Why Care Homes Need a Formal IDDSI Training Programme

Successful IDDSI implementation depends on systematic training, not a single information session. Care home staff turnover is high, and kitchen and care workers do not always have formal healthcare training backgrounds. A repeatable, documented training programme is therefore the foundation of long-term consistency.

The HKCSS Care Food Endorsement Scheme requires staff training records as part of the endorsement application. A documented programme also provides essential protection when food safety incidents occur.

Note: This guide provides a practical reference framework. It does not constitute legal or clinical advice. Engage a speech-language pathologist to help tailor the programme to your home’s specific context.

Training Programme Structure

A complete care home IDDSI training programme should operate at three levels.

Level 1: Foundation Knowledge (All food-handling staff)

Audience: All chefs, kitchen assistants, care workers and nurses

Content:

• IDDSI framework overview: names, colour codes and key features of all 8 levels
• Visual identification of each level (photographs and live demonstration)
• Basic dysphagia concepts: why texture modification matters for resident safety
• Your home’s IDDSI-related policies and documentation requirements

Recommended duration: 1.5–2 hours (can be split into two 45-minute sessions to accommodate shift workers)

Delivery: Use the free IDDSI official e-Learning modules (iddsi.net/Training) as the theoretical base, supplemented by a live demonstration using your own kitchen’s actual foods

Level 2: Role-Specific Training

Chefs and kitchen staff:

• Preparation techniques for each IDDSI level (blending and sieving purées; mincing standards for Level 5)
• Types, properties and measurement of thickeners (using a digital scale)
• Fork Pressure Test: correct procedure and pass criteria
• Syringe Flow Test: applicable levels and step-by-step procedure
• Prohibited food list: identifying common high-risk ingredients
• Label system: how to apply your home’s colour-coded IDDSI labels correctly

Care workers and care assistants:

• Mealtime observation points for each IDDSI level
• Reading and verifying individual dietary records before every meal
• Warning signs during eating: choking responses, voice changes, breathing difficulty
• Documentation: how to complete the mealtime observation form
• When to notify the nurse immediately

Nurses and supervisors:

• Reading and interpreting IDDSI Dysphagia Diet Prescriptions
• Procedures for communicating and documenting level changes
• Medication effects on swallowing function
• Emergency management of choking (Heimlich manoeuvre and care home protocol)

Level 3: Competency Verification (Post-training assessment)

Chef practical verification:

1. Prepare a specified IDDSI level food while observed by the assessor
2. Correctly perform the Fork Pressure Test and interpret the result
3. Correctly weigh thickener and prepare a drink to the specified IDDSI level
4. Apply the home’s labelling system correctly

Care worker knowledge verification:

1. Written quiz (identify IDDSI level from images, 10 questions, pass mark 8/10)
2. Scenario questions: describe what action to take in a given mealtime scenario

Competency Checklist

The following standards should be met before a staff member operates independently. These can be used as internal assessment records.

Chefs / Kitchen Staff

Care Workers / Care Assistants

Texture Testing Procedures

Fork Pressure Test

Applicable levels: Level 4 (Puréed), Level 5 (Minced & Moist), Level 6 (Soft & Bite-Sized)

Steps:

1. Place a small amount (approximately one tablespoon) of food on a clean flat surface
2. Place the back of a standard dinner fork flat on top of the food
3. Apply approximately 140 g of downward pressure (roughly equivalent to the weight of a small apple; you can pre-calibrate your sense of this using a kitchen scale)
4. Observe the food’s response:
   • Level 4 (Puréed): Food flattens completely and does not spring back; no particles visible
   • Level 5 (Minced & Moist): Food compresses but does not flatten completely; individual particles are still distinguishable after the fork is removed
   • Level 6 (Soft & Bite-Sized): Food resists the pressure but can be cut through with the fork side using steady force
5. Record the test result in the kitchen texture testing log

Common errors:

• Applying pressure unevenly or with a sudden push rather than a slow, steady press
• Testing at a different temperature from what will be served (always test at serving temperature)
• Failing to record the result

