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Meeting Nutritional and Hydration Needs Policy

1. Purpose

The purpose of this policy is to ensure that all service users receive adequate nutrition and hydration tailored to their individual needs and preferences. Proper nutrition and hydration are essential for maintaining health, well-being, and overall quality of life. {{org_field_name}} is committed to ensuring that every service user receives the necessary support to meet their dietary needs, preferences, and any medical or cultural requirements.

This policy sets out how {{org_field_name}} meets these needs efficiently, safely, and in line with CIW regulations, ensuring compliance with:

• The Regulation and Inspection of Social Care (Wales) Act 2016.
• The Regulated Services (Service Providers and Responsible Individuals) (Wales) Regulations 2017 (as amended), including:
  • Regulation 21 (Standards of care and support – overarching requirements) to protect, promote and maintain the safety and well-being of individuals; and to provide care and support in accordance with each person’s personal plan.
  • Regulations 15–18 (Personal plans, review of personal plans and provider assessments) to ensure nutritional and hydration needs are assessed, planned for, delivered and kept under review.
• CIW’s Inspection Framework (Care and Support: Lines of Enquiry 1–3 and 6–8; Leadership and Management: Lines of Enquiry 9–15), which considers how people’s well-being outcomes are achieved through assessment, planning, safe care and effective oversight.
• Relevant food hygiene and food allergen information legislation and guidance (including Food Information (Wales) Regulations 2014 and Food Standards Agency guidance) where staff handle, prepare or serve food as part of care and support.

2. Scope

This policy applies to:

• All care staff and support workers providing domiciliary care services.
• The Registered Manager and Responsible Individual, who oversee service quality and compliance.
• Service users and their families, ensuring they are involved in decision-making regarding their nutritional and hydration needs.

3. Legal and Regulatory Requirements

CIW regulations require that domiciliary care providers:

• Assess each service user’s nutritional and hydration needs on admission and throughout care.
• Support individuals to eat and drink safely, considering health conditions, personal choices, and dietary restrictions.
• Ensure access to balanced and adequate meals and fluids.
• Recognise and respond to signs of malnutrition, dehydration, or swallowing difficulties.
• Train staff on food safety, nutrition, and hydration best practices​.

4. Meeting Nutritional and Hydration Needs Efficiently

4.1 Individual Nutritional Assessments

Each service user undergoes a nutritional and hydration assessment as part of their care plan development. This includes:

• Identifying dietary preferences and restrictions (e.g., vegetarian, halal, gluten-free, low-sugar diets).
• Assessing any medical conditions affecting nutrition (e.g., diabetes, dysphagia, swallowing difficulties).
• Evaluating hydration needs, ensuring service users drink enough fluids daily.
• Using standard risk assessment tools such as the Malnutrition Universal Screening Tool (MUST) for early detection of malnutrition.

How we manage this efficiently:

• Staff complete nutritional and hydration risk assessments on an ongoing basis and review them at least every three months (to align with personal plan review), or sooner where there is any change in needs, presentation, appetite, weight, swallowing ability, illness, hospital admission, medicines, or where concerns are raised by the person, their representative or a professional.
• A registered dietitian or GP may be consulted when necessary.
• Changes in dietary needs are communicated immediately to the care team.

4.2 Personal plan linkage and review

Nutritional and hydration needs, risks, and agreed support must be clearly recorded in the individual’s personal plan (including preferences, cultural requirements, support needed, risk controls and escalation actions). The personal plan and associated nutritional/hydration content is reviewed at least every three months, and earlier where needs change or concerns are identified. Any review will consider whether the individual is achieving their outcomes relating to eating, drinking, health and well-being, and the plan will be revised where required.

4.3 Meal Preparation and Support

Care staff provide assistance with:

• Preparing and serving meals in line with the individual’s dietary plan.
• Assisting with feeding where necessary, ensuring dignity and respect.
• Encouraging independence by allowing service users to be involved in meal choices.
• Monitoring food intake and reporting concerns about weight loss, difficulty swallowing, or reduced appetite.

How we manage this efficiently:

• Staff are trained in safe food handling and meal preparation, ensuring compliance with Food Standards Agency guidelines.
• Cultural and religious dietary needs are always respected, and alternative options provided when necessary.
• If a service user has dysphagia, our team works with speech and language therapists (SALT) to provide safe, modified food and drink textures.

