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Archived: Ayrshire House Good

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Inspection report

Date of Inspection: 22 May 2013
Date of Publication: 21 June 2013
Inspection Report published 21 June 2013 PDF

Food and drink should meet people's individual dietary needs (outcome 5)

Not met this standard

We checked that people who use this service

  • Are supported to have adequate nutrition and hydration.

How this check was done

We looked at the personal care or treatment records of people who use the service, carried out a visit on 22 May 2013, observed how people were being cared for and checked how people were cared for at each stage of their treatment and care. We talked with people who use the service, talked with staff, reviewed information given to us by the provider and talked with commissioners of services.

Our judgement

People were not fully protected from the risks of inadequate nutrition and dehydration.

Reasons for our judgement

The people we spoke with who used the service told us they liked the meals provided and that the food portion size was good.

One person told us, “When I have Sunday lunch I have a good nutritional meal inside me.” And, “The food is good.”

Another person said, “We have some good food, I enjoy my meals, I like fish, chips and peas.”

When people were asked if they were offered puddings the people we spoke with said, “Sometimes.” We asked if people were offered snacks during the day. The people we spoke with all said they were offered drinks in the morning and afternoon and could ask for a drink anytime but they were not offered snacks.

When we spoke with the owner and registered manager about the availability of snacks, we were told people could go to the kitchen and help themselves to snacks such as biscuits and fruit at anytime. However, not everyone was able to access the kitchen independently. Some people were reliant on staff asking or they had to ask for a snack themselves.

We had a meeting with a group of people who used the service, everyone was provided with a drink of their choice, however, we saw a person ask if the group could have a plate of biscuits. The owner was observed to reply, “No later.” This demonstrated that people did not feel able to freely help themselves to a snack, which the owner and registered manager said was common practice. They were denied their request without any explanation as to why.

We looked at the menu and saw people were generally offered a light meal at lunchtime such as sandwiches, soup with a yogurt or fruit. A hot meal was served in the evening. We saw the menu did not offer a choice of meals and a pudding was not routinely provided. The menu showed people were offered supper such as crisps, biscuits or cake. The people we spoke with who used the service told us they were not asked what they would like but said they liked the food provided.

Comments from care staff about meals included, “We try and offer well balanced meals. We have fresh vegetables on a Sunday and frozen at other times.” And, “People are not asked about menus, we know people’s preferences and work around them. If people don’t like what’s available we offer something different such as jacket potato.” Care staff spoken with also told us the menu was not developed in advance but decided by the care staff responsible for cooking that day. The provider may find it useful to note that this meant there were no systems in place that assured people that meals were planned and prepared in advance. This meant there was a risk that people may not receive daily nutritional and well balanced meals.

We saw from care files viewed that some people had specific dietary and nutritional needs. We saw these people had separate daily menu diaries that recorded what they had eaten. We also saw health care professionals such as a dietician or a Speech and Language Therapist (SALT), had provided staff with additional information and guidance. We saw individual care plans reflected the recommendations made. However, some of the care plans lacked clarity about how people should have their nutritional needs monitored.

We saw in care plan files there were inconsistencies around monitoring people’s weight. We discussed this with the owner and the registered manager who said they had been advised by a private consultant that people should not be routinely weighed without consent. We suggested to the owner and the registered manager it was good practice to gain people’s consent. However, they had a duty of care to monitor people’s weight where there were any issues or concerns and the Mental Capacity Act (2005) legislation should be used in these circumstances.

In one person’s care file we saw that they were weighed in January 2013 and prior to this in September 2012. During this time the person had a recorded weight loss of seven pounds. Records viewed did not show any action had been taken in relation to this weight loss or that