Care home mealtime support
Failure to provide adequate support and encouragement to residents during mealtimes in care settings, impacting nutrition and welfare.
Strongest theme matches
Mixed across source types and ranked by classifier confidence plus text match strength.
CQC action
100match
Holly House Residential Care Home
The provider must ensure people receive appropriate support to eat and drink sufficient amounts to maintain their health and well-being, including effective monitoring of nutritional needs, provision of adequate and in-date food, and clear instructions for staff.
Matched on
terms: care, home, support
CQC action
99match
Ridgeway Manor Residential Care Home
People who had needs in relation to eating and drinking were not supported to eat and drink safely in a manner consistent with relevant professional guidelines.
Matched on
terms: care, home, support
CQC action
91match
Clova House Residential Care Home
The provider told us they would make arrangements to ensure their weight was monitored more closely.
Matched on
terms: care, home
CQC action
86match
Rosecroft Residential Care Home
The provider should ensure that food and fluid charts for people using the service are completed in detail to monitor the types of foods and amounts people ate.
Matched on
terms: care, home
PFD report
85match
Joan Whitworth
The coroner identified concerns regarding the speech and language therapy assessment process and insufficient training for care home staff in basic life support, nutritional risk assessment, and specific dietary requirements.
Matched on
terms: care, home, support
CQC action
82match
Georgiana Care Home
We recommend the provider assesses the processes in place to monitor people's food and fluid intake to make sure they are effective. We also recommend the provider review how best to serve meals to people with specific diets to make them look appealing and appetising.
Matched on
terms: care, home
PFD report
81match
Frederick King
The coroner noted inadequate fluid intake for the resident, especially during a heatwave and in the days before death. Concerns were also raised about inadequate record keeping and the absence of a manager at the care home for three days prior to the death.
Matched on
terms: care, home
CQC action
81match
Valewood House Nursing Home
The provider must ensure people are protected from the risks of inadequate nutrition and dehydration and receive appropriate support to enable them to eat and drink.
Matched on
terms: home, support
CQC action
81match
Archers Point Residential Home
The provider must ensure people's nutrition and hydration needs are met, including accurate completion of Malnutrition Universal Screening Tools (MUST), appropriate referrals to healthcare professionals, comprehensive nutritional care plans, staff understanding of fortification strategies, offering choice of meals, and providing cooked meals in the evening.
Matched on
terms: care, home
CQC action
81match
Quality Care Management Limited
The provider should review mealtime arrangements to ensure that this is always a positive experience for people and that they receive the support required in an unrushed, caring and dignified way.
Matched on
terms: care, mealtime, support
CQC action
78match
Park Grange Care Home
The registered provider review the process for monitoring people's food and fluid intake.
Matched on
terms: care, home
PFD report
77match
Pamela Thurston
The coroner identified insufficient direct supervision during mealtimes for a resident with dementia, who choked after being given toast following a 17-hour period without food. Her care plan was also not updated despite a prior related incident.
Matched on
terms: care, mealtime
PFD report
77match
Jane Parker
Care home assistants demonstrated a poor understanding of modified diets and the importance of escalating choking episodes to SALT. The system for preparing and marking food for residents with specific dietary requirements was also inadequate.
Matched on
terms: care, home
PFD report
77match
James Astley
The coroner noted insufficient completion of nutrition and fluid documentation, including MUST charts, leading to inadequate monitoring of Mr Astley's intake. Overall documentation at the care home also lacked detail.
Matched on
terms: care, home
PFD report
73match
Lilian Shearing
The coroner noted that no risk assessment was undertaken for the deceased's poor fluid intake upon admission to the care home, and omissions were made from the fluid intake chart. Policies and assessments for fluid and nutritional intake were not in place to cover this eventuality.
Matched on
terms: care, home
PFD report
73match
John Howlett
The coroner noted a patient spent 22 hours in an A&E corridor due to capacity issues, which was a widespread problem. Additionally, the care home lacked robust systems to monitor the patient's nutritional status and fluid intake.
