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Registration Number: {{org_field_registration_no}}

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Mealtimes Policy

1. Purpose

This policy outlines {{org_field_name}}’s approach to providing a positive, person-centred, and nutritionally balanced mealtime experience for the people we support. It ensures compliance with CQC regulations, the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, and Regulation 14 – Meeting Nutritional and Hydration Needs. Our goal is to promote well-being, dignity, choice, and independence while ensuring that all individuals receive adequate nutrition and hydration in a safe and enjoyable manner.

2. Scope

This policy applies to all care staff, catering teams, nurses, and support workers involved in meal preparation, assistance with eating, and nutritional support at {{org_field_name}}. It covers meal provision, dietary requirements, support with eating, and safeguarding individuals against malnutrition and dehydration.

3. Legal and Regulatory Framework

This policy must be implemented in accordance with the legal and regulatory requirements applicable to care homes in England, including:

• Health and Social Care Act 2008 and the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, in particular:
  • Regulation 9 – Person-centred care, requiring care and treatment to be appropriate, meet the individual’s needs and reflect their preferences;
  • Regulation 10 – Dignity and respect, including respect for privacy, autonomy, independence and individual preferences;
  • Regulation 11 – Need for consent, requiring care and treatment to be provided with valid consent and, where a person lacks capacity to make the relevant decision, in accordance with the Mental Capacity Act 2005;
  • Regulation 12 – Safe care and treatment, requiring risks to health and safety, including risks associated with eating, drinking, allergies, choking, aspiration, malnutrition and dehydration, to be assessed and reasonably mitigated;
  • Regulation 14 – Meeting nutritional and hydration needs, requiring people using the service to receive suitable and nutritious food and hydration sufficient to sustain life and good health, prescribed dietary supplements or parenteral nutrition where applicable, reasonable food and drink choices arising from their preferences, religious or cultural background, and appropriate support to eat and drink;
  • Regulation 17 – Good governance, requiring accurate, complete and contemporaneous records and effective systems for assessing, monitoring and improving the quality and safety of the service; and
  • Regulation 18 – Staffing, requiring sufficient numbers of suitably qualified, competent, skilled and experienced staff who receive the training, supervision and support necessary to perform their roles safely.
• Mental Capacity Act 2005, including the statutory principles of capacity, decision-specific assessment of capacity and best-interests decision-making where a person lacks capacity to make a particular decision about nutrition, hydration or associated care.
• Care Act 2014, including the principles of wellbeing, prevention and safeguarding adults from abuse and neglect.
• Applicable food safety and food information legislation, including the Food Safety Act 1990, the Food Safety and Hygiene (England) Regulations 2013 and the Food Information Regulations 2014, together with applicable requirements relating to food hygiene, food safety management and allergen information.
• Applicable professional and nationally recognised guidance used to support lawful and safe practice, including relevant NICE guidance, Food Standards Agency guidance and recognised nutrition, hydration and dysphagia standards.

Where legislation, statutory guidance or an individual assessment imposes a higher or more specific requirement than this policy, that requirement must be followed.

4. Principles of Mealtime Management

• Dignity and Choice: Individuals should have autonomy over their meal choices, including what, when, and where they eat.
• Social and Enjoyable Mealtimes: Mealtimes should be a positive experience that fosters social engagement.
• Nutritional Adequacy: Meals must be balanced, varied, and meet dietary needs.
• Safe and Supportive Eating Environment: Individuals should receive appropriate assistance, with risks such as choking and dehydration mitigated.
• Cultural and Religious Considerations: Meal options must reflect personal, cultural, and religious preferences.

5. Meal Planning, Nutrition and Hydration

Assessment of Nutritional and Hydration Needs

• Each person’s nutritional and hydration needs must be assessed as part of their initial assessment and must be reviewed throughout their placement whenever their needs, health, weight, swallowing ability, appetite, medicines or circumstances change.
• Assessments must be completed by staff who have the appropriate skills and knowledge and must identify, as applicable:
  • the person’s nutritional and hydration requirements;
  • risks of malnutrition or dehydration;
  • food allergies and intolerances;
  • dietary requirements associated with medical conditions;
  • any interaction or contraindication between food or drink and prescribed medicines;
  • swallowing difficulties and risks of choking or aspiration;
  • required food texture and drink consistency;
  • the level of assistance, prompting, supervision or specialist equipment required;
  • preferred meal times and patterns of eating and drinking;
  • cultural, religious, ethical and personal dietary requirements; and
  • any requirement for nutritional supplements, enteral feeding or parenteral nutrition prescribed by an appropriate healthcare professional.
• The outcome of each assessment must be clearly reflected in the person’s care plan and risk assessments and must be readily available to staff responsible for preparing, serving or supporting the person with food and drink.

