Bellevue Nursing Home Care Home Service Adults 15 Racecourse Road Ayr KA7 2DQ Telephone:

Bellevue Nursing Home Care Home Service Adults 15 Racecourse Road Ayr KA7 2DQ Telephone: 01292 610766 Inspected by: Amanda Cross Sean McGeechan Type of inspection: Unannounced Inspection completed on: 19 July 2012

Contents Page No Summary 3 1 About the service we inspected 5 2 How we inspected this service 7 3 The inspection 10 4 Other information 21 5 Summary of grades 22 6 Inspection and grading history 22 Service provided by: Bellevue Nursing Home Service provider number: SP2003002257 Care service number: CS2003010254 Contact details for the inspector who inspected this service: Amanda Cross Telephone 01294 323920 Email enquiries@careinspectorate.com Bellevue Nursing Home, page 2 of 24

Summary This report and grades represent our assessment of the quality of the areas of performance which were examined during this inspection. Grades for this care service may change after this inspection following other regulatory activity. For example, if we have to take enforcement action to make the service improve, or if we investigate and agree with a complaint someone makes about the service. We gave the service these grades Quality of Care and Support 5 Very Good Quality of Environment 5 Very Good Quality of Staffing 5 Very Good Quality of Management and Leadership 5 Very Good What the service does well The service actively promotes engagement with residents and their relatives. Participation is evident within Bellevue with residents and families voicing how approachable the owner, manager and staff are. Through discussion and observation we saw that there are positive relationships between residents and staff and how this made significant impact on the health and well being of the resident and their family. The team at Bellevue have positive relationships with residents and their families. This creates a familiar atmosphere within the home environment. What the service could do better The careplans should be more personalised to reflect the level of care that is provided to each resident. What the service has done since the last inspection The service has updated their medication system, as was requested at the last inspection. Bellevue Nursing Home, page 3 of 24

Conclusion Inspection report continued Bellevue is a service which is responsive to meeting the needs of residents. Staff all have a detailed understanding of residents and their families which assists in the provision of good quality care. The service engages well with peoples, providing good quality care and support which is valued by residents and families alike. Who did this inspection Amanda Cross Sean McGeechan Bellevue Nursing Home, page 4 of 24

1 About the service we inspected Before 1 April 2011 this service was registered with the Care Commission. On this date the new scrutiny body, Social Care and Social Work Improvement Scotland (SCSWIS), took over the work of the Care Commission, including the registration of care services. This means that from 1 April 2011 this service continued its registration under the new body, SCISWIS. We are also known as the Care Inspectorate. Bellevue is a small family run nursing home for older people located in the town centre of Ayr and is privately owned and operated. The accommodation comprises of 12 bedrooms, 3 single and 9 shared. 9 bedrooms are en-suite. At the time of the inspection there were 21 residents. Bellevue states in its aims: Management and staff are committed to effect always a warm, welcoming, secure, loving environment for elderly residents in need of continuing care in the community. In order to achieve and maintain the values that form the basis our "where care comes first" philosophy we will aim to: *Affirm each resident as a unique individual *preserve the quality of life, dignity and independence of the resident as far as possible *Create a warm secure loving environment for residents, families and friends, giving comfort at all times *Ensure that all aspects of our service and philosophy will be related to all residents without discrimination on the grounds of race, religion. *Actively promote and maintain high standards of care and seek to enhance these through evaluation and implementation *Educate and train staff and encourage personal and professional development *Respect and inter-relate with all other disciplines and agencies to meet the need of each individual in our care. Based on the findings of this inspection this service has been awarded the following grades: Quality of Care and Support - Grade 5 - Very Good Quality of Environment - Grade 5 - Very Good Quality of Staffing - Grade 5 - Very Good Quality of Management and Leadership - Grade 5 - Very Good This report and grades represent our assessment of the quality of the areas of performance which were examined during this inspection. Bellevue Nursing Home, page 5 of 24

