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Semelhante a Chefs' Club: Slides for Session 5
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Chefs' Club: Slides for Session 5
- 1. DCHC Chefs’ Club. Session 5 • Course Summary & Overview • Nutritional Strategy and Audit • Outstanding Nutrition & Hydration care – how your nutrition & hydration standards impact your home’s CQC inspection. • Special Diets: Diabetes, Gluten free, Dairy Allergy, Lactose intolerance, End of Life. Vegetarian and vegan. “Vegetarian for Life” Guest Chef: Alex Connell www.vegetarianforlife.org
- 2. Nutrition & Hydration: Legislation & Guidance The Health and Social Care Act 2008: Regulation 14, Outcome 5: Meeting Nutritional Needs: “Providers should have a food and drink strategy that addresses the nutritional needs of people using the service.” Care Quality Commission Fundamental Standards – KLOE “Effective E3” How are people supported to eat and drink enough and to maintain a balanced diet? (also linked to Safe, Caring, Responsive & Well-led) Food Hygiene Legislation includes: • Food safety Act 1990 • HACCP regulations 2004 • EU Allergen Law 2014 ( to be up- dated 2021 Natasha’s Law) • General Food Hygiene ratings, Also: • H&S at work 1974, MH operations Regs 1992, COSHH 2002, Gas Safety regs, Water Regs, BESA TR19 Ventilation Ducts, H&SC Act 2008 Infection control and prevention, Environment Protection Act 1990 (waste), Covid 19. • And – 1998 Human Rights Act
- 3. Course Summary DCHC Nutritional Care Strategy Session: 1. Introduction. Champion role. Legislation & Guidance, What is Outstanding Nutritional Care? 2. Dysphagia & IDDSI – texture modification 3. Nutritional Screening – MUST, Fortification, Food for fingers. 4. Menu planning, Care Planning including preferences & choice, Hydration, Special occasions, Contingency & Sustainability. 5. Course summary & overview. Special diets. “Vegetarian for Life” 2022: 6. Food Safety: Procedures, HACCP, Records, Allergens & Audits. Training.
- 4. Getting your message across: Meetings & Training sessions: virtual or in person Posters, blackboards Message boards Call, Whats app camera Online – care docs, e-mail, zoom, teams, classrooms, wiki Folders, menus Handover, 11 at 11 Always involve your residents
- 5. Importance of Mealtimes “those eating together ate up to 48% more food than solo diners” Source: Outstanding Society – Science daily
- 6. How does the nutrition and hydration provision in your setting and your dining experience impact your CQC Inspection?
- 7. CQC Inspection - ratings Outstanding – Inadequate The “Mum test”!
- 8. CQC Key Lines of Enquiry KLOE Effective - E3 is not seen in isolation. Nutrition and hydration provision must also be: • Safe • Responsive • Caring • Well-led
- 9. The Inspector calls. CQC KLOE Effective E3 “how are people supported to eat and drink enough to maintain a balanced diet?” Evidence is required to show: 3.1 How are people involved in decisions about what they eat and drink and how their cultural and religious preferences are met? 3.2 How are people supported to have a balanced diet that promotes healthy eating and the correct nutrition? 3.3 Are meals appropriately spaced and flexible to meet peoples’ needs and do people enjoy mealtimes and not feel rushed? 3.4 How are risks to people identified and managed in relation to their eating and drinking?
