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Archived: Strathmore House

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Inspection report

Date of Inspection: 8 August 2012
Date of Publication: 20 November 2012
Inspection Report - DN published 20 November 2012 PDF | 61.46 KB

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

Meeting this standard

We checked that people who use this service

  • Are supported to have adequate nutrition and hydration.

How this check was done

We reviewed all the information we hold about this provider, carried out a visit on 08/08/2012, observed how people were being cared for, looked at records of people who use services, talked to staff and talked to people who use services.

Our judgement

The provider was meeting this standard. People were protected from the risks of inadequate nutrition and dehydration.

User experience

We spoke with people who lived at Strathmore House and they told us that they enjoyed their meals. Not everyone knew that there was a menu which offered a choice at mealtimes. One person told us that there were always choices at mealtimes whereas another person said that they were not aware that there was a menu, or that they were able to make a choice about the meals.

The inspection team carried out some observations at breakfast time and lunch time. Some of the team joined people at their tables for lunch so that we could experience a mealtime. The tables were attractively set with serviettes, condiments and sauces. We noted that people were offered drinks at both mealtimes although they were not offered a refill once they had finished. The menu was written in small lettering and situated near the serving hatch and so the menu was not easily available for people living in the home.

We saw that there was a choice, including hot and cold options, at breakfast time. People were eating a range of different things for breakfast, including porridge, poached egg on toast or bacon sandwiches. The main meal of the day was provided at lunchtime and there was a choice of beef stew or omelette with salad. A relative told us that they felt that the options during the evening meal were very limited with sandwiches being provided most days.

It took a long time for people to come to the dining room and this meant that some people had been sitting at the table for at least half an hour before their food came. One person waited 55 minutes. Staff were busy assisting people to the table. Staff did speak with some people during this time but the majority of people spent their time waiting with no interactions with staff. Once people’s meals had arrived staff assisted those people who needed assistance. People who chose to eat their meal in their bedroom were given their main course and their hot dessert at the same time, so the dessert would have been cold by the time they ate it.

We noted that the skills of staff were variable when assisting people. Some staff were patient and took time to explain to people what they were eating as well as checking that they were enjoying their meal. However, we also noted that other staff were not so skilled at this. For example, one member of staff assisted someone with their meal without speaking with them at all. They then left the person alone and no-one assisted them with their pudding. As a consequence of this the person spilled food on themselves and onto their clothes. Another person dropped their fork and tried eating their dinner with their knife until a member of staff noticed and replaced their fork.

Other evidence

Are people given a choice of suitable food and drink to meet their nutritional needs?

The manager said that people living in the home were asked about their likes and dislikes with regard to meals. She said that people were always offered a choice of at least two options at mealtimes. The manager said that fresh produce, including meat, vegetables and fruit were used. This included vegetables from the home’s garden. The chef liaised with the dietician with regard to people’s individual dietary needs.

We looked at a selection of care records and these showed that nutritional assessments had been carried out for people when they moved to the home. These had been reviewed and updated as required. Food and fluid charts had been implemented for those people who needed them. The records included information about people’s likes and dislikes. There was also information about the pureed diet that was required by one person and the care plans included advice that had been given by the dietician and speech and language therapist with regard to this.

The care staff and kitchen staff who spoke with us were aware of the signs to look out for that would indicate that someone was not receiving sufficient amounts of food or fluids. The care records included records of people’s weights and there was evidence that action had been taken if it was identified that someone was at risk of poor nutrition or hydration. The kitchen staff were aware of people’s likes and dislikes as well as any specific dietary needs, such as people with diabetes, or those that required a pureed diet.

Are people’s religious or cultural backgrounds respected?

Staff we spoke with said that there was currently no-one living in the home for whom specific food was needed for cultural or religious reasons. However, the kitchen staff said that they would be told about anyone’s specific dietary needs by the manager and that there would be no problem in providing alternative meals.

Are people supported to eat and drink sufficient amounts to meet their needs?

The care records that we looked at described the support that people required to eat and drink sufficient amounts. One person’s care plan gave good details about the ways in which the person indicated that they did not want a meal through the use of body language and gestures. The records included clear guidance from the dietician and speech and language therapist about the ways in which people needed to be supported. For example, one care record stated the position that the person should be in when they had their meals and we observed that the person was positioned correctly for their meal.

We observed that most people were seated comfortably at the dining table but that one person was unable to fit their wheelchair under the table. This meant that they had to twist to eat their meal whilst sitting sideways on to the table. Staff did not offer this person a more comfortable way to eat, such as an over-chair table in front of them.

The breakfast time experience was calm as there were fewer people present at any one time. However, the provider may find it useful to note that the lunchtime meal was quite chaotic. The time taken for staff to assist everyone into the dining room was unacceptably long. Also, the number of staff and people present in one dining room was not conducive to people being supported and encouraged to eat their meal in a calm, relaxed atmosphere. In addition to this, the support that people received from individual staff was not consistent. Some staff supported people well whilst other people did not have the same experience. For example, some staff did not speak with people while they were assisting them.

We noted that people were offered drinks throughout the day and the majority of people were assisted with these. However, we also noted that for one person who spent the day in their room their water jug was out of their reach and remained there all day without any