planning Policy
• Medication Management Policy
• Infection Prevention and Control Policy
• Risk Assessment Policy
• Record Keeping and Documentation Policy
• Safeguarding Adults Policy
• Equality, Diversity and Inclusion Policy
• Mental Capacity and Consent Policy

4. Policy Statement

At {{org_field_name}}, we are committed to ensuring that everyone we support:

• Is enabled to eat and drink in a way that respects their personal preferences, beliefs, cultural and spiritual values, medical needs, and dignity.
• Receives appropriate, evidence-based nutritional care, as outlined in their personal plan.
• Is assessed regularly for any risk of malnutrition, dehydration, obesity, undernutrition, or poor dietary balance.
• Receives preventative and proactive interventions to promote optimal health outcomes.
• Is empowered to make informed choices around food, portion sizes, and meal patterns.
• Is actively supported to participate in mealtimes as enjoyable, meaningful, and socially valuable activities.

We align our approach with the Health and Social Care Standards, specifically:

• Standard 1.29: I am supported to meet my nutritional needs and enjoy appropriate and healthy meals and snacks that meet my cultural and dietary needs.
• Standard 1.32: As far as possible, I can choose to have meals with other people at times that suit me.
• Standard 1.34: If I need help with eating and drinking, this is carried out in a dignified way and my personal preferences are respected.
• Standard 1.35: I can enjoy unhurried snack and mealtimes in as relaxed an atmosphere as possible.
• Standard 1.37 – 1.40: My meals and snacks meet my needs, I can access fresh water, enjoy healthy options, and have my cultural, medical and personal preferences fully respected.
• Standard 1.42: I can maintain and develop my interests, activities and what matters to me in the way that I like.
• Standard 4.11: My care is provided in line with current evidence, guidance, and best practice.

We also fully reflect the SSSC Codes of Practice 2024 which require care workers and employers to safeguard people’s wellbeing, including safe support with food, fluids, and nutrition.

Legal and regulatory requirements

Our nutrition and hydration practice is delivered and evidenced through each person’s assessment and personal plan, and is reviewed in line with statutory requirements and Care Inspectorate expectations. We will ensure that:

• Nutritional and hydration needs and risks are assessed at the start of service and whenever needs change, and recorded in the person’s personal plan.
• Personal plans (including nutrition and hydration arrangements) are reviewed at least every six months, and sooner where a person’s needs, risks or outcomes change.
• Staff know how to monitor, record, and escalate concerns about weight loss, dehydration, swallowing risk, dental/oral health issues, medication impacts, continence-related reduced drinking, and missed meals.
• We use audit and quality assurance activity (for example record audits, mealtime practice checks where relevant to commissioned tasks, and feedback from people and families) to identify improvement actions and demonstrate impact.

5. How We Manage Nutrition and Hydration Efficiently

5.1. Initial Assessment of Nutritional Needs

Upon commencement of service, we undertake a comprehensive nutritional and hydration needs assessment as part of the person’s personal plan. This covers:

• Dietary preferences, including religious, cultural, vegetarian, vegan, halal, kosher or gluten-free choices.
• Medical needs affecting nutrition (e.g. diabetes, coeliac disease, allergies, dysphagia, IBS, renal failure).
• History of malnutrition, unintentional weight loss, recent hospital stays, or long-term conditions.
• Any current nutritional care plans provided by dietitians or health professionals.
• Risk of dehydration or electrolyte imbalance (especially for people on diuretics or with kidney issues).
• Oral health considerations affecting chewing or swallowing.
• Physical ability to prepare, consume, and manage food independently.
• Personal preferences for mealtime routines, portion sizes, favourite foods, and dislikes.
• Risk factors for obesity, cardiovascular disease or diabetes, where lifestyle interventions may be beneficial.

We use validated nutritional screening tools (e.g. the MUST tool: Malnutrition Universal Screening Tool) where applicable, ensuring high-risk individuals are identified early.

Family members and healthcare professionals may be involved in these assessments, and all findings are documented comprehensively in the personal plan.

