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The Close Care Home – Achieving Outstanding in All Areas

30 Apr 2021

Richard Edwards and The Close Care Home team have worked with Oak House Kitchen since we developed our standardised approach to catering for dysphagia. Richard and his chefs attended our first ORAL course and, we are pleased to say, this has developed into a great professional friendship. Since the beginning, Richard has always supported  our work, however it was only recently that he made us aware of how our dysphagia training helped to improve the CQC rating to outstanding in all areas.

Written by Richard Edwards, Non-Clinical General Manager, The Close Care Home, Abingdon, Burcot, OX14 3DP

The Close Care Home logo - Outstanding in all areas

Changes to the requirements of dysphagia diets

Back in the misty days of late 2018 I came across IDDSI (The International Dysphagia Diet Standardisation Initiative) in a NACC publication and information pack. At the time this seemed to be a kept secret and to be honest a bit of a mystery on the agenda for the course, after attending the course and gaining knowledge of IDDSI and the guidelines change we started looking at the home and how we have been producing the texture modified diets at the time.

Since my commencement to the home, we have made massive improvements to texture modified foods in the home, priding ourselves on one simple ethos, “why should texture modified food look, smell, taste any different to regular food?”

At first it was baby steps with the separation of foods by using sectioned plates. Then onto moulding the foods with silicone moulds and thickener to hold shape. We worked a process where foods were cooked, texture modified, thickened, and set in a blast freezer then regenerated on plates back up to the correct temperature. All our research, trials and development was based around the very lose and vague guidelines set out by speech and language therapist guidelines at the time.

Implementing IDDSI

IDDSI standardized this completely with new descriptions and audits to set a benchmark and guidelines definitively on what a texture modified item of food should look like, what the consistency should be, what the particle size if any should be and how it can be audited.

So, with this revelation and definitive information passed on, now it was down to individuals to work out how to achieve this. With the time of the launch of IDDSI in the UK fast approaching (as we had only been given a couple of months notice before the commencement and also informed that CQC will be now assessing on IDDSI) we needed to work on this and dedicate time to its development.

I turned to the local speech and language therapists for assistance, they said they would be implementing some of IDDSIs guidelines but not all of them. I spoke with CQC who said yes, they will be inspecting on this new format. I then spoke with the local council commissioning body who knew nothing about IDDSI at all and seemed annoyed nobody had informed them about it.

All in all very confusing and a big concern; at the time the home had just had a CQC rating of “good”, a step up from the previous rating of “requires improvement”, we couldn’t afford for the home’s reputation and the benefit of the residents to drop down due to on-compliance from a new food safety standard.

Finding a solution

At this stage I did what most people do in this day and age, hit the internet to get information. By chance and good fortune I came across The Oak House Kitchen YouTube page with Preston and James explaining clearly, concisely and, more importantly definitively in plain English, what IDDSI was and how to achieve each level of IDDSI with various food items.

This I cannot understate enough, watching this with the chefs and the management team was like the parting of the clouds in understanding what IDDSI was, how it would impact the catering in the home but far more importantly how this would improve the quality of the food and dining experience for many of our residents.

I contacted James and Preston at Oak House Kitchen and arranged for all the kitchen team and myself to attend one of the live hands-on training events they had available. The course was fantastic, well structured, well set out, clear and straightforward advice and guidance.

The Dysphagia Diets for IDDSI Course

Normally when the staff go on a course it is a chore and they forget 70% the day after, however the chefs came back enthused, motivated, and passionate about texture modified foods. This had changed the attitude in the kitchen from the area nobody really wanted to do, (it was looked down on a little if we are all honest) to an area of catering new and exciting. I believe my assessment of Preston and James as “The Morecambe and Wise of IDDSI” down to the entertaining and factually passionate interest in helping staff with IDDSI. Preston and James as Morecambe and Wise - Outstanding

Further changes at The Close Care Home

On the return to the home, I had a meeting with the MD and we agreed due to the volume of residents we have requiring IDDSI texture modification we would need an additional chef, an additional cost to the home but on looking at the fees to the residents this was less than £7 per month per resident in fee increases to cover all costs.

In addition to the live training course with Oak House Kitchen both James and Preston were always available via the website for information and guidance. We signed up all the chefs to the Online Dysphagia Diets for IDDSI Course to complete over time and found this again to be very easy to use, plain English no jargon, easy to navigate and a massive resource to the team.

Pride in our work

We converted a storeroom to an IDDSI kitchen and put a window into the kitchen so residents, family members and visitors can see what the chefs are doing and explain why they are doing it. We did not want to hide the texture modified foods we wanted to celebrate and show them to everyone. This meant for an all-encompassing dining with dignity environment for the guests and visitors to the home. Again, supported by James and Preston with any questions we had happily answered, or assistance given.

Achieving Outstanding in All Areas!

On the 16th of October 2019 we received our latest CQC inspection. The feedback on the day was fantastic with five of the inspectors each commenting on the food in the home, the standard of attention and implementation of IDDSI to the home. We received the final report on January 22nd 2020 and given the rating of outstanding in all 5 areas of assessment, the following is one of several direct notes relating to the food in the home

“The service was exemplary in keeping up to date with new developments and best practice. For example, National guidance (IDDSI) has recently been given surrounding the consistencies of food to meet specific and complex dietary requirements, for those people who have swallowing difficulties. Some people within the service required their food to be pureed which was in line with IDDSI guidance and recommendations made by professionals. The leadership team wanted to ensure that people who required pureed food still experienced the same standards and experience as everyone else.

Therefore, they employed a specific chef whose job it was to puree and re mould food to its original state. Following the initial success of the IDDSI developments, the provider decided to expand the catering team and build a purpose built IDDSI kitchen. We saw many examples of how the service had made this possible with a wide range of menu options ranging from full English breakfasts, roast dinners, cottage pies and baked beans on toast. To ensure that this truly unique way of delivering food to a standard were everyone one was equal was not just decorative, the provider had a robust quality monitoring system in place to ensure they and kitchen staff tried the food first before giving it as a choice to people. This meant that creative ways were implemented to encourage food to be as attractive as possible for people on specific diets”

Continued support for healthcare chefs

The home and kitchen teams continue to improve with further development, guidance and training with Oak House Kitchens online training portal, we run a chefs club for local surrounding care homes to share information and experiences free of charge so other homes don’t have to go through the hard learning pains we had to experience.

I asked James from Oak House Kitchen if he would mind coming along and sharing a few ideas and experience with the Chefs club in an online webinar. This evolved to be a 4-week hour long webinar free of charge given by James and Preston to help others again. True testament to Oak House Kitchen’s commitment and expertise and I truly believe to be instrumental in our achieving the highest rating in the CQC standards ultimately resulting in better lives for all our guests.

To James and Preston, we thank you and look forward to a continued long and creative friendship.

Richard Edwards

The Close Care Home and Oak House Kitchen