- 10. Characteristics of Ratings: Nutrition and Hydration (NACC) Outstanding Good Requires Improvement Inadequate Highly personalised Creativity Flexibility Innovation Positive support for diversity Strong emphasis on eating well Always sufficient Choice Access Personalised Pleasant dining environment People involved Recognition of complex needs Regular monitoring Not always sufficient Limited options Not always balanced People not always involved Limited attention to culture/ethics Variable quality Risk management lapses Varied access to / requests for specialist advice Insufficient Access restricted No choice Rushed mealtimes Poor experiences Staff don’t have required knowledge and skills No involvement No attention to culture/ethics No access to specialist advice People at risk
- 11. 2.5 Mealtime Procedures and Protocols: A comfortable, relaxed, and appropriate environment is provided that is conducive to people enjoying and safely consuming their meals and drinks without being interrupted by non-urgent or routine activities such as drugs rounds. Inviting, warm and friendly, well-lit Tables laid with cloths, placemats & napkins, cutlery, jugs and glasses, condiments, flowers, sauces, “stuff” How personal can you make it? Clean but not clinical Soft background music (loop?) Small friendly groups, include staff, invite guests. Serving dishes and spoons Mini kitchenettes rather than trolleys Noise! Language – “she’s a feeder”
- 12. 2.5 Care staff must ensure that within residential settings residents can sit with friends and family and enable those who prefer or may be distracted to sit alone or in a quiet area or eat at a different time. Care staff must be available to dine with residents and assist by: aiding with hand hygiene and seating helping with meal choices ensuring people can reach their meal and drink. ensuring people can assist to lay up, serve and clear where appropriate. physically assisting people to eat and drink where required and maintaining their dignity. enabling people to make choices. ensuring adequate diet and fluid intake making sure meals are put back or replacements offered if mealtime is missed.
- 14. Outstanding? Going the extra mile • Highly personalised • Creative • Flexible • Innovative • Positive support for diversity • Strong emphasis on eating well
- 15. Thinking outside the box & involve as many people as possible (source: Apetito & The Outstanding Society) Personalised placemats – Clothes protectors Care plan reviews “around the clock” menus • residents, dining assistants, activity co-ordinators, chefs, etc • Chefs, care team, laundry team, residents etc • Chef, Care team, resident & family/friends • Chefs, residents, care team, night team
- 16. What works in your setting? Safe & sufficient? Flexible? Support to eat & drink • Food for fingers • Portion size • “round the clock menu” - Night staff • Specialist involvement? • Fortification, Iddsi • Physical – dignity: language, time, environment, training, “stuff” – conversation pieces
- 17. Creative; support for diversity; innovative. Fish and chip atmosphere Take-away/themed days chosen by residents Picking herbs & Bud vases Observation Sherry before lunch? Hydration – Mocktails, themed drink days Fine dining Menu committee/cooking club Eat-in room experience Pub or Spa Religious festivities – Diwali, Ramadan etc
- 19. KLOE: Safe, Well-led, Responsive Food Safety actions – records EHO rating staff training mini kitchens & gift food pets & pest control Managing risk – HACCP individual – Choking, Weight loss, burns, ingestion, Covid 19, etc Incident reports – incidents/near misses – what has been learnt, how is that practice changed? How is it evidenced/recorded?
- 20. Different Diets Diabetes Gluten Free Lactose intolerant Dairy Allergy Vegetarian & Vegan
- 23. Living with Diabetes - Why should we be concerned? It is estimated that 1 in 4 care home residents may have diabetes and a similar proportion may be undiagnosed ( IDOP 2014) Left untreated it can cause problematic symptoms and complex, chronic long-term health conditions with serious complications such as amputation and blindness Can be life-threatening eg hypoglycaemia and diabetic keto-acidosis May go undetected eg in dementia
- 25. Diabetes – healthy diet advice: Balanced diet Regular meals High fibre – low GI Limit sugar and sugary food Include more fruit and veg Decrease fats Include dairy – milk, cheese, yoghurt Limit salt, fatty and processed food Alcohol in moderation Adequate fluids
- 26. There is no “one size fits all” diabetic diet, it must be tailored to the individual and involve the resident and other appropriate people such as family, care and catering team and professionals. The nutrition/hydration care plan should link to the diabetic care plan There is no need for “Diabetic food”, but low sugar or sugar free options are available such as squash, hot chocolate, jam and marmalade
- 27. Carbohydrate-containing food and drink breakdown to release glucose into the bloodstream Starch Added sugar Natural sugar Breakfast cereals Table sugar fruit Potatoes & pasta Sugary drinks Fruit juice Flour, rice Sweets & Chocolate Milk, yoghurt, fromage frais bread jellies Some vegetables especially root vegetables Cakes, biscuits, puddings
- 28. Avoid large portions portion size is still the biggest factor affecting blood glucose levels ( Diabetes UK Nutrition Working Group 2011)
- 29. Diabetes & Undernutrition (Diabetes UK Nutrition Working Group 2010) Diabetes is known to increase the risk of undernutrition. Residents with diabetes, identified as Malnourished or at risk of malnutrition must be managed in line with the MUST protocol and food first approach .. In most situations …an adjustment of diabetic medication should be prioritised over dietary restriction, with a diabetic review requested. If there are concerns about increased blood glucose levels focus on proteins & fats ( cream, cheese, butter, oils ) rather than sugars for fortification as these will have less impact on blood glucose levels.