Grades for this care service may change following other regulatory activity. You can find the most up-to-date grades for this service by visiting our website www.careinspectorate.com or by calling us on 0845 600 9527 or visiting one of our offices. Bellevue Nursing Home, page 6 of 24

2 How we inspected this service The level of inspection we carried out In this service we carried out a low intensity inspection. We carry out these inspections when we are satisfied that services are working hard to provide consistently high standards of care. What we did during the inspection We wrote this report after an unannounced inspection that took place between 10:15 and 17:30 on 3 July and 14:00 and 15:30 on 19 July. The inspection was carried out by Care Inspectors Amanda Cross and Sean McGeechan As requested by us the service submitted an annual return and a self assessment. We took account of the 10 questionnaires returned from the 12 we sent to relatives/ friends before the unannounced inspection. During the inspection process we spoke to a number of residents and some family and friends of residents. We also gathered evidence from various sources including the relevant sections of the policies, procedures, records and other documents including: Resident files Resident Careplans Minutes of residents meetings Minutes of relatives meetings Staff and Management meeting minutes Quality Assurance System Documentation Accident and Incident records Staff rotas Insurance Certificate Certificate of Registration Previous Inspection Report Refurbishment Plan Communication systems Medication Systems and records Residency Agreements Aims and Objectives of the service Staff training records Complaints records Repairs and maintenance records Participation strategy Policies and procedures Bellevue Nursing Home, page 7 of 24

We conducted a review of the premises and observed staff interactions with residents and carers family/visitors. We also spoke with: Residents Family and friends of residents Care and nursing staff The manager The provider Grading the service against quality themes and statements We inspect and grade elements of care that we call 'quality themes'. For example, one of the quality themes we might look at is 'Quality of care and support'. Under each quality theme are 'quality statements' which describe what a service should be doing well for that theme. We grade how the service performs against the quality themes and statements. Details of what we found are in Section 3: The inspection Inspection Focus Areas (IFAs) In any year we may decide on specific aspects of care to focus on during our inspections. These are extra checks we make on top of all the normal ones we make during inspection. We do this to gather information about the quality of these aspects of care on a national basis. Where we have examined an inspection focus area we will clearly identify it under the relevant quality statement. Fire safety issues We do not regulate fire safety. Local fire and rescue services are responsible for checking services. However, where significant fire safety issues become apparent, we will alert the relevant fire and rescue services so they may consider what action to take. You can find out more about care services' responsibilities for fire safety at www.firelawscotland.org Bellevue Nursing Home, page 8 of 24

The annual return Every year all care services must complete an 'annual return' form to make sure the information we hold is up to date. We also use annual returns to decide how we will inspect the service. Annual Return Received: Yes - Electronic Comments on Self Assessment Every year all care services must complete a 'self assessment' form telling us how their service is performing. We check to make sure this assessment is accurate. The service submitted an appropriately completed self assessment within the allocated timeframe. The Self Assessment reflected the findings of this inspection. Taking the views of people using the care service into account Residents told us they liked living in Bellevue and the staff were wonderful. Comments made to us included: "I'm very happy" smiling she added "I like it here". "I'm very lucky being here" Taking carers' views into account Relatives told us they are very happy with the care and were delighted with how welcome they felt when visiting. Comments made to us included: "The management and staff at Bellevue go above and beyond what would be required from a care home... They care for us all as a family, which makes visiting so much easier, we always receive a warm welcome from all the staff." "I am extremely happy with all aspects of my mum's care in Bellevue Nursing Home. The atmosphere in the home is exceptional and this is down to the staff. They treat all the residents as individuals which is a great comfort to me. They take so much care when dressing my mum as well. I can't praise this nursing home enough and would recommend it to anyone." Bellevue Nursing Home, page 9 of 24