5.2. Planning and Personalisation

Each personal plan includes:

• Individualised nutritional goals.
• Support needs (e.g. assistance cutting food, full feeding assistance, or verbal prompts).
• Meal timing preferences (e.g. religious fasting periods, time-restricted eating patterns).
• Safe hydration requirements (including daily fluid targets where relevant).
• Emergency protocols for allergic reactions, choking risks, or dysphagia.
• Cultural, sensory, or texture preferences (e.g. soft diets, fortified diets, thickened fluids).

We engage in ongoing discussion with the person and their family to ensure plans reflect changing needs, capacities, and preferences.

5.3. Meal Preparation and Support in Practice

Care staff are trained to:

• Prepare meals in accordance with personal plans and safe food handling procedures.
• Follow infection prevention protocols, ensuring kitchen hygiene and correct food storage.
• Assist with modified diets following SALT (Speech and Language Therapy) guidelines, using correct texture levels for people with swallowing difficulties (e.g. IDDSI framework).
• Monitor portion sizes to ensure nutritional balance while respecting the person’s appetite.
• Use nutritional supplements or prescribed fortifications where clinically indicated.
• Promote safe reheating practices for pre-prepared meals, checking temperatures before serving.
• Encourage independence by involving the person in food preparation where possible.
• Promote dignity by sitting at eye level when feeding and ensuring appropriate positioning.

Where enteral feeding or clinically complex nutritional care is required, this will only be undertaken by trained and delegated staff following healthcare professional protocols.

5.4. Hydration Support

Dehydration is a key risk factor for urinary tract infections, confusion, falls, constipation, and hospital admissions, particularly in older adults. Our hydration approach includes:

• Daily fluid plans incorporated into personal care planning.
• Offering drinks regularly throughout visits.
• Use of fluid charts where dehydration risk is identified.
• Provision of adapted equipment such as non-spill beakers or wide-grip cups.
• Promoting variety in fluids (water, teas, diluted juices, smoothies) to encourage adequate intake.
• Monitoring for signs of dehydration including dry skin, low urine output, headaches, dizziness or confusion.
• Escalating concerns promptly to the Registered Manager or health professionals.
• Educating staff and people we support on the importance of maintaining hydration.

5.5. Ensuring access to food and fluids between visits and in the event of disruption

Because people may not have staff present outside scheduled visits, we will ensure (as part of assessment and personal planning) that the person has safe, agreed access to drinks and food between visits, including arrangements for hot/cold drinks, easy-to-prepare options, and any support from family, community services or telecare where appropriate.
Where a visit is delayed, missed or disrupted, staff must follow the service’s escalation process to ensure the person’s nutrition, hydration and medication-related needs are not compromised, and actions are recorded in the daily notes and communication logs.

5.6. Monitoring and Risk Management

For people at nutritional risk, we apply enhanced monitoring protocols:

• Regular weight monitoring with consent.
• Recording of daily intake using food and fluid balance charts.
• Use of validated BMI and malnutrition screening tools.
• Regular liaison with GPs, dietitians, SALT teams, district nurses, or hospital-based nutritionists.
• Early intervention where risks of unintentional weight loss or gain are identified.
• Review of medications that may influence appetite, fluid balance, or nutrient absorption.

Our risk management is aligned with safeguarding frameworks, ensuring deterioration or unaddressed malnutrition triggers prompt multidisciplinary response.

5.7. Promoting Healthy Lifestyle and Nutritional Education

In addition to reactive care, {{org_field_name}} actively promotes preventative health through:

• Encouraging a balanced diet aligned with the Scottish Dietary Goals and Eatwell Guide.
• Promoting adequate intake of fresh fruits, vegetables, wholegrains, and fibre.
• Supporting people to reduce intake of salt, sugars, saturated fats and highly processed foods.
• Raising awareness of healthy snacking alternatives.
• Collaborating with families to develop shopping lists aligned with healthy eating principles.
• Facilitating healthy lifestyle discussions during reviews or support plan updates.
• Encouraging suitable levels of physical activity where possible to complement healthy eating habits.
• Signposting individuals to weight management support services or NHS health checks when appropriate.