- 30. Hyper-glycaemia high glucose level – persistently over 15mmols may result in diabetic ketoacidosis requiring urgent action!
- 31. Hypoglycaemia – low blood sugar level – 4mmols or less – too low to provide enough energy for the body’s activities (Diabetes UK 2010) May be precipitated by: • Missed or delayed meals – no supper, late breakfast? • Erratic eating – slept through lunch? • Poor appetite – sore mouth/teeth, feeling unwell, depressed? • Dysphagia or malabsorption • Insufficient carbohydrates • Exercise/unusual activity eg wandering • Cognitive impairment • Heat May be hard to spot especially for residents living with dementia
- 32. Hypoglycaemia • Offer fresh orange juice, fizzy drink or squash ( not reduced sugar!), sweets such as jelly babies, glucagel or dextrose tablets. (note – check dysphagia plan and do not offer oral fluids/food if drowsy) • Do not offer sweet milky drinks, cakes, biscuits, chocolate as fat content can slow absorption of glucose. • Follow Hypo protocol and seek urgent emergency help if no improvement • Make referral to GP, diabetic specialist nurse, dietician, salt as required
- 33. Allergy or Intolerance? “food hypersensitivity” includes the conditions of food allergy, food intolerance and coeliac disease (FSA)
- 35. What is Food Intolerance? A food intolerance is difficulty digesting certain foods and having an unpleasant physical reaction to them. It causes symptoms, such as bloating and tummy pain, which usually happen a few hours after eating the food. A food intolerance is not the same as a food allergy which is a reaction by your immune system (your body's defence against infection). (NHS)
- 36. Lactose Intolerant or Dairy Allergy? Lactose intolerance is caused by the inability to completely digest lactose, the sugar found in all mammalian milk, due to the absence or deficiency of the enzyme lactase in the gut3,4. CMA is an immunologic hypersensitivity to one or more of the proteins found in milk5. This means CMA is an allergic reaction, involving the body’s immune system; lactose intolerance does not involve the immune system3,4.
- 37. Lactose Intolerant or Cows Milk Allergy? some symptoms overlap (and can be similar to IBS & Coeliac disease) • Lactose intolerance symptoms are purely gastrointestinal, e.g. abdominal pain, diarrhoea and bloating2,7. • CMA, symptoms can be gastrointestinal, or they can be respiratory (e.g., wheezing, rhinitis), or skin-related (urticaria) and, in some cases, can lead to anaphylaxis8.
- 38. Dairy allergy – foods to avoid Foods to avoid may include: • Bread, pancakes, • Pastries glazed with milk, • Salad dressings, • hot dogs and French fries, • ghee, • caramel flavourings, • sheep & goat’s milk, • chocolate. Always check the label for MILK & Milk derivatives such as Casein
- 39. Allergies & Intolerances Allergen & Intolerances Training: https://www.food.gov.uk/safety-hygiene/food-allergy-and-intolerance You can report food allergic, intolerance or coeliac reactions to us (FSA) through our online food reaction reporting tool.
- 40. Coeliac disease Coeliac disease is not a food allergy or an intolerance, it is an autoimmune disease. In coeliac disease, eating gluten causes the lining of the small intestine to become damaged. Other parts of the body may be affected. (FSA)
- 41. What foods contain gluten? wheat, barley and rye https://www.coeliac.org.uk/docum ent-library/6679-gluten-free- checklist-january-2020/ Read the labels – oats are included as often contaminated with other cereals. The foods should be labelled “Gluten free” – and not confused with a specific cereal allergy
- 43. Eating and drinking at the end of life. End_of_life__nutrition_HMMC_062018.pdf “When someone is approaching the end of his or her life the focus of care for the person may change and tends to be centred on helping them to be as comfortable as possible.