3 The inspection We looked at how the service performs against the following quality themes and statements. Here are the details of what we found. Quality Theme 1: Quality of Care and Support Grade awarded for this theme: 5 - Very Good Statement 1 We ensure that service users and carers participate in assessing and improving the quality of the care and support provided by the service. Service strengths The grade awarded for this Quality Statement is 5 - very good. The evidence that we sampled at this inspection maintained the grade of 5 - very good. We reached this decision after we read the participation strategy and saw evidence of how it was implemented, read residents records, and examined questionnaire returns. We also spoke with residents and families. The service provided clear evidence of frequent resident and family involvement. The service responded to requests from residents and their families for activities. An example of this involved baking heart shaped biscuits and cakes for Valentine's day. We saw photographic evidence of this through direction from residents when they recalled the activity during discussion. Residents told us how forward planning of activities is decided through resident meetings. We were told of how in May, preparation to create decorations using arts and craft activities took place to promote enjoyment of celebratory days such as the Diamond Jubilee. We saw how a white notice board in the lounge had been updated to detail activities happening within the home for that day. A menu was also contained here to inform residents of choices at mealtimes. We observed staff reinforcing what activities were available, trying to promote engagement and participation. We observed that residents were engaged in reading newspapers within the lounge area, having discussion with each other and care staff about the newsworthy events. Staff told us this promoted stimulation and reduced the risk of isolation. We reviewed several care plans and found that six monthly care reviews were being undertaken. Residents and their families/representatives attended to ensure the Bellevue Nursing Home, page 10 of 24

needs of residents continued to be met and family are involved in care planning. We read service questionnaire returns and found they were audited. We saw how this feedback was used to inform ongoing development of the home to improve the quality of service. The service is positively responsive to suggestions to promote family involvement. An example of this came through discussion with families. Skype has been introduced into the service for resident use. An example of the use of this was to allow a resident to attend a family wedding that took place abroad. Although the service has a payphone, we observed the use of mobile phones by residents. A private area is made available outwith the bedrooms, to enable residents to make calls at their leisure. Staff provided assistance to dial the number as requested. Areas for improvement The service should continue to develop methods of participation with service users and relatives/representatives to improve the quality of care and support provided by the service. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0 Inspection report continued Statement 3 We ensure that service user's health and wellbeing needs are met. Service strengths The grade awarded for this Quality Statement at the last inspection in November 2010 was 5 - Very Good. Based on the evidence provided during this inspection process, the grade has been maintained at 5 - Very Good. We reached this decision after we had spoken with the manager, provider, staff members, residents and relatives/friends during the visit. We also reviewed a number of relevant documents and records and observed practice. Each resident had an individualised careplan based on an assessment of their needs. The careplan provided the detail on how each resident's needs would be met. Health needs were identified by nursing staff through the use of a range of best practice tools which were fully completed. Where necessary, residents had access to a range of specialist NHS personnel such as the Parkinson's Nurses and Consultant, Care Home Liaison Nurse, Dietician, Bellevue Nursing Home, page 11 of 24

Chiropodist. Palliative Care/District Nurses/Hospice to provide appropriate care to residents. The manager and staff team had a clear knowledge of each resident and their family. This was demonstrated to us during discussions and observations. This facilitated positive communications between staff and residents and staff and families, promoting person centred care. We reviewed the service's arrangements for medication and found that it was well managed and regularly audited. This was to ensure that medication was administered appropriately. The service facilitated six monthly reviews with appropriate people, with feedback from relatives and attendees recorded. The outcome of reviews was used to inform ongoing development of the careplans. Family members confirmed they were invited to and had participated in the review process within the last six months. To promote continuity of care, new residents from the local area may retain their own G.P. if possible. Areas for improvement The service should review the current careplanning process. This should ensure careplans reflect the intimate knowledge staff have of each resident, and reflect the more personalised approach to care that we observed being provided. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0 Inspection report continued Bellevue Nursing Home, page 12 of 24

