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Registration Number: {{org_field_registration_no}}

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Meeting Nutritional and Hydration Needs Policy

1. Purpose

The purpose of this policy is to ensure that people who use our supported living service are supported to access and consume adequate nutrition and hydration to sustain life and good health and to reduce the risk of malnutrition and dehydration, in line with Regulation 14 (Meeting nutritional and hydration needs) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

In supported living, people may shop for, prepare and eat their own food; however, where our regulated activity includes support with meal planning, shopping, preparing food and drink, prompting, or assistance with eating and drinking, we will assess needs, plan support, manage risks (including choking/dysphagia), and keep appropriate records to evidence safe, person-centred support. This policy must be read alongside our policies on consent and capacity, safeguarding, infection prevention, medicines, and incident reporting, because nutrition and hydration risks often overlap with these areas.

2. Scope

This policy applies to all support staff, including support workers, supervisors, and managers who are involved in planning, preparing, or assisting with food and drink provision for tenants. It covers all aspects of nutritional support, 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.

This policy applies whenever staff are involved in any part of a person’s nutrition or hydration (including prompting, support with shopping/budgeting for food, meal preparation, supporting access to drinks, supporting eating/drinking, monitoring intake, or implementing SALT/dietetic guidance). Where people independently manage food and drink with no staff involvement, this policy still applies to:

• initial and ongoing risk identification
• signposting and health promotion
• safeguarding action if there are concerns about self-neglect, neglect, malnutrition, dehydration or choking risk.

3. Relevant legislation, regulations and guidance

We will comply with all applicable legal and regulatory requirements, including (where relevant):

• Health and Social Care Act 2008 (and CQC’s regulatory functions).
• Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (as amended), including:
  • Regulation 14 (Meeting nutritional and hydration needs)
  • Regulation 9 (Person-centred care), Regulation 11 (Need for consent), Regulation 12 (Safe care and treatment), Regulation 13 (Safeguarding), Regulation 17 (Good governance), Regulation 18 (Staffing).
• CQC guidance on Regulation 14 and related regulations (as updated).
• Food allergen requirements and best practice guidance (including “Natasha’s Law” PPDS labelling changes and FSA guidance for the out-of-home sector).
• IDDSI Framework for texture-modified diets and thickened fluids where dysphagia is present.
  We will also take account of relevant NHS/SALT/dietetic guidance provided for the individual.

4. 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 tenants receive meals and fluids appropriate to their dietary needs, preferences, and medical conditions. Care plans are developed in collaboration with the scheme user, their family, and healthsupport professionals to ensure that dietary requirements are identified and met. We also prioritise the dignity and independence of tenants by encouraging choice and participation in meal planning where possible.

We will support people to make their own informed choices about food and drink wherever possible. Where a person may lack capacity to make specific decisions about nutrition/hydration support, staff must follow our Mental Capacity and Consent procedures to complete a decision-specific capacity assessment and (where required) a best-interests decision, involving family/advocates and relevant professionals. Any restriction (for example, to reduce choking risk) must be the least restrictive option and clearly documented with rationale and review dates.

5. Assessing Nutritional and Hydration Needs

On commencement of support, staff must complete and document a nutrition and hydration assessment within 48 hours (or sooner where risk indicators are present). Assessments must be reviewed:

• at least monthly for people identified as at risk, and at least every 6 months for people with no identified risk; and
• immediately following triggers such as illness/infection, significant weight change, reduced appetite, constipation, vomiting/diarrhoea, a choking/coughing episode, changes to medication that affect appetite/thirst, hospital admission/discharge, or professional concern raised by family/GP/dietitian/SALT.
  The assessment will consider (as a minimum): dietary preferences, culture/religion, allergies/intolerances, medical conditions, oral health, mobility and ability to shop/prepare food, support needed to eat/drink safely, swallowing/choking risk, and hydration risks. We will use a recognised screening tool such as MUST where appropriate and record the score, actions taken, and review date.
  Where the assessment identifies elevated risk (malnutrition, dehydration, dysphagia/choking, allergy risk, or inability to access food/drinks), staff must create or update the individual’s support plan with clear instructions and escalation thresholds (see “Monitoring, escalation and record keeping”).

6. Food and Drink Provision

We ensure that tenants have access to meals and drinks that are nutritious, balanced, and suited to their dietary needs. Staff assist tenants 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 schemes. Fluids are offered regularly throughout the day, and support staff are trained to recognise signs of dehydration, encouraging tenants to drink appropriate amounts of fluids.

7. Food safety and allergens

Where staff handle, prepare or serve food/drink, we will follow safe food practices to reduce infection and allergic reaction risks. Staff must:

• maintain good hand hygiene and clean food preparation areas/equipment before and after use;
• prevent cross-contamination (especially for allergens);
• check food is in date, stored safely and (where relevant) cooked/reheated according to safe practice;
• record and communicate each person’s allergies and intolerances clearly in the support plan and daily information used by staff; and
• ensure allergen information is obtained and communicated when ordering food from external suppliers.
  If we prepare prepacked for direct sale (PPDS) foods (for example, food packed on the premises before being selected), we will ensure labelling meets current allergen requirements.

We will also follow the Food Standards Agency’s best-practice guidance encouraging allergen information to be available in writing for non-prepacked foods in the out-of-home sector, supported by staff-to-person discussion.