- 44. Nutrition or nourishment? meeting nutritional needs becomes less important than providing comfort, and even very small amounts of the person’s favourite food and drink can provide comfort.
- 45. Other ideas that may help: Keep asking “what is helpful for this person at this time?” - there is no single ‘right’ answer as it depends on each person’s individual situation Continue to offer other forms of support such as gentle massage, skin care, music and conversation Keep the person company - talk to them, read to them, watch films together, or simply sit and hold their hand Even when people cannot speak or smile, their need for companionship remains. The person may no longer recognise you, but may still draw comfort from your touch or the sound of your voice What about food? Let the person choose if and when they want to eat or drink Offer small amounts of food, especially the person’s favourite flavours Don’t worry about providing a balanced diet Try small snacks and nutritious drinks What about drinks? Frequent mouth care can prevent the person feeling thirsty, even if they cannot drink very much Keep lips moist with lip balm Use a small spray bottle to mist the mouth with water, being careful not to give too much Offer small pieces of ice or small ice lollies instead of drinks
Notas do Editor
- So welcome to our last session before Christmas. I hope you enjoyed Alex’s session today. The Vege for life team are brilliant and very supportive for care home chefs. I urge you to check out their excellent on-line resources and share them with your colleagues. Today I want to finish by reviewing what we have covered so far and look in a bit more detail at what is Outstanding nutrition and hydration care. And finally touch on the most common special diets you will use.
- As chefs working in a commercial setting we are all aware of the laws governing food safety, which you can see here in the right hand column. They include the food safety act, haccp regulations and allergen law amongst others and also the food hygiene ratings awarded by your local authority. In the care sector we are also governed by the health and social care act as seen in the left hand column which sets other standards we are required to meet. These are inspected by CQC. In addition, we are governed by the the Human rights act, which is concerned with individual freedoms of choice and decision making. So we can see many people have a finger in the care sector pie!
- On inspection CQC is looking for a clear strategy on nutrition and hydration in your setting. This is not the chef’s responsibility, but as nutrition champion it is something you should be involved in implementing. As chefs it is really important that you champion all things “food” in your Home! This is your area of expertise and the more pro-active you can be in guiding nutrition and hydration care the more your residents and wider staff team will benefit. This course has followed the draft Nutrition and hydration strategy which you can find on the dchc web-site. It has looked at legislation and guidance, what outstanding nutrition and hydration care looks like, Dysphagia and texture modification referring to the iddsi guidelines, nutritional screening and fortification including food for fingers, and menu planning and hydration. We have not so far covered food which has had to be carried forward to the new year.
- It is important that, even if you don’t expect to introduce a nutrition and hydration champion approach in your settings you take back the information gained to inform and hopefully influence positive changes. There are many ways to do this as shown on the slide. Don’t forget to involve your residents, keeping them at the heart of everything you do, and make sure you seek advice and support from your care and clinical team and professional partners
- So why should we aim to be outstanding in nutrition and hydration care? This interesting statistic shows how important other factors, not just the food on the plate can be.
- We have looked before at the importance of recognising what “home” is for our residents on a personal level.
- When CQC inspect they will use the “mum test”, would you want your mum to live here? with specific criteria to rate your setting from Inadequate, requires improvement, good or outstanding
- They break down the inspection into 5 KLOE’s, key lines of enquiry and may do a targeted inspection on just one of these. Nutrition and hydration falls mainly under the Kloe effective, but also comes under safe, responsive, caring and well-led. CQC gather information by collecting reports and data such as incident reports, reviewing care plans and charts, observing people, practice and environment, and talking to residents, staff, families and professionals. They then triangulate that data to make sure what they hear and see matches what is written and recorded and results in positive outcomes for people living in the service.
- CQC look for evidence to show how each kloe is met. For example, you may tell the inspector that you produce a texture modified level 5 meal for Mrs Jones. They may observe that at mealtimes, what the meal looks like and how well Mrs Jones likes it. Then check how it is recorded in the care plan, how it is supported and monitored, how Mrs Jones, her family and relevant professionals have been involved in the process, and if the outcomes have been positive.