Suitable and Nutritious Food

• People must receive suitable and nutritious food in sufficient quantity and variety to sustain life and good health and to meet their assessed needs.
• Menus must provide appropriate choice and must take account of individual preferences, cultural and religious requirements and ethical dietary choices.
• Where a person requires a specific therapeutic or medically indicated diet, the diet provided must correspond with their current assessment, prescription or healthcare professional advice.
• Suitable alternatives must be available where a person does not want, cannot tolerate or cannot safely eat the meal originally offered.
• Snacks or other suitable food must be available between usual meal times for people who require or prefer to eat little and often.
• If a person is asleep, absent or otherwise unable to eat at the usual meal time, arrangements must be made for them to receive an appropriate meal at another time.

Hydration

• Drinking water must be available and accessible to people at all times, unless a clinically authorised restriction applies.
• A suitable choice of other drinks must be offered regularly throughout the day and night according to individual need.
• People who are unable to obtain drinks independently must be offered and assisted with drinks at appropriate intervals.
• Where increased, restricted or otherwise modified fluid intake is clinically required, this must be documented in the person’s care plan and followed by staff.
• Thickened fluids must only be provided at the level and consistency specified in the person’s current swallowing assessment or other appropriate healthcare professional guidance.

Prescribed Nutritional Support

• Any dietary supplement, oral nutritional supplement, enteral nutrition or parenteral nutrition prescribed by a healthcare professional must be provided at the prescribed dose, amount, frequency and time.
• Such nutritional support must only be prepared, administered or managed by staff who are appropriately trained, skilled and competent for the intervention concerned.
• Refusal, omission or inability to provide prescribed nutritional support must be recorded and escalated promptly in accordance with the person’s care plan and clinical advice.

Special Dietary and Swallowing Requirements

• Vegetarian, vegan, halal, kosher and other reasonable dietary requirements arising from a person’s preferences, beliefs, religion or culture must be identified and met.
• Food allergies and intolerances must be clearly identified, recorded and communicated to staff involved in food preparation, meal service and direct care.
• People with dysphagia must receive food and drink that complies with their current swallowing assessment and any recommendations made by an appropriately qualified healthcare professional.
• Where the International Dysphagia Diet Standardisation Initiative (IDDSI) is used within a person’s swallowing plan, the prescribed IDDSI food texture and drink thickness level must be followed consistently.
• Staff must not independently alter a clinically prescribed texture, fluid consistency, nutritional supplement or feeding plan without appropriate clinical review.

5.1 Food Safety and Allergen Management

• All food must be stored, prepared, handled, cooked, reheated, cooled and served in accordance with applicable food hygiene and food safety legislation and the service’s documented food safety management procedures.
• The service must maintain and implement documented food safety procedures based on Hazard Analysis and Critical Control Point principles, or another legally compliant food safety management system appropriate to the service.
• Up-to-date information about each person’s food allergies, intolerances and other medically significant dietary restrictions must be clearly recorded in their care documentation and communicated effectively to catering staff, care staff and any other person responsible for preparing or serving food.
• Staff must check the individual’s current dietary and allergen information before providing food where there is any identified allergy, intolerance or other significant dietary risk.
• The presence of any of the 14 allergens required to be declared under food information law must be identifiable for food provided by the service. Allergen information supplied to people must be accurate and must not be based on guesswork or assumption.
• Where food is prepacked for direct sale and falls within the applicable legal definition, it must carry the legally required food name and ingredients information, with allergenic ingredients identified in accordance with applicable food information legislation.
• Changes to ingredients, recipes, suppliers or substitute products must be checked before use to determine whether allergen information or an individual’s dietary risk has changed.
• Appropriate measures must be taken to prevent avoidable allergen cross-contact and other food contamination.
• Staff involved in preparing, handling or serving food must receive food hygiene and allergen instruction, supervision or training appropriate to their duties and must be competent to apply the service’s food safety and allergen procedures.
• Any suspected allergic reaction or other food-related medical emergency must be responded to immediately in accordance with the person’s emergency care plan and the service’s emergency procedures, including obtaining emergency medical assistance where required.

