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Inspection report

Date of Inspection: 14 January and 14 June 2011
Date of Publication: 23 August 2011
Inspection Report published 23 August 2011 PDF

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

Enforcement action taken

We checked that people who use this service

  • Are supported to have adequate nutrition and hydration.

How this check was done

Our judgement

There were inadequate records kept to identify where people who used services were at risk of malnutrition, poor nutrition, and dehydration.

The plans of care did not include how any risks identified could be managed.

User experience

One service user said that enjoyed going out for meals with staff. He said meals in the home were good.

Other evidence

The acting manager said that she had requested a visit from Environmental Health because she had concerns about how food was being prepared by staff for service users. An Environmental Health Officer from Darlington Borough Council had visited Middleton Lodge on 7 June 2011. We saw a report which stated that 2 legal requirements relating to Food Safety Act 1990, EC Regulation 852/2004, Food Hygiene (England) Regulations 2006 and Food Labelling Regulations 1996 had been contravened; and that these had also been previously contravened at an earlier inspection on 12 June 2009.

On 27 July 2011 we examined the care plans of one service user which stated that they were at risk of poor nutrition and needed a suitable diet with encouragement and support from staff. The care plan stated, “I need encouragement to eat at meal times as I keep losing a lot of weight.” And “I have puddings with all of my meals and ‘Complan’ drinks twice per day.” In the section entitled “How to support the service user, the care plan stated, “The service user is offered a choice of cereals and toast and hot and cold drinks for breakfast. Team members will organise this. “The service user is offered a choice of meals at lunch time. Team members will organise this.” The service user will choose their evening meal from the selection available”.

We saw that the care plan stated “The service user eats a variety of foods which are all monitored on a dietary recording sheet.”

On 30 June we visited Middleton Lodge and asked the senior in charge of the home for the dietary recording sheet for this service user, the senior provided us with records entitled ‘Menu Planner and confirmed that this was the only record kept which showed what the service user’s diet had been. We saw that the entries for the week beginning on 16 May 2011 showed that there was no record of breakfast being given to this service user for one day, no record of mid morning snacks for three days, no record of lunch for two days, no record of a mid afternoon snack on five days, no record of dinner on three days and no record of supper on five days. Records showed that on 18 May 2011 the only food given was a drink of milk. We saw that the entries for the week beginning on 13 June 2011 showed that there was no record of mid morning snacks for one day, no record of lunch for three days, no record of a mid afternoon snack for two days, and no record of supper for five days. A total of seven entries in the ‘snacks’ section stated that only the drinks “juice’, drinks’ or ‘tea’ were given. We saw that the entries for the week beginning on 20 June 2011 showed that there was no record of mid morning snacks for four days, no record of lunch for three days, no record of a mid afternoon snack for four days, no record of dinner for two days and no record of supper for the entire seven days. Records showed that on 22 and 23 June 2011 the only food that was given at each of these days was at breakfast.

We looked at the service users care plan which stated that a ‘Weight and

Malnutrition Screening Tool’ was to be used and stated that their “weight is recorded weekly.” However records at the home showed that the service user had only been weighed twice in each month from 1 January to 31 March 2011 a total of six times in 13 weeks, but also had not been weighed at all since 23 May 2011, a total omission of five weeks. When we asked the senior in charge she confirmed there were no other records of the service users weight kept.

On 5 July 2011 we looked at the medication administration record (MAR) for the same service user. They had been prescribed with two nutritional supplements by a doctor because they needed specific support to manage their diet. We saw that the medication ‘Pro-Cal shot liquid’ had been prescribed and treatment had commenced on 29 January 2011. Person 1 should have received 40ml of this supplement 3 times per day. However when we examined the MAR chart we saw that staff ha