- This chart attempts to highlight the key differences between the ratings. For example in the right hand column you can see that things like lack of choice and no involvement by the residents or others is viewed as inadequate.
- The nutrition and hydration draft policy describes mealtimes and how they should look.
- Also how staff are support residents to eat and drink enough.
- But what extra things are you doing to provide that outstanding care?
- Specifically, what inspectors are looking for are: evidence of good quality food and drink with a variety of different options to choose from. That people are fully involved and help to plan their meals with staff, taking into account nutritional advice. Also that staff are aware of personal preferences and preferred patterns of eating and drinking and there is flexibility where needed or requested. Creativity and innovation are looked for, such as how people are supported with texture modified meals or when they don’t feel like eating or drinking? Evidence is required to show how the service embraces different cultural, religious and ethical choices for example celebrating specific festivals, Also that dietetic professionals are feeding back that they are being asked for advice and it has been properly applied.
- So there are many ways to think outside of the box and I am sure you may already have had some great ideas. For example, being involved in care plan reviews, working together with team members from other departments such as activities, laundry, maintenance and admin to create things like personalised placemats, clothes protectors, themed days and festivals, “experience” boxes, raised planters for herbs etc
- And these are some of the other things we have already looked at, for example a “food for fingers menu” and a “round the clock menu” getting ideas from the night staff. And remember to evidence everything. An example given by the outstanding society was a resident who often slept through lunch as he was usually awake at night. A member of the night team noticed that he was interested in her microwaved porridge pot, so she offered him one and he ate all of it. So she mentioned this to the kitchen team in handover and they then bought in some specifically to offer to him if he was awake at night. This was documented in his care plan. He had been previously losing weight, but by recognising that he was awake and hungry at different times, and making sure there were options available that he liked for the night team to offer meant his weight began to stabilise and improve. So this demonstrated that the staff team had worked together, identified and met a need which then had a positive outcome.
- I am sure you have had to come up with many creative and innovative ideas during Covid, so do share these with your inspector and anyone else who is interested – be proud of what you do, and don’t assume people, including relatives and friends, actually realise what you may have done, collectively, or for individual residents. Shout it from the roof-tops! You deserve recognition! We are still in Covid times, but moving forward other ways of being creative, innovative and supporting diversity could include things like creating a “pub” or spa where residents can meet in groups to eat drink and socialise. Even having a sherry tray or trolley before Sunday lunch creates a sense of occasion that can encourage a positive dining experience. And don’t forget those people who maybe can’t have alcohol – what about ice and a slice in a wine glass of sparkling water? It offers the same experience if not the same taste. And there are non-alcohol essences that can be added to drinks that taste exactly like the real thing eg gin and vodka! Or you may have a resident that used to love gardening? Perhaps they could be encouraged to grow or pick herbs for the kitchen, or make up bud vases for trays?
- The fish and chip experience was another suggested by the outstanding society; having an “experience box” – a sand tray with mini sandcastles and bunting so residents can feel the sand – and a spray bottle with vinegar and water to capture the smell experience, newspaper wraps and maybe a recording of waves and seagulls - all evoke the atmosphere of eating fish and chips by the sea-side. Not every Friday, but worth thinking about how you can introduce not only the food but also the whole experience
- And of course, CQC will check your food safety records and training, EHO reports, and review incidents and near-misses. The work that you do every day is crucial to the health and well-being of the people living in your service, it makes a real difference. I hope this information has highlighted where you are already out-standing and perhaps some new ideas to take away.
- Moving on, I thought it might be useful to have a look at some of the different diets you may cater for. Alex has covered Vegetarianism earlier and you know where to find more resources on this. So I will run through what is diabetes and what kind of diet diabetics need? Also a brief look at the differences between allergies, intolerance and coeliac disease and some of the most common diets here, gluten free, lactose intolerance and cows milk allergy.