6. Person-Centred Mealtime Support

Choice and Independence

• People must be supported to make informed choices about what they eat and drink, when they eat and drink and, wherever reasonably practicable, where they eat and drink.
• Staff must take account of each person’s preferences, routines, culture, religion, ethical beliefs, communication needs, abilities and assessed health needs when providing mealtime support.
• People who are able to eat and drink independently must be encouraged and supported to do so.
• Appropriate equipment, adapted crockery, cutlery, cups or other aids required to promote safe independence must be provided and used in accordance with the person’s assessment.

Assistance with Eating and Drinking

• People who require assistance, prompting, encouragement or supervision to eat or drink must receive the level of support specified in their current assessment and care plan.
• Support must be provided respectfully, patiently and without unnecessary delay or rushing.
• Staff must ensure that food and drink are placed within the person’s reach and are presented in a form that the person can manage safely.
• People must be given sufficient time to eat and drink the amount required to meet their assessed nutritional and hydration needs.
• Appropriate positioning must be maintained where this is required to reduce the risk of choking or aspiration.
• Food must be served and maintained at an appropriate and safe temperature throughout the period in which the person is being supported to eat.
• Staff must observe for changes in the person’s ability to chew, swallow, eat or drink and must report and escalate concerns promptly.

Communication

• Information and choices about food and drink must be communicated in a way that the person can understand.
• Where required, this may include accessible or pictorial menus, objects of reference, Makaton, British Sign Language, communication aids, appropriate interpretation or other communication methods identified in the person’s care plan.
• Staff must not assume that a person lacks choice because they communicate non-verbally or require assistance with decision-making.
• Where a person has difficulty expressing a preference, staff must use their known communication methods and information about their established likes, dislikes and routines to maximise their involvement.

6.1 Consent, Refusal, Capacity and Best Interests

• People must be supported to make their own decisions about food, drink and nutritional support wherever they have capacity to make the particular decision concerned.
• Consent must be sought in a way that takes account of the person’s communication needs and must be respected.
• A capacitous person has the right to refuse food, drink, nutritional supplements or other nutritional intervention, even where staff consider the decision to be unwise.
• Staff must not force, coerce, threaten, deceive or improperly restrict a person in order to make them eat or drink.
• Where a person refuses food or drink, staff must:
  • respect the refusal where the person has capacity to make that decision;
  • offer reasonable alternatives where appropriate;
  • establish, where possible, whether there is an identifiable reason for the refusal;
  • monitor the person in accordance with their assessed level of risk;
  • record significant or repeated refusals; and
  • escalate concerns promptly where the refusal may place the person at risk of malnutrition, dehydration or other harm.
• Capacity must not be assumed to be absent solely because a person has dementia, a learning disability, mental illness, communication difficulty or makes a decision that others consider unwise.
• Where there is reason to doubt a person’s capacity to make a specific decision concerning nutrition or hydration, a decision-specific capacity assessment must be undertaken in accordance with the Mental Capacity Act 2005.
• Where the person lacks capacity to make the relevant decision, any decision made or action taken on their behalf must be in their best interests and must follow the Mental Capacity Act 2005, including consultation with appropriate people and consideration of the person’s past and present wishes, feelings, beliefs and values.
• Any valid and applicable advance decision, health and welfare Lasting Power of Attorney, court-appointed deputy or relevant Court of Protection decision must be identified and respected within the limits of the authority granted.
• Where restrictive intervention is being considered in relation to eating, drinking or nutritional support, staff must ensure that the intervention is lawful, necessary, proportionate and the least restrictive available option.
• Capacity assessments, best-interests decisions and any relevant legal authority must be clearly documented in the person’s care records and reviewed where circumstances or the person’s capacity change.
• Urgent clinical advice must be sought where a person’s refusal of nutrition or hydration creates an immediate or significant risk to their health.

7. Creating a Positive Dining Environment

Comfortable and Welcoming Setting

• Tables must be set appropriately, with attention to cleanliness and presentation.
• Mealtime areas should be calm, free from excessive noise, and pleasant.

Flexibility in Mealtimes

• Individuals should be offered meals at their preferred times, accommodating late risers and early eaters.

