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Chesterfield Royal Hospital Good

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: 5, 6 June 2013
Date of Publication: 23 July 2013
Inspection Report published 23 July 2013 PDF | 97.19 KB

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

We looked at the personal care or treatment records of people who use the service, carried out a visit on 5 June 2013 and 6 June 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 carers and / or family members, talked with staff and reviewed information given to us by the provider. We reviewed information sent to us by local groups of people in the community or voluntary sector and were accompanied by a specialist advisor.

We used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us.

We were supported on this inspection by an expert-by-experience. This is a person who has personal experience of using or caring for someone who uses this type of care service.

Our judgement

People were not protected from the risks of inadequate nutrition because they were not always provided with a choice of suitable food or supported to eat sufficient amounts for their needs. There were arrangements in place to ensure that people had food and drink to meet requirements arising from their cultural or religious background.

Reasons for our judgement

At our previous inspection in August 2012 we found that people were not always protected from the risks of inadequate nutrition and dehydration. We judged that this had a moderate impact on people using the service and told the provider that action was needed. The provider’s action plan received in November 2012 told us about the action they had already taken and further action they planned to take to achieve compliance. The provider told us they would be compliant by the end of April 2013.

At this inspection we found that people were not always provided with a choice of suitable and nutritious food and drink. Some of the people we spoke with were satisfied with the choice, quality and quantity of the food provided. They told us, "I can't complain about the food. It's usually tasty enough", and, “There’s always something I can eat. You get a choice and the nurses help people who can’t fill in their forms, so they get what they like.”

Seven people told us they were unhappy with the food. Two of these people said they did not like the taste of the food. Both of these people were observed eating very little of their main meal, but they ate and enjoyed their puddings. They both said this was often the case. They were not offered alternative main meals. One of these people said “It’s always the same. It’s rubbish what you get.” Four people on one ward told us they found the food tasteless and cold. They had complained about the food on the day before our visit. They said that a representative from the catering provider had visited the ward to speak with them and was investigating their comments.

Staff told us that people needing pureed food had a limited variety to choose from. This meant that people found the food monotonous and did not always want to eat it. This was a particular issue for people who were in hospital for many weeks following a stroke.

We saw that people on one ward had been asked about their food likes and dislikes. These were displayed on handwritten notices above their beds, though were not included in their nursing care plans. One person told us they were often served meals that they did not like and they were frustrated by this. Relatives had complained on the person’s behalf as the person had some difficulties in communicating, but the problem persisted. The person was able to indicate to us that all other aspects of their hospital stay (care, dignity, privacy and so on) were fine and they would give eight out of ten as marks of satisfaction. For the provision of appropriate food they would only give three marks out of ten.

We found that if people required food in between meal times, staff could order a snack box for them. The snack boxes consisted of sandwiches and cold food. However, the snack boxes were not suitable for people who required a soft or pureed diet. We found that one person was admitted the previous night and had not eaten since their lunch at home the previous day. Staff told us that the person required pureed food and this would be ordered for teatime, (approximately two hours after we spoke with staff). There was no attempt to provide food for the person before teatime, although they were offered drinks.

We observed three mealtimes on each ward: teatime on the first day of our visit, then breakfast and lunch on the second day. On two of the wards the teatime meal we observed was very disorganised.The meal on one of these wards took so long to serve that the food dropped below a safe serving temperature. At this point three people had not had meals. Snack boxes were ordered for these people and they were offered desserts while they were waiting for the snack boxes. A hot meal alternative was not offered. We saw that breakfast and lunch the following day were better organised on both wards and most people appeared to receive what they had ordered from the menu.

We did not identify any people using the service with nutritional needs related to their cultural or religious background.