Where staff prepare, handle or serve food, we will take all reasonable steps to prevent cross-contamination and to support safe choices for people with allergies or intolerances. Staff will follow the individual’s recorded allergens/intolerances, check ingredient information where applicable, and ensure allergen risks are communicated clearly in the care record and handovers. This aligns with legal requirements for provision of allergen information and safe food handling.

4.4 Hydration Monitoring and Support

Ensuring adequate fluid intake is essential for preventing dehydration, urinary tract infections, and kidney problems.

• Care staff regularly encourage drinking fluids, especially for those at risk of dehydration.
• Where necessary, fluids are thickened for service users with swallowing difficulties.
• Hydration records are maintained for those identified as being at risk of dehydration.

Where hydration monitoring is required, we will record: the target intake (if advised), intake offered and taken (including thickened fluids), refusals, prompts/assistance provided, and any signs of dehydration. Immediate escalation will occur where there are indicators of dehydration, repeated refusal of fluids, reduced urine output, new confusion/delirium, vomiting/diarrhoea, fever, or any swallowing/choking concern. Escalation will be to the appropriate professional (e.g., GP/NHS 111/urgent services) and/or service commissioner in line with the person’s plan and assessed risk.

How we manage this efficiently:

• Staff prompt and assist with drinking throughout the day.
• We monitor signs of dehydration, such as dry skin, confusion, or dizziness, and report concerns to a GP.
• Service users who struggle with fluid intake are offered high-water-content foods like soups, fruits, and yoghurts.

4.5 Recognising and Managing Nutritional Risks

• Staff are trained to recognise signs of malnutrition, dehydration, and weight loss.
• Concerns are reported to healthcare professionals promptly.
• Care plans are adjusted if a service user’s needs change.

How we manage this efficiently:

• Regular weigh-ins and assessments are conducted.
• We maintain clear communication with families and healthcare providers about any concerns.

4.6 Special Dietary Requirements and Medical Conditions

For service users with medical conditions, care staff ensure that:

• Diabetics receive low-sugar meals tailored to their needs.
• Individuals with allergies or intolerances avoid harmful ingredients.
• Service users with dementia receive nutritious meals in a way that supports their cognitive and sensory needs.

How we manage this efficiently:

• Care plans clearly document dietary needs, and staff follow them strictly.
• Staff are trained on the impact of nutrition on long-term health conditions.
• We liaise with dietitians, speech and language therapists (SALT), and GPs when required.

4.7 Staff Training and Responsibilities

• All care workers receive training appropriate to their role in: nutrition and hydration support; recognising and responding to malnutrition and dehydration risk; safe assistance with eating and drinking; dysphagia awareness and escalation; accurate record keeping; and food hygiene and allergen awareness where staff handle, prepare or serve food.
• Staff must follow best practices for food preparation, meal assistance, and hydration encouragement.
• The Registered Manager ensures training is refreshed annually.

How we manage this efficiently:

• Training includes hands-on demonstrations, workshops, and e-learning modules.
• Staff are encouraged to record and report any concerns about a service user’s food and drink intake.

4.8 Record keeping and evidence

Staff must record nutritional and hydration support in a way that is timely, accurate and reflects the person’s personal plan. Records (as applicable) will include: nutritional/hydration assessment outcomes (including MUST where used), agreed interventions and preferences, food and fluid intake monitoring where required, weight monitoring where required, refusals and actions taken, professional advice received (e.g., Dietitian/SALT/GP) and the outcome of any escalation. Records must be sufficiently clear to demonstrate how care and support is delivered in line with the person’s assessed needs and personal outcomes.

5. Related Policies

This policy aligns with:

• Person-Centred Care Policy (DCW07)​.
• Safe Care and Treatment Policy (DCW11)​.
• Health and Safety at Work Policy (DCW16)​.
• Risk Management and Assessment Policy (DCW18)​.
• Safeguarding Adults Policy (DCW13)​.

6. Policy Review

This policy will be reviewed at least annually, or sooner if there are changes to legislation, statutory guidance, CIW requirements, best practice guidance, or as a result of learning from audits, incidents, complaints, safeguarding concerns, or inspection outcomes. The review will ensure the policy remains up to date, effective, and reflective of current expectations for safe, person-centred nutritional and hydration support within domiciliary care services in Wales.

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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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