DC12-Meeting Nutritional and Hydration Needs Policy

Registration Number: {{org_field_registration_no}}

Meeting Nutritional and Hydration Needs Policy

1. Purpose

The purpose of this policy is to ensure that all individuals receiving domiciliary care services are supported to maintain adequate nutrition and hydration to sustain life and good health, reduce the risk of malnutrition, dehydration and choking, and to promote wellbeing.

This policy supports compliance with Regulation 14 (Meeting nutritional and hydration needs) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and reflects CQC guidance for providers and managers. Regulation 14 requires that people’s nutritional and hydration needs are met where this forms part of the care arrangements, but not where doing so would breach consent requirements (Regulation 11) or would not be in the person’s best interests.

2. Scope

This policy applies to all staff, including care workers, supervisors, and managers who are involved in planning, preparing, or assisting with food and drink provision for service users. It covers all aspects of nutritional care, including food preparation, dietary preferences, medical requirements, and the monitoring of fluid intake to ensure hydration needs are met. It also applies to those who support individuals with complex needs, including those requiring enteral feeding or additional nutritional support.

3. Legal and regulatory framework

This policy is written to meet the Fundamental Standards and CQC guidance, including:

Regulation 14 (Meeting nutritional and hydration needs) – ensuring adequate food and drink, including support to eat and drink and, where prescribed, dietary supplements and/or parenteral nutrition.
Regulation 11 (Need for consent) – care and support must be provided with valid consent, or in accordance with the Mental Capacity Act 2005 where the person lacks capacity.
Regulation 9 (Person-centred care) – nutrition and hydration support must be based on assessed needs and preferences and reflected in the care plan.
Regulation 10 (Dignity and respect) – assistance with eating and drinking must protect dignity, privacy and independence.
Regulation 12 (Safe care and treatment) – risks such as choking, aspiration, dehydration and poor nutrition must be assessed and mitigated.
Regulation 13 (Safeguarding) – failure to support adequate intake may constitute neglect and must be escalated via safeguarding processes.
Regulation 17 (Good governance) – providers must have systems to assess, monitor, record, audit and improve nutrition and hydration practice.

4. Definitions

For the purposes of this policy, “nutritional and hydration needs” include:

Suitable and nutritious food and hydration sufficient to sustain life and good health;
Dietary supplements and/or parenteral nutrition where prescribed by a healthcare professional;
Meeting any reasonable requirements arising from preferences and religious/cultural background; and
Support to eat or drink where needed.

5. Our Commitment to Meeting Nutritional and Hydration Needs

{{org_field_name}} recognises that good nutrition and hydration are fundamental to maintaining health and well-being. We are committed to ensuring that all service users receive meals and fluids appropriate to their dietary needs, preferences, and medical conditions. Care plans are developed in collaboration with the service user, their family, and healthcare professionals to ensure that dietary requirements are identified and met. We also prioritise the dignity and independence of service users by encouraging choice and participation in meal planning where possible.

Where people are prescribed nutritional supplements and/or parenteral nutrition, we will support safe administration and/or monitoring only within the scope of domiciliary care, and in line with written clinical instructions, training and assessed competency.

We will always seek the person’s consent for nutrition and hydration support and, where the person lacks capacity, we will act in accordance with the Mental Capacity Act 2005, including best-interest decision making.

6. Assessing Nutritional and Hydration Needs

Upon commencement of care, and whenever needs change, {{org_field_name}} will complete and document an assessment of nutrition and hydration needs that includes (where relevant): weight and Body Mass Index (BMI) where possible, appetite, usual diet and fluid intake, allergies and intolerances, oral health factors affecting intake, continence issues affecting fluid intake, relevant diagnoses and medication effects, and the person’s preferences and religious/cultural requirements.

We will use a recognised screening tool (for example MUST) where appropriate and proportionate, and we will identify and record hydration risk indicators (for example reduced intake, confusion, dizziness, constipation, dark urine, dry mouth).

Where there are concerns about swallowing safety (for example coughing during meals, recurrent chest infections, “wet” voice, choking episodes), we will treat this as a high-risk issue, implement immediate safety measures, and escalate promptly for clinical assessment (for example GP and/or Speech and Language Therapy) and for a texture and fluid consistency plan (for example IDDSI) as applicable.

7. Consent, capacity and refusal

Staff must obtain and record valid consent for any support with eating and drinking. If the person refuses food or fluids, staff must respect the refusal, explore reasons (for example pain, nausea, low mood, cultural preference, denture issues, swallowing discomfort), offer suitable alternatives, and document actions taken.

Where there is reason to believe the person may lack capacity to make decisions about nutrition or hydration, staff must escalate to a supervisor/manager and ensure decisions are made in line with the Mental Capacity Act 2005, including best-interest decision making and involvement of family/advocates as appropriate.

Staff must not provide nutrition or hydration support in a way that would breach consent requirements, and where best-interest decisions are required they must be properly recorded, with clear rationale and least-restrictive options considered.