Encouraging Social Interaction

• Those wishing to eat with others should be encouraged to dine in communal areas.
• Private dining options should be available for those preferring to eat alone.

8. Monitoring Nutritional and Hydration Wellbeing

Nutritional Screening and Review

• Every person’s nutritional and hydration needs must be assessed on admission or commencement of the service and reviewed thereafter at a frequency appropriate to their needs and level of risk.
• A recognised and appropriate nutritional screening method must be used where clinically indicated. The Malnutrition Universal Screening Tool (MUST) may be used for adults where it is suitable for the individual and the setting.
• Weight, body mass index and other relevant clinical or nutritional indicators must be monitored at the frequency identified by the person’s assessment, care plan or healthcare professional advice.
• A change in weight, appetite, swallowing ability, fluid intake, physical health, medicines or level of independence must trigger review where it may affect the person’s nutritional or hydration needs.

Food and Fluid Monitoring

• Food and/or fluid intake must be monitored and recorded where this is required by the person’s assessment, care plan, clinical condition or identified risk.
• Where food or fluid charts are required, entries must be made contemporaneously and must provide sufficient information to determine whether the person is meeting their assessed needs.
• Staff completing monitoring records must not simply record that a meal or drink was “offered”; the record must accurately reflect intake where the purpose of the record is to monitor consumption.
• Any prescribed fluid target, fluid restriction or nutritional target must be clearly identified in the care plan and monitoring documentation.

Response to Deterioration or Risk

• Staff must take action without delay where monitoring identifies:
  • unexplained or unintended weight loss or significant weight gain;
  • reduced food or fluid intake;
  • signs or symptoms of dehydration;
  • persistent refusal of food or drink;
  • new or worsening swallowing difficulties;
  • coughing, choking or signs of aspiration during meals;
  • difficulty managing a prescribed diet, food texture or fluid consistency; or
  • any other indication that nutritional or hydration needs are not being met.
• Action may include immediate review of the care plan and risk assessment and referral to an appropriate healthcare professional, such as the GP, dietitian or Speech and Language Therapist, according to the identified need.
• Advice and recommendations from healthcare professionals must be documented, communicated to relevant staff and implemented promptly.
• Where there is an immediate threat to life or serious deterioration, emergency medical assistance must be obtained without delay.

9. Safeguarding Against Malnutrition and Dehydration

Identifying At-Risk Individuals

• Staff must be vigilant in recognising signs of poor appetite, swallowing difficulties, and dehydration.
• Individuals with dementia, swallowing disorders, or long-term conditions require proactive monitoring.

Choking Prevention Measures

• Staff must be trained in safe swallowing techniques and first aid for choking.
• Individuals requiring modified diets must have clear care plans and risk assessments.

Escalation Procedures

• Any concerns must be reported immediately to healthcare professionals.
• Adjustments to meals must be made as necessary following dietitian or speech and language therapist (SALT) advice.

10. Staff Training, Competence and Responsibilities

Training and Competence

• Staff must receive induction, training, supervision and competency assessment appropriate to the nutritional, hydration and mealtime responsibilities of their role.
• Training must be refreshed where required to maintain competence, where practice changes, where an individual’s needs require additional knowledge or skills, or where supervision, audit, an incident or a competency assessment identifies a need.
• Staff involved in preparing, handling or serving food must receive appropriate food hygiene and allergen training, instruction and supervision.
• Staff who support people with dysphagia must receive training and competency assessment appropriate to their role, including understanding and following the person’s swallowing plan, prescribed food texture and fluid consistency and, where applicable, IDDSI terminology and levels.
• Staff providing direct assistance with eating and drinking must be competent in:
  • person-centred mealtime support;
  • recognising and responding to signs of malnutrition and dehydration;
  • recognising swallowing difficulties and signs of choking or aspiration;
  • appropriate positioning and use of prescribed equipment;
  • recognising food allergies and responding to allergic reactions;
  • recording and escalating reduced food or fluid intake;
  • respecting consent and refusals; and
  • applying the relevant principles of the Mental Capacity Act 2005.
• Only staff who have the appropriate qualifications, skills, competence and authorisation may undertake specialist nutritional interventions such as the management of enteral or parenteral nutrition.

