CQC Regulation 14 Nutrition and Hydration: What Care Providers Must Do

CQC Regulation 14 Nutrition and Hydration: What Care Providers Must Do

Regulation 14 is about whether people have enough to eat and drink, in the way they want it and with the help they need. Here is what CQC expects and how to evidence it.

CQC Regulation 14 requires you to meet people’s nutritional and hydration needs wherever you provide accommodation or an overnight stay, or where meeting those needs is part of the care you provide. That means assessing needs, providing suitable food and drink that reflects preferences and religious or cultural background, giving support to eat and drink, and monitoring intake. CQC can prosecute without a warning notice if a failure causes avoidable harm or significant risk of harm.

Food and drink are everyday care, which is why inspectors watch mealtimes closely. CQC’s guidance (CQC: Regulation 14) aims to ensure people have adequate nutrition and hydration to sustain life and good health, and to reduce the risk of malnutrition and dehydration.

This guide turns the guidance into practical steps for registered managers working towards a Good or Outstanding rating. It links to Regulation 12 on risk, to Regulation 11 on consent, and to person-centred care.

What Does Regulation 14 Require?

The regulation says nutritional and hydration needs must be met. “Nutritional and hydration needs” means:

• suitable and nutritious food and hydration, adequate to sustain life and good health;
• parenteral nutrition and dietary supplements when prescribed by a health care professional;
• reasonable requirements arising from preferences or religious or cultural background; and
• if necessary, support to eat or drink.

The duty does not apply to the extent that meeting a need would breach Regulation 11 (consent) or would not be in the person’s best interests. CQC says providers must follow a person’s wishes if they refuse nutrition and hydration unless a best interests decision has been made under the Mental Capacity Act 2005, and should also take account of advance decisions. CQC recognises some services, such as specialist eating disorder services and some palliative or end of life situations, may vary how they apply the regulation to reflect assessed needs and wishes.

Assessing and Reviewing Nutrition and Hydration Needs

CQC expects nutrition and hydration to be part of the initial assessment and ongoing review of each person’s needs, including related risks. Assessments must be carried out by people with the right skills and follow nationally recognised guidance. As a minimum they should identify:

• what the person needs to sustain life, support agreed care and treatment and maintain good health;
• dietary intolerances, allergies and medication contraindications; and
• how to support them: the level of help, timing of meals and appropriate quantities.

Review regularly and respond promptly to changes. Staff must follow the latest assessment and act if people are not eating or drinking in line with it, and know when to seek specialist advice. Many services use a recognised screening tool and a dietitian or speech and language therapist (SALT) referral route. See what is a care plan.

A Food and Drink Strategy That Works in Practice

CQC says providers should have a food and drink strategy that addresses the nutritional needs of people using the service. It should cover:

• Variety: nutritious, appetising food, served at the right temperature, for the whole mealtime.
• Specific diets: provided exactly as assessed, such as modified texture or diabetic diets.
• Drinks: water available and accessible at all times, other drinks offered periodically through the day and night, and people encouraged and supported to drink.
• Flexibility: meals later for people who are absent or asleep, and snacks between meals for those who prefer “little and often”.
• Choice: people choose what they eat, and their preferences about timing, place and quantity are met as far as possible.

Preferences, Religion, Culture and Ethics

CQC’s guidance says religious and cultural needs must be identified in the nutrition and hydration assessment and met. Where there are clinical contraindications or risks, discuss them with the person so they can make an informed choice. Dietary requirements based on moral or ethical beliefs, such as vegetarianism, must be fully considered and met. See culturally appropriate care.

Support to Eat and Drink

• Place food within reach and present it so it is easy to eat, for example liquidised or finger foods where appropriate.
• Encourage independence, with encouragement and physical support when needed.
• Provide appropriate equipment and give staff time to assist, rather than rushing.
• Where a person lacks capacity, give prompts, encouragement and help to eat as appropriate.
• Make sure people at risk of choking have detailed plans from a SALT that staff understand and follow. CQC’s “learning from safety incidents” case on choking led to a prosecution; see learning from safety incidents.

Monitoring Intake and Acting Quickly

Nutritional and hydration intake should be monitored and recorded to prevent unnecessary dehydration, weight loss or weight gain, and action taken without delay on concerns. Practical measures:

• Weigh people regularly and record changes, with a clear trigger for escalation.
• Use food and fluid charts for those at risk, and review them daily rather than just completing them.
• Make sure charts show amounts, not just “eaten well”.
• Report weight loss, poor intake or swallowing problems to the GP, dietitian or SALT promptly.
• Ensure staff administering prescribed supplements or parenteral nutrition are suitably qualified and competent, and that supplements are given at the specified times.

Evidence to Keep and Common Gaps

Common gaps: SALT advice not passed to the kitchen or care staff, charts completed but not reviewed, no drinks offered to people in bed, and cultural needs recorded but not catered for.

What Happens If You Breach Regulation 14?

CQC can prosecute for a breach of Regulation 14, or part of it, if the failure results in avoidable harm to a person or exposes them to significant risk of harm. It does not have to serve a warning notice first. See CQC prosecutions and offences and enforcement action explained.

CQCLogic’s audit schedule lets you add a mealtime and nutrition audit as a custom audit, track findings and re-audit dates, and assign actions as tasks. Care records and food charts themselves are kept in your care records system.