What I want within reason, mealtimes in care homes

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Summary of report content

As the number of older people living in care homes is set to rise, Healthwatch Surrey has made it a priority to amplify the voice of older people in care homes and ensure that their experiences, and the associated learning, are shared with homes across the county. In an effort to hear more from residents themselves a programme of 20 Enter and View visits were conducted with the aim of hearing from care home residents, their friends and relatives, and care home staff. Visits were conducted by a team of Authorised Representatives made up of Healthwatch Surrey staff and volunteers. The information gathered through this programme of visits highlights a number of themes, explored in this full report, which will be shared with care providers, commissioners and other organisations across Surrey. Across the homes visited there were examples of person-centred care and of small actions homes had taken to promote dignity and respect; these included the use of large napkins instead of protective aprons at mealtimes and preparing fruit for easy eating. We also saw examples of staff working flexibly to ensure residents’ needs were met, for example providing finger food, using a clock face as a reference to help a visually impaired resident enjoy their food at mealtimes, and offering ice lollies to encourage fluid intake. Homes told us they often celebrated special occasions such as birthdays and Christmas with special foods, with some homes going the extra mile to make meals varied and enjoyable for residents: for example preparing a special Halloween menu, holding themed meals such as a ‘seaside theme’ and making use of outdoor spaces during good weather with barbeques and garden parties. Many homes were proactive in inviting friends and relatives to get involved, with some homes offering visitors the opportunity to eat with residents and a handful also holding ‘coffee mornings’ and special lunches for friends and relatives to attend. The involvement of friends and relatives was something highlighted as important by the visitors we spoke to and residents also commented that they enjoyed these occasions. On the whole homes did have methods for gathering and welcoming resident and visitor feedback, however the responsiveness to this feedback varied and some homes appeared to be more proactive, using varied methods of engaging with residents (e.g. residents’ meetings, feedback books). One method of gathering feedback that appeared to be particularly appreciated by residents was face to face contact with the chef, often towards the end of a mealtime, to check the food was enjoyed and listen to residents’ comments. One area that particularly varied was choice at mealtimes; although all homes stated that residents had a choice of main meal and had access to alternatives, residents explained that sometimes they did not have a choice or were unaware that there were alternatives available. Some residents also reported that they did not have access to condiments/ seasoning, would like healthier snack options, and would like more flexibility with meal times, particularly at breakfast. It is possible that choice is available, but residents are not always aware of this. In some homes we noted that choices were not clearly presented, for example residents were asked to make decisions about meals ahead of time, menus were unavailable or had small print, and special diet options seemed limited in some cases. During busy mealtimes we noted that in some homes staff were slow to respond to and assist residents; staff, residents and visitors noted the pressure on staff and in some cases this led to residents moderating their expectations.

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General details

Report title 
What I want within reason, mealtimes in care homes
Local Healthwatch 
Healthwatch Surrey
Date of publication 
Friday, 30 March, 2018
Date evidence capture began 
Monday, 1 January, 2018
Date evidence capture finished 
Friday, 30 March, 2018
Type of report 
Enter and view
Report
Key themes 
Food and nutrition
Healthwatch reference number 
Rep-7286

Methodology and approach

Was the work undertaken at the request of another organisation? 
No
What type of organisation requested the work 
N/A
Primary research method used 
Observation
Structured interview
Survey
How was the information collected? 
Visit to provider
If an Enter and View methodology was applied, was the visit announced or unannounced? 
Announced

Details of health and care services included in the report

Social care services 
Nursing care home
Residential care home

Details of people who shared their views

Number of people who shared their views 
237
Age group 
Not known
Gender 
Not known
Ethnicity 
Not known
Sexual orientation 
Not known
Does the information include public's views? 
Yes
Does the information include carer's, friend's or relative's views? 
Yes
Does the information include staff's views? 
Yes
Types of health and care professionals engaged 
All care professionals
Does the information include other people's views? 
No
What was the main sentiment of the people who shared their views? 
Negative

Outcomes and impact

Were recommendations made by local Healthwatch in the report? 
Yes
Does the information contain a response from a provider? 
No
Is there evidence of impact in the report? 
Yes
Is there evidence of impact external to the report? 
No
What type of impact was determined? 
Implied Impact

Network Impact
Relationships that exist locally, regionally, nationally have benefited from the work undertaken in the report
 
Implied Impact
Where it is implied that change may occur in the future as a result of Healthwatch work. This can be implied in a provider  response, press release or other source. Implied impact can become tangible impact once change has occurred.
 
Tangible Impact
There is evidence of change that can be directly attributed to Healthwatch work undertaken in the report.