We promote informed choice, recognising that while we encourage healthy options, individuals have the right to make autonomous dietary decisions, provided risks are clearly explained.

5.8. Supporting Dignity and Choice at Mealtimes

Mealtimes are approached holistically, as important social, cultural, and emotional experiences.

Our staff:

• Offer varied daily choices wherever possible.
• Promote food presentation, colour, and plating to stimulate appetite.
• Respect fasting, cultural dietary restrictions, and mealtime rituals.
• Allow unhurried mealtimes, avoiding rushing or excessive prompting.
• Support people to eat at times they choose, including flexible meal windows.
• Provide companionship where appropriate, respecting preferences for solitary or social dining.
• Enable people to enjoy music, conversation, or quiet during mealtimes based on their wishes.
• Ensure appropriate seating, adaptive cutlery, and supportive positioning for those requiring assistance.
• Respect people’s right to decline food while escalating persistent refusals for professional review.

5.9. Information, feedback and concerns about food and drink support

People we support (and those important to them) will be given information—in a format they can understand—about how nutrition and hydration support will be delivered (for example, meal preparation, shopping support, prompting/assistance, and any recording such as food/fluid charts).
We actively seek feedback on whether the person feels supported to eat and drink well, and we will respond to concerns promptly. Any complaint or concern relating to nutrition and hydration will be recorded, investigated and used as part of quality improvement activity.

5.10. Staff Training and Competency

All care staff receive mandatory training on:

• Safe food preparation, storage and handling.
• Nutritional awareness and prevention of malnutrition.
• Dehydration recognition and response.
• Supporting people with dysphagia and modified diets.
• Recognising choking hazards and first aid response.
• Infection control in food preparation.
• Culturally sensitive meal planning.
• Healthy lifestyle promotion.
• Professional responsibilities under the SSSC Codes of Practice.

Ongoing competency is assessed through:

• Supervision observations.
• Spot checks and audits.
• Structured learning updates.
• Reflection sessions at team meetings.
• Additional targeted training where individuals have complex nutritional needs.

Staff are required to escalate concerns around changing nutritional status, swallowing difficulties or persistent weight changes.

5.11. Documentation and Record-Keeping

All nutritional and hydration interventions are documented thoroughly in:

• Personal plans.
• Daily care notes.
• Food and fluid intake charts.
• Weight monitoring records.
• Communication logs with health professionals.
• Risk assessment reviews.
• Incident reports where necessary.

Records are regularly audited by management to ensure completeness, accuracy, and prompt identification of emerging nutritional risks.

Nutrition and hydration arrangements recorded within the personal plan will be reviewed with the person (and those important to them where appropriate) at least every six months, and sooner if needs or risks change, with a record kept of each review.

6. Roles and Responsibilities

Registered Manager

• Maintains oversight of nutritional care delivery.
• Ensures staff receive appropriate training.
• Reviews nutritional incidents, risk assessments, and audits.
• Coordinates input from external healthcare professionals.
• Ensures Care Inspectorate requirements are fully met.

Deputy Manager / Team Leaders

• Coordinate reviews of personal plans.
• Monitor staff competence in nutrition support.
• Review high-risk individuals regularly.
• Supervise documentation and follow up on concerns.

Care Staff

• Provide person-centred nutritional support.
• Accurately record care provided.
• Observe and escalate signs of nutritional deterioration or dehydration.
• Promote safe and respectful mealtime practices.

People We Support and Families

• Actively engage in care planning and meal choices.
• Provide information on preferences, allergies, or religious considerations.
• Raise concerns or request reviews as needs change.

7. Policy Review

This policy will be reviewed annually or sooner if:

• National guidance changes.
• Care Inspectorate, Public Health Scotland or NHS Scotland update nutritional frameworks.
• An inspection identifies areas for improvement.
• Staff or people we support identify gaps or suggest improvements.
• Relevant legislation is amended.

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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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