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We are carrying out a review of quality at Leighton Hospital. We will publish a report when our review is complete. Find out more about our inspection reports.
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Inspection report

Date of Inspection: 4 May 2011
Date of Publication: 4 July 2011
Dignity and Nutrition Report published 4 July 2011 PDF | 80.02 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 04/05/2011, checked the provider's records, 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. We were supported on this review by an expert-by-experience who has personal experience of using or caring for someone who uses this type of care service.

Our judgement

The provider is meeting most elements of this essential standard by ensuring that people have adequate nutrition and hydration. They provide choices of food and drink to meet individual needs and the food supports their health.

However we saw that the system that The Trust has in place for identifying patients who need help in eating or their intake monitoring using a red plate was confusing and not consistently applied. We also saw that fluid and nutrition charts were not always accurately completed on all of the wards.

User experience

East Cheshire Local Involvement Network made a visit to Ward 6a, a stroke rehabilitation unit, in June 2010. Comment was generally positive in respect of this outcome. They noted that all patients had a nutritional assessment during the early part of their stay and that there were regular weight checks and visits by dieticians. They said there was a protected mealtime policy and that "patients whose needs need to be monitored are given red trays and beakers". Patients told the enter and view team a variety of opinions of the food quality.

We spoke to seven patients on two wards about the hospital food and most told us that staff had discussed what they liked to eat and that staff checked that they had eaten enough. No patient had missed a meal for a reason other than personal choice.

Most patients seemed satisfied with the quality of the food and commented that it arrived hot. There were specific comments from individuals that portion sizes were too small and there was not enough salt used in cooking. Those patients who said they needed help with their meals said that they got it.

Other evidence

Leighton Hospital prepares its own food on site and as a district general hospital has a requirement to cater for a wide range of special diets and patient preferences. The Trust submitted as part of its submitted evidence a wide variety of documents that demonstrate that they have the catering systems in place to deliver against this requirement.

There is a Food Nutrition and Hydration Policy in place which recognises the importance of nutrition to the recovery of patients and sets expectations for the service that will be provided. This policy assigns roles and responsibilities to staff and is supported by comprehensive enteral feeding guidelines and guidelines for patient menus.

The Trust operates a protected mealtime policy and the times differ between wards depending on the nature of the ward. We saw evidence of a protected mealtime audit which took place in place May 2011.

There is a seven day rolling menu with three hot choices at lunchtime and sandwiches in the evening plus a hot choice. Patients choose on a card the day before and food is delivered to the ward. We saw a variety of special menus appropriate to clinical needs and there are mechanisms for the ward to order particular patient requirements if they are not eating from the standard menus. We saw that the standard menu identified "soft" food choices suitable for some older patients and we also saw that a pureed menu was also available to the wards.

Every ward has a nutrition champion assigned to each shift and they are responsible for ensuring that patients are adequately fed. On both wards we visited a member of staff was identified on the staffing roster as the "nutritional champion" and we saw them fulfilling the role during the mealtime.

There are pictorial menus for patients with communication difficulties and staffs were able to discuss with us how they worked with such patients. Staff told us how resources used to address The Trust's privacy and dignity agenda such as the "getting to know you" pack for patients with dementia were used to support the menu choices of patients.

We saw evidence of training in the feeding of patients such as the "Keeping Nourished – Getting Better" training package. There are dementia swallowing guidelines and staff told us that they had access to specialist support from dieticians and speech and language therapists whenever they needed it.

Patients are informed about the importance of hand hygiene in their information pack and wipes were available on all beds during the mealtime on one of the wards. On the other ward these wipes were distributed to all patients during the morning observation and when we asked staff about this it was clear that this had been missed out and this had happened in response to our visit.

We saw that one patient's head board noted that they needed to be prompted for diet and drinking and when their meal was delivered the member of staff told them to leave the lid on to keep it warm and someone would come and help. We noted that the food was not on a red tray or plate. This help was provided within about five minutes and they and two other patients were offered support with eating. This was done with patience and a good deal of time was spent with them. However we further noted that while these patients had support in eating their food did not arrive on a red tray or plate.

The food appeared to be of an acceptable quality. The opinion of the food by a member of staff was that is was "a mixed bag", some days good, other days not so good. We were told by the same person that the catering department was good at supporting special requests for patients. Two patients interviewed said that the food was good, was served hot and they got enough, one said "I enjoyed the meat pie, the pastry was very good". The patients confirmed that there were always snacks and drinks available. Two members of staff commented that there had been recent improvements in the quality of the food. We were told by staff