8. Food and Drink Provision

We ensure that service users have access to meals and drinks that are nutritious, balanced, and suited to their dietary needs. Staff assist service users with food preparation where necessary, taking into account their abilities and preferences. Where individuals are unable to prepare meals themselves, arrangements are made for meal deliveries, home-cooked meals, or external catering services. Fluids are offered regularly throughout the day, and staff are trained to recognise signs of dehydration, encouraging service users to drink appropriate amounts of fluids.

Staff will support people to access food and drink throughout the day in a way that reflects the care plan and the outcomes the person wants to achieve, including prompts, preparing drinks within reach, offering preferred beverages, and supporting safe positioning for eating and drinking.

Where a person is identified as at risk of malnutrition or dehydration, the care plan must specify what to monitor (for example food intake, fluid intake, weekly weights where feasible), how often, and the escalation thresholds that must be followed (for example persistent poor intake, rapid weight loss, signs of dehydration). Monitoring tools such as food and fluid charts must be used when indicated and reviewed by a supervisor/manager.

9. Supporting Special Dietary Needs

{{org_field_name}} recognises that some service users have specific dietary requirements due to medical conditions such as diabetes, coeliac disease, renal conditions, dyslipidaemia, or conditions affecting appetite and absorption. In such cases, food and drink are prepared following guidance from healthcare professionals. Allergies and intolerances must be clearly recorded in the care plan and communicated to all staff supporting food and drink tasks.

Where a person is prescribed oral nutritional supplements and/or parenteral nutrition, staff will only support administration and/or monitoring where this is within the scope of the service, the care plan includes clear written instructions, and staff have been trained and assessed as competent.

Texture-modified diets and thickened fluids will be provided only in accordance with an agreed plan (for example IDDSI level) and staff competency, to reduce choking and aspiration risk. Religious and cultural dietary practices must be respected, and appropriate meal options made available in accordance with individual beliefs and customs.

10. Monitoring and Record Keeping

Records must show how nutritional and hydration needs are met and must be completed contemporaneously. Where monitoring is required, staff must accurately record food and fluid intake, the level of assistance provided, and any concerns (for example refusal, nausea, vomiting, swallowing difficulty, coughing or choking).

Where concerns arise, staff must document: the actions taken (for example alternatives offered, prompts, fortification, additional drinks), who was informed (for example family, manager, clinician), and any referrals made (for example GP, dietitian, Speech and Language Therapy).

All records are securely stored and shared lawfully with relevant healthcare professionals as required.

11. Training and Competency of Staff

All staff involved in food preparation or assistance with eating and drinking will receive training on food hygiene, nutrition and hydration, dignity during mealtimes, recognition of malnutrition and dehydration, and escalation procedures.

Staff must also complete role-appropriate training and competency assessment for higher-risk needs, including dysphagia awareness and IDDSI implementation, safe feeding techniques, choking risk, and (where provided) support with prescribed nutritional supplements and/or parenteral nutrition. Staff must not undertake these tasks until competence is assessed and recorded.

12. Encouraging Independence and Choice

We believe in promoting independence wherever possible. Service users are encouraged to participate in meal selection, preparation, and decision-making regarding their dietary needs. Our staff provide appropriate support based on individual capabilities, enabling service users to maintain control over their diet and hydration. Support may include verbal prompting, physical assistance, or the use of adapted utensils for those with limited mobility.

13. Safeguarding and Risk Management

{{org_field_name}} has a duty to safeguard service users from neglect, including failure to provide adequate nutrition and hydration. Staff are trained to recognise indicators of neglect, malnutrition, and dehydration, and they are required to report any concerns immediately. Risk assessments are conducted to identify potential issues related to food and drink provision, and safeguarding procedures are followed in accordance with local authority guidance.

Failure to support adequate nutrition and hydration may constitute neglect and must be treated as a safeguarding concern. Immediate escalation is required where there is: repeated refusal with signs of dehydration, suspected aspiration or choking risk, significant unplanned weight loss, inability to swallow safely, or evidence that the person is not able to access food or drink and has no alternative support.

14. Compliance with Regulatory Standards

Compliance with Regulation 14 and related Fundamental Standards will be monitored through: care plan audits, record audits (including food and fluid charts where used), incident and near-miss review (for example choking episodes), supervision and spot checks, and review of referrals and escalations. Actions and learning will be captured in governance meetings and used to improve practice in line with Regulation 17 (Good governance).

15. Roles and responsibilities

Care staff: Follow the care plan; support choice and independence; record intake where required; recognise and escalate concerns immediately.

Supervisors/Managers: Ensure assessments and care plans include nutrition/hydration needs and risk controls; ensure staff training and competency; review monitoring records; coordinate referrals and multi-disciplinary input; maintain oversight through audits.

Registered Manager: Overall accountability for compliance with Regulation 14 and related Fundamental Standards; ensures governance systems are effective and lessons learned are embedded.

16. Policy Review and Continuous Improvement

This policy is reviewed annually or in response to changes in legislation, best practice guidance, or service user needs. Feedback from staff, service users, and their families is actively sought to identify areas for improvement. {{org_field_name}} is committed to continuously enhancing our approach to nutrition and hydration to ensure that all service users receive the highest quality of care and support.

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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