Matched on
terms: care, home
PFD report
73match
Alfred Sparrow
The coroner noted that staff at The Meadows Nursing Home did not consistently provide assistance with Mr. Sparrow's food and fluid intake, and that care notes contained false entries. This raised concerns about the accuracy of record-keeping and the thoroughness of internal investigations.
Matched on
terms: care, home
LGO / SPSO decision
71match
21-000-498b - Brighton & Hove Clinical Commissioning Group (21 000 498b)
Summary: The Ombudsmen found no fault by a Council, a CCG and a care home in relation to the nutritional support and personal care provided to Mrs Y. We have found fault with how nutritional risk was assessed, but this did not affect the care provided and the care home has now remedied this by making changes with...
Matched on
terms: care, home, support
LGO / SPSO decision
71match
21-000-498 - Brighton & Hove City Council
Summary: The Ombudsmen found no fault by a Council, a CCG and a care home in relation to the nutritional support and personal care provided to Mrs Y. We have found fault with how nutritional risk was assessed, but this did not affect the care provided and the care home has now remedied this by making changes with...
Matched on
terms: care, home, support
CQC action
69match
St Marys Care Centre
The provider reviews mealtime experiences to ensure people are consistently happy that their dietary needs are met.
Matched on
terms: care, mealtime
PFD report
65match
John Bartle
The family perceived a lack of staff over a Bank Holiday weekend, leading to delayed interventions, poor nutritional support, and inadequate pain control. Concerns were also raised about poor communication from nursing staff.
Matched on
terms: support
CQC action
65match
Bellevue Healthcare Limited
The provider must ensure people receive safe care and treatment, specifically regarding nutrition and hydration to prevent malnutrition and dehydration.
Matched on
terms: care
CQC action
65match
Affinity Trust Specialist Support Division North
The provider had failed to ensure monitor and consider information related to hydration and nutrition.
Matched on
terms: support
CQC action
65match
Haisthorpe House
The provider must ensure people who used services are protected from the risk of inadequate nutrition and dehydration by means of the provision of support for the purposes of enabling them to eat and drink sufficient amounts to meet their needs.
Matched on
terms: support
CQC action
65match
Newland House
People were not always provided with adequate support and encouragement to eat their meals.
Matched on
terms: support
PFD report
61match
Helen Burnell
The coroner identified that staff did not adequately recognise choking risks for adults with autism and learning disabilities. Improved training for staff and managers on choking risks and adherence to mealtime recommendations is needed.
Matched on
terms: mealtime
PFD report
61match
Maureen Woollen
The coroner identified a lack of processes to ensure prompt medical attention for residents and full utilisation of care notes for recording injuries and incidents. Concerns were also raised regarding the absence of falls risk assessments on admission.
Matched on
terms: care
CQC action
61match
Dr French Memorial Home Limited
Meeting nutritional and hydration needs
Matched on
terms: home
CQC action
61match
St Paul's Lodge
The registered person must ensure the nutritional and hydration needs of service users are met by ensuring service users receive suitable and nutritious food and hydration adequate to sustain life and good health and dietary supplements prescribed by a healthcare professional.
Matched on
terms: care
CQC action
61match
Westacre Nursing Home
We recommend that the registered manager implement competency assessments to provide assurances that staff understand the training provided and are able to confidently put their learning regarding nutritional risks into practice.
Matched on
terms: home
CQC action
61match
V&C Family Care Ltd
The nutritional and hydration needs of service users must be met. Paragraph (1) applies where— care or treatment involves— the meeting of the nutritional or hydration needs of service users is part of the arrangements made for the provision of care or treatment by the service provider.
Matched on
terms: care
PHSO casework decision
59match
P-003662 - Bedfordshire Hospitals NHS Foundation Trust
Mrs L complained the Trust failed to support her father's nutrition, oral care, and mobility, or provide physiotherapy after discharge, which she believes led to his death.
Matched on
terms: care, support
PFD report
57match
Louise Cooper
The coroner raised concerns about the lack of availability of sustained daily supported eating for patients with anorexia nervosa. This treatment, recommended by clinicians, could be more effective and less costly than repeated inpatient admissions.
