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Chesterfield Royal Hospital Requires improvement

We are carrying out a review of quality at Chesterfield Royal 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: 17 May 2011
Date of Publication: 12 July 2011
Inspection Report published 12 July 2011 PDF

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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

Our judgement

People are provided with and supported to have adequate food and drink. Not all people consider that the food provided meets their preferences. There is limited choice for people who require pureed, soft or mash able meals.

User experience

The people we spoke with had mixed views about the quality, choice and appearance of the food provided. Some people said the food was good whilst others said that the food did not meet their needs and preferences. One person was pleased with the choice available for their gluten free diet. Other people said the food was tasteless and could be better presented. One person said “it all tastes the same” and another commented that the food was “abysmal”.

People told us they were offered a choice of hot drinks throughout the day and always had a jug of fresh water available to maintain hydration.

We observed lunch time on four of the wards we visited. We saw that the protected meal times policy was followed. A protected meal times policy ensures that there are no unnecessary interruptions to the meal, for example, if people need to have blood taken for tests this should be done at other times.

We saw that there were sufficient staff available to assist people with their meals and observed appropriate and sensitive assistance given where needed. Staff told us that people who needed assistance with eating or drinking were highlighted on the printed handover information they received at the beginning of each shift. Meals were served promptly and the main course and dessert were served separately, although on one ward the dessert was served so quickly that people were still eating their main meal.

On one ward, the presentation of the main meal served to a person who required a pureed diet did not look appetising and was not well presented. We found that there was a limited choice and variety of foods for people who required pureed, soft or mash able meals. This meant that people were offered very similar meals at lunch and tea time.

We found that people were assessed on admission using the Malnutrition Universal Screening Tool (MUST). This helps identify people who are malnourished and / or at risk of not having adequate nutrition. We saw that where risks were identified, the person’s food and fluid intake was monitored and their nutritional risk was regularly re-assessed.

We saw that people’s weight was recorded as part of their nutritional assessment and was monitored during their stay. One person was seen by the dietician who requested weekly weights as the person had lost weight since admission, but there was no record showing weekly weights. Staff said this person was difficult to weigh because of their lack of mobility. Another person was admitted to a medical ward in February and had not been weighed. Staff had recorded that they were unable to weigh the person because of their leg amputation. Staff had not considered alternative ways of assessing the weight of these two people. This could lead to inaccurate assessment of the person’s nutritional state and so their needs may not be properly met.

We found some gaps in care plans regarding meeting people’s nutritional needs. This could result in people not having their dietary needs met. For example, one person had been receiving parenteral nutrition until two days before our visit when they had started eating normally again – their care plan had not been updated with this change, although the nursing notes did reflect the change in their needs. Another person was seen by the dietician and was to have diet supplements - this was not recorded in their care plan, but was noted in the daily nursing records.

Other evidence

The 2010 findings from the Patient Environment Action Team (PEAT) inspections rated Chesterfield Royal Hospital as ‘good’ with regard to the food provided. The PEAT inspections are self-assessments managed by the National Patient Safety Agency that check non-clinical aspects of patient experience.

In the surveys and other information we looked at people said they were usually offered a choice of food. In the adult inpatient survey carried out in 2010 people rated the hospital food in the worst 20% of similar trusts. The provider told us they were considering ways of improving the choice and quality of food offered to people. In the 2010 adult inpatient survey people said that they did not always get enough help from staff to eat meals. However, on the wards we visited, we found that people did have enough help with eating meals.