8. Supporting Special Dietary Needs

{{org_field_name}} recognises that some tenants have specific dietary requirements due to medical conditions such as diabetes, coeliac disease, or renal conditions. In such cases, food and drink are prepared following guidance from healthsupport professionals. Texture-modified diets are provided for those with swallowing difficulties, in line with the International Dysphagia Diet Standardisation Initiative (IDDSI). Religious and cultural dietary practices are fully respected, and appropriate meal options are made available in accordance with individual beliefs and customs.

Where a person has dysphagia or choking risk, staff must only provide food and drink textures exactly as specified by Speech and Language Therapy (SALT) and/or dietetic guidance, using the IDDSI levels recorded in the support plan. Staff must not introduce or change texture levels without professional authorisation.

The support plan must include: required positioning, supervision level, pace of eating/drinking, prompts, adaptive equipment, and what to do if the person coughs/chokes/refuses. Any thickener use must be documented with instructions.

9. Enteral feeding and prescribed nutritional supplements

Where a person receives enteral feeding (e.g., PEG/JEJ/NG) or prescribed oral nutritional supplements, staff will only support in line with the individual’s current clinical plan and training requirements.

• Only staff who have completed role-specific training and competency sign-off may support with enteral feeding tasks assigned to the service.
• The support plan must set out: feeding regimen, equipment, infection prevention steps, storage, checking expiry, troubleshooting guidance, and clear escalation routes (e.g., community nursing team, GP, 111/999 in emergencies).
• Any concerns such as tube displacement, blockage, leakage, signs of infection, vomiting, aspiration risk, or refusal must be recorded and escalated immediately in line with the plan.

10. Monitoring and Record Keeping

Where a person is assessed as being at risk of malnutrition, dehydration, choking/dysphagia, or poor access to food and drink, staff must implement the monitoring actions in the support plan, which may include food/fluid intake charts, daily wellbeing notes, and regular weight recording in line with MUST actions. Records must be complete, contemporaneous, and sufficient to evidence that risks were identified and managed.
Staff must escalate and record actions taken when any of the following occur (as applicable to the individual):

• reduced intake (e.g., missed meals, poor fluid intake, persistent refusal)
• signs of dehydration (e.g., dizziness, confusion, dry mouth, dark urine)
• significant weight loss, or MUST score deterioration
• repeated coughing/choking, wet voice, recurrent chest infections, or suspected aspiration
• suspected allergic reaction or allergen exposure

Escalation must follow the person’s plan and may include: contacting the manager on duty, GP, dietitian, SALT, community nursing, or emergency services. Where there is immediate risk to life (e.g., choking, severe allergic reaction), staff must call 999 and provide first aid within their training.

Monitoring records and incidents will be reviewed through governance processes (see “Quality assurance”) to ensure learning and improvement.

11. Training and Competency of Staff

All support staff involved in food preparation or assistance with eating and drinking receive training on food hygiene, nutrition, and hydration. Additional training is provided on specific dietary needs, including dysphagia management, fortified diets, and cultural dietary considerations. Staff are also trained to recognise and respond to signs of malnutrition and dehydration, ensuring that timely interventions are made to prevent complications.

Minimum training requirements for roles involved in nutrition/hydration support include:

• nutrition and hydration awareness (including signs of malnutrition/dehydration)
• MUST (where used)
• food hygiene appropriate to role
• allergen awareness and safe communication of allergen information
• dysphagia awareness and IDDSI application where relevant
• emergency response relevant to role (including choking response where the person’s risk assessment indicates need)
  Competency must be assessed on induction and at least annually, and whenever a person’s needs change or an incident indicates additional training is required.

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 support staff provide appropriate support based on individual capabilities, enabling tenants 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 tenants 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.

14. Compliance with Regulatory Standards and CQC Assessment

We will evidence compliance with Regulation 14 through robust assessment, person-centred planning, safe delivery of support, risk management and timely escalation, and accurate record keeping.

Because nutrition and hydration risks overlap with other Fundamental Standards, we will also monitor compliance with Regulations 9, 11, 12, 13, 17 and 18 through supervision, incident review and audit.

We will maintain evidence in a way that aligns with CQC’s current assessment approach (including use of quality statements and evidence categories), ensuring people’s experience, outcomes and safety can be clearly demonstrated.

15. Quality assurance and audit

To meet Regulation 17 (Good governance), we will operate effective systems to assess, monitor and improve the quality and safety of nutrition and hydration support.

As a minimum, this includes:

• periodic audits of nutrition/hydration documentation (assessments, plans, MUST scores where used, intake charts where used)
• review of incidents related to choking, dehydration, weight loss, allergies, and hospital admissions linked to nutrition/hydration
• staff supervision and competency checks for high-risk support (e.g., dysphagia or enteral feeding)
• feedback from people using the service about choice, dignity and support with food and drink
  Findings, actions and learning will be recorded and tracked to completion.

16. Policy Review and Continuous Improvement

This policy is reviewed annually or in response to changes in legislation, best practice guidance, or scheme user needs. Feedback from support staff, tenants, 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 tenants receive the highest quality of support and support. This review will specifically include checking CQC Regulation 14 guidance updates and relevant Food Standards Agency allergen guidance updates.

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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