Matched on
terms: support
PFD report
57match
John Lee
The coroner noted concerns that dementia patients at the Trust may not be receiving mouth care on each occasion they eat, which presents a risk of future deaths.
Matched on
terms: care
PFD report
57match
Marina Waldron
The coroner raised concerns regarding the poor management of MW’s nutritional needs during her hospital admission. This included a failure to heed family concerns, formally monitor dietary intake, or respond to signs of malnutrition, with dietary interventions considered too late.
Matched on
classifier match
CQC action
57match
Havilah Office
The provider did not ensure people were supported to eat and drink enough in a safe manner and in line with their preferences.
Matched on
terms: support
CQC action
56match
Chatting Independently Limited - Rectory Drive
People were not protected from the risk of adequate nutrition and hydration by means of the provision of a choice of suitable and nutritious food and hydration, and support for the purposes of enabling people to eat and drink for their needs.
Matched on
terms: support
CQC action
56match
Chatting Independently Limited - Orchard View
The provider must ensure people are protected from the risk of inadequate nutrition and hydration by means of the provision of a choice of suitable and nutritious food and hydration, and support for the purposes of enabling people to eat and drink for their needs.
Matched on
terms: support
PFD report
53match
Barbara Haley
Concerns were raised that a resident, assessed as high risk of choking and on a soft diet, was provided unsuitable food items and left unattended while eating.
Matched on
classifier match
PFD report
53match
Kathleen Smith
Staff lacked sufficient training in first aid, assisting choking residents, and preparing special dietary foods. There was also inadequate management oversight regarding staff deployment for residents at risk of choking.
Matched on
classifier match
PHSO casework decision
52match
P-004422 - Calderdale and Huddersfield NHS Foundation Trust
A wife complained about multiple aspects of her husband's care, including nutrition, medication, ward placement, and communication, impacting his recovery.
Matched on
terms: care
PFD report
49match
Dorothy Clarkson
The coroner noted issues with the procedure for providing food to residents requiring special preparation and assistance, and a lack of appropriate ongoing professional development training for nursing staff.
Matched on
classifier match
PFD report
49match
Catherine Best
An inadequate regime of supplemented nasogastric tube feeding resulted in inconsistent calorie intake for the patient, who was challenging and not always able to consume sufficient calories orally.
Matched on
classifier match
PFD report
49match
Bruce Caulfield
The coroner identified delays in medical review after a family member raised concerns about a patient's condition. Further concerns included insufficient nursing practices for vulnerable patients' hydration and nutrition, and that comparable communication improvements may not be Trust-wide.
Matched on
classifier match
PHSO casework decision
48match
P-004409 - Kingston and Richmond NHS Foundation Trust
A man complained his vulnerable father with dementia received insufficient assistance with eating and drinking, poor oral care, and inadequate communication from staff.
Matched on
terms: care
LGO / SPSO decision
48match
202203333 - East Renfrewshire Health and Social Care Partnership
C complained on behalf of a relative (A) who had a learning disability and had been prescribed a special adjusted diet according to the International Dysphagia Diet Standardisation Initiative (IDDSI) guidelines. A had choked on their food and required emergency care. C complained that A’s food, a takeaway meal, had not been suitable for them and had not...
Matched on
terms: care
PFD report
45match
Margaret Rogerson
The coroner noted a lack of staff training in patient feeding mechanisms, techniques, and associated risks, including no refresher training. Additionally, no training was available for family members on safe feeding practices.
Matched on
classifier match
CQC action
44match
Nicholas House
The provider must ensure that the nutritional and hydration needs of service users, including preferences and provision of appropriate nutrition, are consistently met.
Matched on
classifier match
CQC action
44match
Grosvenor Hall
The provider failed to ensure people's nutritional and hydration needs were being met, monitored and recorded.
Matched on
classifier match
PHSO casework decision
44match
P-003071 - University Hospitals of North Midlands NHS Trust
Mrs C complained the Trust inappropriately managed her husband's eating and nausea, insensitively discussed palliative care, administered midazolam, and did not call her before his death, believing this hastened his death.
Matched on
terms: care