- We are all likely to have people living with diabetes in our services. In the BDA Nutrition and Hydration digest, Diabetics are not flagged up as needing a “special” or specific diabetic diet, but sit under the Standard diets, healthier eating section. And Diabetes UK says “There is no specific diet for diabetes. But the foods you eat not only make a difference to how you manage your diabetes, but also to how well you feel and how much energy you have.” I want to stress that none of us are diabetic specialists and therefore this information, whilst evidence-based, is not person-specific. So if you have, in particular, diabetics with unstable blood sugar levels or other co-morbidities you must work together with the clinical team and diabetic specialists including the diabetic specialist nurse and dieticians who may recommend specific dietary changes for that person.
- There are essentially 3 types of diabetes, type 1, 2 and gestational – in pregnancy.
- It’s important we recognise it as it can not only cause chronic long-term health conditions, but can also be life-threatening. It is easy to miss it in dementia – one of the signs to watch out for is insatiable thirst.
- So treatment can be a combination of healthy diet alone, or together with medication or insulin injections and blood sugar monitoring. Interventions such as a healthy balanced diet, maintaining a normal weight and exercise can all help reduce the risk. Signs someone may have or be developing diabetes may include being always hungry or thirsty, more tired than usual, going to the loo more often, and slow wound healing
- In the past diabetics were encouraged to count their carbs and avoid added sugar in their diet. This may still be true particularly for type 1 diabetics who regularly check their own blood sugar levels. But generally diabetics are now advised to follow healthy eating advice which includes
- There is no need for specific “diabetic foods”, but it is advisable to provide low sugar or sugar free options for typically sugary foods such as squash, jam, marmalade and hot chocolate. There is no one size fits all, so it is important to work with residents and their families, clinical teams and professionals in decision-making around diet. The nutritional care plan must link to the diabetic care plan and diet information must be shared with the kitchen and wider care team.
- This table shows the different categories of carbohydrate-containing food and drinks and on the right ways to reduce added sugars and excess calorie intake, for example using high GI foods with complex carbohydrates that release sugar slower into the bloodstream. If you apply healthy eating principles to your standard menu then it becomes accessible to everyone. You can tweak it, for example you could still offer that apple sponge pudding, but add some wholemeal flour and oats to the sponge mix, serve a smaller portion with cream instead of custard.
- Diabetes UK reported that portion size is the biggest factor affecting blood glucose levels, so it is better for diabetics avoid large meals and spread their intake across the day to reduce those peaks and troughs in their blood sugar levels.
- Remember the statistic that @ 35% of residents in care homes are at risk of malnutrition? Diabetes increases this risk. So if your diabetic resident has a MUST score of 1 or above, or is losing weight, then it is important to use the food first approach we looked at in session 3. Supplement food with proteins and fats rather than sugary snacks – remember milk powder - your secret weapon! If your diabetic resident is undernourished then they should be reviewed by the GP, district nurse or specialists such as the diabetic specialist nurse and dietician, especially if blood sugar levels are difficult to control. Diabetes UK suggests that in most cases of undernutrition, adjustment of diabetic medication should be prioritised over dietary restriction, but this is the always the decision of the clinical team.
- If blood sugar levels are unstable they can result in a medical emergency. Too high may result in diabetic ketoacidosis which can be life-threatening and may affect the vital organs such as brain and kidneys.
- Too low can result in hypoglycaemia which can quickly lead to coma and death, but may also manifest as an increase in “behaviours”, falls and confusion.
- Your setting should have individual plans in place for your diabetics in case of these emergencies, which may include rescue medication such as glucagon and a “hypo” box containing things like jelly babies and glucogel. Although sweet milky drinks are not advised in a hypo situation, a normal cup of hot sweet tea is one option that is usually well accepted if the person is sufficiently alert.
- Next allergies and intolerances. Before looking at gluten free, lactose intolerance and dairy allergy, I just wanted to remind us of the fundamental differences between food allergy and intolerance. The food standard agency uses the umbrella term food hypersensitivity for food allergies, intolerances and coeliac disease. This describes people who have an adverse physical reaction to food which is otherwise harmless.
