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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: 11 August 2012
Date of Publication: 5 October 2012
Inspection report published 5 October 2012 PDF

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

Not met 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

The provider was not meeting this standard.

People were not protected from the risks of inadequate nutrition and dehydration. The systems in place were not used consistently or effectively to ensure that people had appropriate support to eat and drink sufficient amounts to meet their needs.

We judged that this had a moderate impact on people using the service and action was needed for this essential standard.

User experience

Patients told us they chose meals from a menu each day and there was a suitable variety to choose from. Patients we spoke with had mixed views about the food provided. Some told us it was good enough, such as, "Adequate, a reasonable choice, portions are adequate", "I'm not going to get fat here, but when you aren't doing anything it is ample", "The meals are generally good, you can't fault them". Others thought the food could be better, "The meals don't tempt you to eat when you are unwell as the food is bland and not appetising".

One patient told us they had pureed food and felt that the portions were too big as they were unable to eat more than a few spoonfuls. They said that staff, "Can't understand I can't take it, they keep bringing it". We observed at lunchtime that this patient was served a large portion and refused their meal after trying a small amount. We saw that the patient was quite frustrated by being given portions they could not eat.

Other evidence

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

We saw that the menus gave a variety of hot and cold meals for patients to choose from. The menus included choices for patients who required specific diets, for example, patients who had diabetes. We observed lunchtime on the wards we visited. We saw that the meals were individually served from a trolley and looked appetising.

We saw that patients were offered hot and cold drinks throughout the day. We saw patients' water jugs being replenished to ensure they always had fresh water available.

Staff told us that snack boxes were always available for patients who needed food between regular mealtimes.

Were people's religious or cultural backgrounds respected?

The care records we saw did not include details of the patient's likes and dislikes regarding food and drink. Patients' preferred routines were not recorded and the care plans lacked detail of the individual assistance required with eating and drinking. It is particularly important for these details to be obtained and recorded for patients who are unable to express their needs and preferences.

We did not identify any patients with nutritional needs related to their religious background. Staff told us that meals could be ordered to meet specific religious requirements if necessary.

Were people supported to eat and drink sufficient amounts for their needs?

On both of the wards we saw that the nurses, health care assistants and catering staff all helped to give out the meals at lunchtime. The courses were served separately so that patients could finish their main meal before they received their dessert. We saw that patients were given time to eat their meals and that the lunchtime was 'protected'. This meant that no unnecessary visitors were allowed on the ward at lunchtime to minimise interruption to patients. We observed that on one ward patients who required assistance were served first. This meant that patients who could eat without assistance were left waiting up to 30 minutes for their meals.

Discussion with staff and observation showed that several patients required assistance, prompting and supervision with eating and drinking. We saw that one patient was provided with adapted cutlery to support their independence. We did not see any patients who required staff assistance being given the opportunity to wash their hands prior to and after their meal.

We saw that various signs were available on both wards to help staff identify patients' dietary needs, such as thickened fluids, low fibre diet, or if they required assistance with eating and drinking. However, the signs were not well used; only one person had a sign in place above their bed. Staff had sometimes written a patient's dietary needs on the wipe board above their bed. Although there were systems in place to identify patients' needing support, these were not used consistently or effectively.

We observed staff assisting and encouraging some patients to eat their lunch. However, we saw that some patients did not receive appropriate support and encouragement. For example, staff woke one patient when they took the patient's lunch to them. The patient went back to sleep and the meal remained in front of them until they woke up. By this time the meal was cold. We saw another patient whose recorded dietary intake was poor and the board above their bed stated "assist and supervise and chart all intake". This patient only ate a small amount of lunch but we did not see staff encouraging them to eat more or trying to establish why they had eaten so little. The patient's daily food intake chart was not completed before we left the ward later in the afternoon. If staff were not aware of the patient's limited food intake they may not take appropriate action to ensure the patient had adequate nutrition.

We saw from patients records that they were promptly referred for specialist advice as required. For example