Meals make sense An audit checklist to consider how far a Care Home is implementing quality care re the mealtime experience. Place a tick in one of the 3 boxes Yes, No, Partly in relation to your Care Home. ATMOSPHERE 1 Soothing enjoyable music at mealtimes Provision of soothing and positive music during mealtimes that people enjoy. 2 Providing physical activity to stimulate appetite People who are active will have higher energy requirements and be more hungry physical activity is provided for people with a dementia on a daily basis. 3 Company and relieving boredom are provided for people who overeat. 4 Seating arrangements are considered In order to enable those who eat traditionally to be not off put by those who because of their degree of dementia are eating differently. 5 Use of fresh air to stimulate appetite is thought about. 6 Cues to mealtimes are used i.e. smells, sounds etc 7 Mealtimes free from distraction. i.e. No GP visits 8 Plain crockery and placemats are used to avoid 3D problems.
9 Attention is paid to lighting in rooms where people eat. 10 Behaviours we find difficult in residents at mealtimes are seen as our problem in not getting the mealtime experience right. 11 Subjects to talk about at mealtimes Staff regularly think about in team meetings. ASSESSMENT 12 Assessments re chewing and swallowing Assessments recorded as to whether the person can chew or swallow. 13 Eating alone or together Assessments recorded as to whether people prefer to eat alone or together. 14 Monitoring of weight Individual weight is measured and monitored regularly and a nutrition assessment tool is in place. 15 Changes to weight, eating and drinking habits recorded. 16 Mouth care assessments are carried out Poor dental health, ill fitting dentures, mouth ulcers and swallowing problems are assessed and acted upon. 17 Assessment re types of cups and glasses occurs for each individual - small cups, small drinking glasses preferable, large handles easier to grip, two handled cups for people with a tremor - an OT is involved in these assessments. 18 Coloured liquids more noticeable than water Assessments in relation to the level of perception in each individual are made.
19 Drinks and fluids intake assessments undertaken People with dementia can forget to drink, do not recognise sensation of thirst or may not notice what a drink is or remember that it is there. 20 Fibre intake assessments are undertaken Daily consumption of moderate fibre rich food is provided. Whole grain cereals, wholemeal bread, fruit, vegetables, peas, beans and lentils all good sources of fibre. (avoid raw bran) 21 Cultural and religious beliefs concerning food and eating are assessed for and provided. 22 Amounts of waste food are monitored by kitchen staff and reviewed. 23 Pain assessments during eating are considered for people who are eating little. 24 Oral and dental health is regularly checked. 25 Assessments are made on need for food that is soft enough to eat. 26 Swallowing assessments are made in relation to loss of eating skills i.e. re holding food in the mouth, chewing continuously, putting too much food in the mouth at once, eating too quickly, fear of choking etc. 27 Individual records are used to record capabilities and preferences re food and mealtimes. SKILLS 28 No reply doesn t mean remove the food For individuals who don t reply when asked if they are hungry or have finished continuing encouragement and not removing the meal.
29 Training in nutrition and dementia Kitchen staff have training in how dementia and poor nutrition are related and know how to prepare and present food in relation to dementia and how to provide energy food and increased nutritional value of foods. 30 Cognitive difficulties at mealtimes are assessed. Forgetting when to eat, losing the skills associated with eating, difficulty seeing food, problems making food choices can occur because of damage to the brain these needs should be regularly assessed. 31 Skills are known in encouraging people to drink Encouraging, prompting a person to drink, offering them a cup, lifting it towards their mouth, not leaving drinks on the table, half filling and returning to refill to remind person to drink. 32 Specialist help from a dietician is provided Care Homes need access to a dietician with experience in dementia care. 33 Unusual ways of eating are accepted i.e. eating courses in the wrong order, mixing sweet and savoury foods together, pouring a drink over a meal are accepted. 34 A variety of ways to offer real choice are considered i.e. use of pictorial menus, plating out a choice of meals on trays, serving several small portions, taking the person to see the food. 35 Activities involving food are provided to stimulate interest. i.e. discussions about food etc. 36 Themed events are provided as a focus i.e. festivals, Halloween, harvest, Pancake Tuesday, Wimbledon etc. 37 Party style or buffet foods are tried as activities i.e. a breakfast buffet, making an exotic fruit salad to create discussion with residents, adding toppings to pizza. 38 Trying out different places to eat for each resident.
39 Assessing difficulties to eat with ease i.e. with utensils, picking up items, adapted eating aids, non-slip placemats, rimmed plates, plates that retain heat and keep food warmer etc. QUALITY 40 Visible snacks Provision of visible snacks in the lounges that people can help themselves to. 41 Favourite mealtime extra food In relation to each person their favourite mealtime is recorded and if someone has a small appetite they are given extra food at their favourite mealtime. 42 Extra time to eat For individuals who eat slowly extra time beyond the normal mealtime is given. 43 Small portions but often For individuals who eat slowly small portions and/or only one item of food per plate is given and lots of small foods are provided one at a time. 44 Individual preferences are provided: This means providing for preferences re food textures, meal/snack frequency and familiar routines. 45 Healthier, nutrient rich snacks provided for people with a tendency to overeat. 46 Food which extra stimulates smell and taste is provided Generally smell and taste become less in people with a dementia and herbs and spices can stimulate taste again. 47 Lightly spicing up and lightly sweetening foods are considered for people who are struggling to have a sense of taste.
48 Attention given to provide well known brands of food from the past Long term memory is likely to be functioning better. Traditional dishes or food revamped and made modern may not be recognised. 49 Clever ways to provide food for people with a dementia with a sweet tooth caused by their dementia are used: i.e. sweeter tasting vegetables, sugar in sauces, gravies or egg dishes, sweet sauces provide with meat, yoghurt, custard etc used. This is balanced with watching for diabetes. 50 Two choices of meal always provided and shown to people. 51 Food enrichment or fortified food is provided for those with poor appetite or high energy requirements i.e. adding butter, cream, cheese, milk powders, full fat milk or extra sugar to food. Use of high energy supplement drinks to support intake. 52 Nutritious snacks and milky drinks provided between meals and at supper time. 53 Menu meetings are held between kitchen staff, care staff and Managers. 54 Bright and contrasting colours of food used. 55 Portion size is matched to each individual to prevent their feeling overwhelmed. 56 Finger foods are provided to help people to recover early skills. i.e. finger food buffets