- An allergic response happens when our immune system reacts to proteins in certain substances such as food as a threat. In this example the allergen, pollen, is inhaled. Chemicals are released in the body which cause the symptoms of an allergic reaction, for example sneezing and runny nose in hay-fever. The type and severity of the reaction depends on different factors such as the individual, the severity of their allergy, the amount of allergen they are exposed to and other factors such as medication, lack of sleep and exercise. So it is vital to find out the exact details if someone is reported to have an allergy because very tiny amounts of the allergen can cause a severe, adverse reaction, the most potentially life-threatening being anaphylaxis.
- People with an intolerance may be able eat or drink some of the food they are intolerant to, but this can vary significantly. So it is really important to check labels as you would for those with an allergy.
- The main difference between a lactose intolerance and milk allergy is: Lactose intolerance is caused by a lack of an enzyme in the gut making it difficult to digest lactose, the sugar that occurs in milk. Cows milk allergy is an immune reaction to one or more protein found in milk – so an allergic response.
- You will need to check with your resident, their family or advocate, and clinical team how their allergy or intolerance is managed and what specific alternatives you can provide – there are plenty on the market now. This should be recorded in the care plan, on the MAR charts and on your allergen records in the kitchen and flagged up to staff.
- If your resident has a Milk allergy they must avoid all milk products so you need to check food labels very carefully – you may be surprised where it turns up!
- If you are uncertain at all you can refer to the FSA allergen and intolerances training online
- Finally, Coeliac disease. This is not a food allergy or intolerance. It is an autoimmune disease which causes damage to the lining of the gut, and may affect other organs. People who have Coeliac disease need a gluten-free diet. This is the only way they can avoid symptoms and damage to their gut and other organs.
- It is caused by a sensitivity to wheat, barley and rye which all contain gluten. You can find information about what foods contain gluten on the coeliac disease uk’s checklist via the link shown. Many residents or their families will be able to tell you what their Gluten free food preferences are. You should check ingredient labels carefully and could make some minor adjustments to your main menu so you are not constantly cooking separate meals, such as using cornflour as a thickener in casseroles or gravy instead of flour or a normal gravy mix. Keep a laminated copy of the Coeliac uk checklist in the kitchen to help you and your team. And of course, be scrupulous in making sure that cross contamination does not occur. Ideally you should have a separate preparation and storage area, but if your kitchen is too small, keep labelled storage boxes and utensils and clean down thoroughly before prepping Gluten free meals.
- You have all been through an extremely tough time with the covid pandemic in the last year or so, both at work and personally, and may have lost some cherished loved ones
- So I just wanted to share some ideas about how to support eating and drinking at the very end of life. We are usually very focused on making sure people have enough to eat and drink, but at this time, people often experience a decrease in appetite and a loss of interest in food and drink. This can be worrying for families and carers but it is a natural and expected part of the dying process. Most people at the end of life do not experience hunger or thirst. The body is slowing down, and if someone eats or drinks more than they really want to it can cause them discomfort. Families and carers may be concerned about the effects of reduced food intake or dehydration on the person who is dying, and it is natural for families to want to continue providing nourishment at this time”
- Tube feeding via a drip or ‘food’ via a feeding tube do not usually improve quality of life or prolong life and can be distressing for the person who is dying. Prescribed nutritional products do not contain anything which can’t be found in food, and most people seem to prefer the flavour of ordinary food and drink
- Many families find it helpful to look at other ways in which they can provide ‘nourishment’ in terms of comfort and support for their loved one as you can see on this slide.
- Focus on personal preferences and favourite meals, snacks and drinks – and of course remember the family too.
- On a more joyful note I think we are all looking forward to Christmas and hoping we can get together with family and friends this year.
- I hope your plans and preparations are going well? How about this for an edible Christmas tree! It’s a cone of savoury cream cheese and ham with cheesey biscuits and a bacon star courtesy of tic tok! Before you get lost in celebrations (and hard work!!), please remember to complete all 5 session quizzes if you would like a certificate. Make sure you write your name on your quiz before returning it. And let me know if you haven’t received the quiz or certificate you are expecting by the end of December. We are hoping to resume probably on the last Thursday in January. All suggestions and ideas are welcome for future topics. The first planned session will be on food safety and records.