Nutrition and Hydration Audit - Care Homes

Evidence to check

• • Staff can explain practical nutrition and hydration responsibilities
• • Nutrition and hydration policy is current and accessible
• • Staff know how to escalate poor intake, weight loss or swallowing concerns
• • Policy is reflected in care plans, daily notes and observed practice

Evidence to check

• • Admission nutritional risk assessment, such as MUST
• • Height, weight, BMI and weight loss history recorded accurately
• • Risk score matches the information recorded
• • Immediate actions taken where risk is identified on admission

Evidence to check

• • Regular review records
• • Reassessment after weight loss, illness or deterioration
• • Risk score updated when circumstances change
• • Care plan changed following reassessment

Evidence to check

• • Nutrition and hydration care plans for at-risk residents
• • Clear actions such as fortified meals, snacks, monitoring or referrals
• • Staff can explain what support the resident needs
• • Daily notes show the care plan is being followed

Evidence to check

• • Dietary preferences and allergy records
• • Kitchen and care staff have consistent information
• • Observed meals match the resident's recorded needs
• • Residents confirm their preferences are known and respected where possible

Evidence to check

• • Hydration risk assessment
• • Target fluid intake recorded where clinically appropriate
• • Care plan identifies preferred drinks and support needed
• • Staff escalate reduced intake, dark urine, confusion or dehydration concerns

Evidence to check

• • Food and fluid charts for sampled residents
• • Charts include amounts consumed, not vague entries only
• • Charts reviewed by senior staff or nurses
• • Low intake leads to action, escalation or care plan review

Evidence to check

• • Observation of meal service
• • Texture-modified diets match SALT or IDDSI guidance where applicable
• • Food temperature and presentation checked
• • Residents receive the correct meal, portion size and support

Evidence to check

• • Observation of dining areas and bedroom meals
• • Residents are not rushed or ignored during meals
• • Staff support social interaction where appropriate
• • Distress, poor positioning or environmental barriers are addressed

Evidence to check

• • Observation of staff assisting residents
• • Staff sit at eye level and explain what they are doing
• • Residents are offered choice and time to swallow
• • No unsafe rushing, poor positioning or lack of engagement

Evidence to check

• • Care plan identifies independence abilities and equipment needed
• • Adaptive cutlery, cups, plates or plate guards available where required
• • Staff encourage independence before taking over
• • Resident progress or decline reviewed

Evidence to check

• • Menu and snack schedules
• • Night-time or early morning food and drink options where appropriate
• • Records of snacks and drinks offered to at-risk residents
• • Residents confirm they can access food and drinks when wanted where possible

Evidence to check

• • Dietitian, GP or healthcare professional recommendations
• • Supplement or fortified diet records
• • Staff know when and how support should be given
• • Weight, intake and wellbeing reviewed to assess effectiveness

Evidence to check

• • Weight records and weighing frequency
• • Weight loss or gain trends identified
• • Action taken after significant weight change
• • Equipment used for weighing is suitable and safe

Evidence to check

• • Kitchen and food storage observations
• • Fridge, freezer and food temperature records
• • Food labelled, dated and stored correctly
• • Cleaning, pest control and food hygiene records

Evidence to check

• • Training records for food hygiene, nutrition, hydration and choking awareness
• • Staff can explain choking risks and safe positioning
• • Staff know how to respond to choking
• • Competency concerns are addressed through supervision or retraining

Evidence to check

• • Care plan and medication records include supplements or thickeners where relevant
• • Thickener instructions match SALT guidance
• • Staff understand correct preparation and administration
• • Products are stored safely and reviewed regularly

Evidence to check

• • Care notes recording swallowing concerns
• • SALT referral records
• • Interim safety measures recorded while awaiting assessment
• • SALT guidance reflected in care plans and staff practice

Evidence to check

• • Professional advice records
• • Care plan updates after advice received
• • Kitchen communication records
• • Staff can explain new dietary or hydration instructions

Evidence to check

• • Observation of drinks availability
• • Preferred drinks recorded and offered
• • Residents can reach drinks or receive regular support
• • Hydration risks escalated when intake is low

Evidence to check

• • Hydration support tools available where needed
• • Care plans identify preferred hydration strategies
• • Staff use prompts and encouragement appropriately
• • Fluid intake improves or is reviewed where strategies are ineffective

Evidence to check

• • Activity and menu planning records
• • Resident feedback about special meals or occasions
• • Cultural or religious food needs included in planning
• • Individual birthdays or preferences reflected where possible

Evidence to check

• • Observation of meal choices being offered
• • Picture menus, show plates or verbal prompts used where helpful
• • Staff adapt communication for dementia, sensory loss or speech needs
• • Residents are not simply given food without choice unless clearly justified

Evidence to check

• • Handover records
• • Clinical review or residents-at-risk meeting notes
• • Supervision or team meeting records
• • Staff are informed about residents with changing intake, weight or swallowing risk

Evidence to check

• • Incident records
• • Post-incident reviews
• • Care plan and risk assessment updates
• • Learning shared with care and catering staff

Evidence to check

• • Family or representative input recorded
• • Life history and food preference information gathered
• • Advocate involvement where the resident has no suitable representative
• • Resident consent and confidentiality respected

Evidence to check

• • Kitchen communication records
• • Dietary list is current and matches care plans
• • Catering staff know high-risk dietary requirements
• • Changes are communicated promptly after reviews or professional advice

Evidence to check

• • Resident surveys or food feedback records
• • Residents' meetings discussing meals
• • Complaints or compliments about food reviewed
• • Menu or service changes made following feedback

Evidence to check

• • Current menus and menu rotation
• • Evidence of nutritional review of menus
• • Alternatives available for dislikes, allergies and cultural needs
• • Menus reflect seasonal variety and resident feedback

Evidence to check

• • Nutrition and hydration audit records
• • Weight loss, dehydration, choking and food/fluid chart trends reviewed
• • Actions tracked through governance or quality meetings
• • Repeated issues lead to service-level improvement

Evidence to check

• • Cross-check care plans, kitchen records and monitoring charts
• • Staff describe the same needs as recorded
• • Outdated dietary information removed or updated
• • Discrepancies corrected promptly

Evidence to check

• • Observation of positioning during meals
• • Care plans include positioning guidance where needed
• • Staff support residents to sit upright where appropriate
• • Poor posture, sliding or unsafe feeding positions are corrected

Evidence to check

• • Observation of bedroom meal service
• • Care notes for residents eating in rooms
• • Staff check intake and provide assistance where needed
• • Resident choice to eat alone is respected but isolation risk is considered

Evidence to check

• • Care plans link hydration and nutrition to wider health risks
• • Fluid intake monitored where clinically relevant
• • Constipation, UTI, skin integrity and falls records reviewed for hydration links
• • Action taken where poor intake may be contributing to deterioration