Syringe Flow Test

Applicable levels: Drinks at Level 0–4

Steps:

1. Draw 10 ml of the drink into a 10 ml syringe
2. Hold the syringe vertically with the tip pointing downward and start timing 10 seconds
3. After 10 seconds, note the volume remaining in the syringe:
   • Level 0 (Thin): All 10 ml flows out within 10 seconds (0 ml remaining)
   • Level 1 (Slightly Thick): 1–4 ml remaining
   • Level 2 (Mildly Thick): 4–8 ml remaining
   • Level 3 (Moderately Thick): Flows slowly; more than 8 ml remaining
   • Level 4 (Extremely Thick): Barely flows or does not flow; most or all remaining

Notes:

• Clean and disinfect syringes after each use (autoclave-safe syringes are recommended)
• Allow hot drinks to cool to room temperature before testing (temperature affects viscosity)
• Different production batches of the same thickener brand may show slight variation; verify each new batch

Documentation Requirements

Staff Training Records

Each trained staff member should have the following on file:

• Name, role and training date
• Training content checklist with trainer signature
• Competency verification outcome (passed / needs retraining)
• Retraining date (if applicable)

Renewal training and competency re-verification is recommended annually at minimum. New staff should complete training before working unsupervised with residents.

Kitchen Texture Testing Log

Daily kitchen records should include:

• Date and meal (breakfast / lunch / dinner)
• Food type and target IDDSI level
• Fork Pressure Test result (pass / fail)
• Thickened drink consistency test result
• Any issues found and corrective action taken
• Chef’s signature

Incident and Non-Conformance Records

The following must be recorded immediately and reported per care home protocol:

• Food that failed texture testing but was served (record affected residents and follow-up actions)
• Thickener dosing error (record when discovered and corrective action)
• A resident consuming food above their prescribed IDDSI level from a care home meal

Training Resources

IDDSI Official Resources (free)

• e-Learning modules: iddsi.net/Training
• Testing cards (visual reference for Fork Pressure Test and Syringe Flow Test, printable): iddsi.net
• Multilingual framework documents including traditional Chinese

Hong Kong Resources

• HKSLTA (Hong Kong Speech and Language Therapy Association): refer SLPs experienced in care home training — hkslta.org.hk
• HKDA (Hong Kong Dysphagia Association): care home workshops — hkda.org.hk
• HKCSS Care Food Endorsement Scheme: training requirements and endorsement standards — hkcss.org.hk

Frequently Asked Questions

Q: What happens if a staff member does not pass the competency verification?

A: Staff who do not pass competency verification should not work unsupervised with resident meals until they complete supplementary training and pass re-verification. A paired arrangement — working alongside a verified senior colleague — is recommended during this period. Retraining should target the specific competency items that were not met, rather than repeating the entire programme.

Q: How often does retraining need to happen?

A: Annual renewal training for all relevant staff is recommended, covering any updates to the IDDSI framework and your home’s policies. Immediate targeted retraining should also be arranged after any food safety incident, when new IDDSI levels are introduced to the menu, or when an external audit identifies operational issues. New staff should complete initial training within two weeks of starting, working under supervision until cleared.

Q: Our home is small with only 2–3 chefs. Do we still need formal training records?

A: Yes. Care home size does not affect the documentation requirement — in practice, smaller homes often find it easier to maintain complete individual training records. The primary purposes of the records are to protect the home in the event of an adverse incident and to demonstrate compliance during HKCSS or SWD audits.

Q: Can we rely entirely on the IDDSI official online course without additional practical training?

A: The IDDSI e-Learning provides an excellent theoretical foundation but cannot fully replace practical training, particularly for chefs practising the Fork Pressure Test and thickener measurement. The recommended approach is to use the online course to build theory, followed by a half-day hands-on workshop facilitated by an SLP with care home training experience, where chefs can practise testing techniques and receive immediate feedback.

Information is updated periodically to reflect the latest clinical guidance and Hong Kong regulatory developments. For enquiries, contact [email protected].