Care Staff Responsibilities

Care staff must:

• follow the person’s current nutrition and hydration care plan, risk assessments and professional recommendations;
• provide support in a dignified, respectful and unhurried manner;
• promote independence wherever safe and practicable;
• accurately monitor and record food and fluid intake where required;
• recognise changes or concerns and escalate them promptly; and
• respect the person’s choices, consent and lawful decisions.

Catering Staff Responsibilities

Catering staff must:

• prepare and provide food that meets identified dietary, cultural, religious, ethical, allergy and texture requirements;
• follow food safety and allergen controls;
• ensure that changes to products, ingredients or recipes are checked before meals are provided to people with dietary restrictions or allergies; and
• communicate promptly with care staff or management where a required meal cannot be supplied safely.

Registered Manager Responsibilities

The Registered Manager must ensure that:

• effective systems are in place to assess, plan, provide, monitor and review nutrition and hydration;
• sufficient competent staff are available to support people safely during mealtimes;
• staff training and competency are appropriate to the needs of people using the service;
• identified nutritional, hydration, swallowing, choking, allergy and food safety risks are appropriately managed;
• professional advice is obtained and acted upon where required; and
• audits and other governance processes identify concerns and lead to timely corrective action.

11. Documentation, Records and Governance

Individual Care Records

• Each person must have accurate, complete and up-to-date documentation of their nutritional and hydration needs.
• Records must include, where applicable:
  • nutritional and hydration assessments and screening outcomes;
  • current weight-monitoring requirements;
  • allergies and intolerances;
  • dietary preferences and cultural, religious or ethical requirements;
  • therapeutic or medically indicated diets;
  • swallowing assessments and prescribed food texture or fluid consistency;
  • choking and aspiration risk;
  • level of assistance, prompting or supervision required;
  • equipment required to support safe eating and drinking;
  • prescribed nutritional supplements, enteral nutrition or parenteral nutrition;
  • food or fluid monitoring requirements and targets;
  • relevant professional advice and referrals;
  • significant refusals of food, drink or prescribed nutritional support;
  • capacity assessments and best-interests decisions where relevant; and
  • action to be taken if intake falls below the person’s assessed requirement.

Recording Standards

• All records relating to nutrition and hydration must be accurate, complete, legible and contemporaneous.
• Food and fluid monitoring charts must accurately reflect what the person consumed where monitoring of intake is required.
• Changes in need, concerns identified, action taken, referrals made and advice received from healthcare professionals must be recorded promptly.
• Information affecting food preparation or meal provision, including allergies, swallowing requirements and prescribed diets, must be communicated promptly to all relevant staff.

Review and Escalation

• Care plans and associated risk assessments must be reviewed when monitoring identifies a change, when new professional advice is received, following a relevant incident or whenever the person’s needs change.
• Where concerns indicate that a person may not be receiving adequate nutrition or hydration, action must be taken without delay and the outcome must be documented.

Audit and Governance

• The Registered Manager must maintain effective systems to monitor compliance with this policy and the quality and safety of nutritional and hydration support.
• Governance arrangements must include review, at appropriate intervals, of:
  • nutrition and hydration assessments;
  • weight loss or other adverse nutritional trends;
  • food and fluid monitoring records;
  • choking or aspiration incidents and near misses;
  • adherence to prescribed food textures and fluid consistencies;
  • allergy and food safety controls;
  • referrals and implementation of healthcare professional advice;
  • staff training and competency; and
  • complaints, concerns and feedback relating to food, drink or mealtime support.
• Where audits, incidents, complaints or monitoring identify deficiencies, corrective action must be documented, allocated to an appropriate person, completed within an appropriate timescale and subsequently checked for effectiveness.
• Feedback from people using the service must be used, where appropriate, to assess and improve the quality of food, drink and the mealtime experience.

12. Related Policies

• CH09-Person-Centred Care Policy
• CH10-Dignity and Respect Policy
• CH12-Safe Care and Treatment Policy
• CH14-Meeting Nutritional and Hydration Needs Policy
• CH17-Infection Prevention and Control Policy
• CH18-Risk Management and Assessment Policy
• CH27-Staff Supervision, Training, and Development Policy

13. Policy Review

• This policy will be reviewed annually or sooner if there are updates in CQC regulations, nutritional guidance, or best practice standards.
• Amendments will be made to ensure continued compliance and high-quality mealtime experiences.

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Responsible Person: {{org_field_registered_manager_first_name}} {{org_field_registered_manager_last_name}}
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Next Review Date: {{next_review_date}}
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