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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: 8 August 2013
Date of Publication: 24 August 2013
Inspection Report published 24 August 2013 PDF

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 looked at the personal care or treatment records of people who use the service, carried out a visit on 8 August 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 talked with other authorities.

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 protected from the risks of inadequate nutrition and dehydration.

Reasons for our judgement

At our inspection in June 2013, we found that the provider was failing to protect people using the service from the risks of inadequate nutrition. This was because people were not provided with an adequate choice of suitable food to meet their needs or with appropriate support to eat and drink sufficient amounts. We issued a warning notice telling the provider they were failing to comply with this standard and requiring them to become compliant by 26 July 2013.

At this inspection we found that the provider had made changes to protect people from the risks of inadequate nutrition.

People were provided with a choice of suitable and nutritious food and drink. People we spoke with were satisfied with the choice, quality and quantity of the food provided. They told us, “I can't fault it. Good choice, hot and there's variety.”, and “The meals are good and there’s always plenty.” A patient who was vegetarian told us, “I have had a good choice of meals. I get plenty to eat and drink, I've no worries here."

We found that the menu choices had been expanded for people who required pureed or soft food. We observed that the pureed and soft meals served on the day of our visit were attractively presented. Staff told us that these meals had improved since our last visit, although some felt there was room for further improvement.

We saw that people were asked about their preferences regarding food and drink on admission to the wards. A visitor told us that one person had been on the same ward last year and said, “It is much, much better. The food charts are followed and his likes and dislikes are known.”

People’s preferences were noted in their care records and also displayed on a notice by each bed on one ward we visited. However, the provider should note that this information was not always completed. We saw that one person with dementia had been on the ward for a week but their food and drink preferences were not recorded on the notice by their bed. The person’s relative told us they had not been asked about the person’s likes and dislikes. We observed that this person ate very little of their lunch on the day we visited.

People were supported to be able to eat and drink sufficient amounts to meet their needs. One person told us, “Some people don’t fancy food at meal times, but they get hungry later, so they (the staff) will get them something to eat any time.” Another person said “They (the staff) couldn’t be more helpful. They watch us all the time and you can see they’re always trying to help where they can.” We observed staff on the three wards we visited providing unhurried and sensitive assistance to people with eating and drinking. We saw one staff encouraging a person with dementia to eat and offering alternatives when the person refused food. We saw another staff approach a person who was struggling with a tub of ice cream and offered a dish to make eating easier. The person was then able to eat their dessert independently. We saw that equipment was available to assist people as necessary, such as adapted cutlery and other aids.

We found that a new standard operating procedure for mealtimes had been introduced on all wards. We saw that this procedure was followed in practice on the three wards we visited. All of the staff we spoke with were positive about the new procedure for mealtimes. They told us, “There have been huge changes. It’s much better organised now, more structured.”, and, “We can't miss anyone now - before it was a possibility."

We saw that each ward now had a designated Nutrition Champion, a qualified nurse with responsibility for ensuring that people’s nutritional and hydration needs were met. We spoke with the Nutrition Champions for the three wards we visited. They told us about the training and support being provided to them and other colleagues. They said that, through their role, there was an increased understanding of the issues and concerns about nutrition and hydration. They told us they could