Quality Theme 2: Quality of Environment Grade awarded for this theme: 5 - Very Good Statement 1 We ensure that service users and carers participate in assessing and improving the quality of the environment within the service. Service strengths The grade awarded for this Quality Statement is 5 - Very Good. We reached this decision after we had spoken with the manager, the provider, residents and their families during the inspection visit. We also reviewed a number of relevant documents. We considered this statement alongside the information in statements 1.1, 3.1 and 4.1. The service provided clear evidence of resident and family involvement as stated in their participation strategy, through receiving feedback from questionnaire returns, service users and family meeting minutes and 1:1 meetings with staff and residents. Relatives told us how they hold the management in high regard and are made to feel like one of the family when they visit. They also told us of repeated consultation relating to the use of shared rooms for some residents but had no concerns on this matter. Bedrooms were observed to be individualised with décor, fabrics, items of furniture, photographs and ornaments which reflected the residents' personal choices. Residents told us of how they are involved in making decisions within the home relating to their care and lifestyle through informal chats and discussions at resident meetings. A recent outcome of discussion at a residents meeting was the purchase of a new hair washing sink from money bequeathed to the home by a former resident. Some residents who share a bedroom told us how they enjoy sharing their bedroom and the comfort and sense of purpose this can bring them. One resident told us they were "happy sharing my bedroom, I look after (resident) and make sure she is okay". Areas for improvement The service should continue to expand their methods of engagement to encourage involvement of service users and families in assessing and improving the quality of the environment within the service. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0 Bellevue Nursing Home, page 13 of 24

Statement 2 We make sure that the environment is safe and service users are protected. Service strengths The grade awarded for this Quality Statement is 5 - Very Good. Inspection report continued We reached this decision after we had spoken with the manager, provider, staff members, resident and relatives/friends. We also reviewed a number of relevant documents and records. The home had appropriate policies and procedures which are in place to support this quality statement. There were ongoing risk assessments carried out on matters of health and safety. All documentation was appropriately completed and audited to ensure the safety checks of the physical environment took place, to maintain a safe environment for residents. The service had a variety of contracts in place. These ensured that the home and its equipment were being maintained and operating as required. The service employed maintenance staff who were dedicated to undertaking general repairs around the home. These general repairs were then completed by staff who recorded this in the maintenance log book. This ensured that all reported issues were addressed in a timely manner to ensure safety. All residents had a contract of service which is signed by residents and/or family or their representative for their stay in Bellevue. At this time the service provides care only for female residents which residents and relatives told us they feel promotes dignity. The service had an ongoing refurbishment plan which was regularly reviewed and issues were prioritised to promote the safety, and reflect the changing needs of the residents. We observed housekeeping staff cleaning around the home environment in accordance with their cleaning schedule. In addition staff took time to interact with residents and receive feedback on their work. We observed staff practice and saw evidence that staff training is effective. For example we witnessed moving and handling activities which were undertaken using best practice and with due care. Residents stated they enjoyed looking out at the picturesque landscaped gardens and took pleasure in sitting in the garden during the good weather. Some residents, and staff, told us of how they assisted in the upkeep of the window boxes and took pleasure in this activity. Bellevue Nursing Home, page 14 of 24

The service had a contingency plan in place. In the event of an emergency the service could ensure the promotion of a safe environment. Areas for improvement The service should ensure that they maintain the high standard of practice undertaken to ensure the safety of service users and the environment. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0 Bellevue Nursing Home, page 15 of 24

Quality Theme 3: Quality of Staffing Grade awarded for this theme: 5 - Very Good Statement 1 We ensure that service users and carers participate in assessing and improving the quality of staffing in the service. Service Strengths The grade awarded for this Quality Statement is 5 - Very Good. We reached this decision after we had spoken with the manager, provider, staff members, resident and relatives/friends. We also reviewed a number of relevant documents and records. The strengths for this statement already include those already mentioned in Statement 1.1 and 2.1 and 4.1. Relatives told us how the familial environment within Bellevue, where their family member is cared for, felt supported by the team as much as their relative. Areas for improvement The service should continue to implement their participation strategy to involve residents and families in recruitment and appraisal processes. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0 Statement 3 We have a professional, trained and motivated workforce which operates to National Care Standards, legislation and best practice. Service strengths The grade awarded for this Quality Statement is 5 - Very Good. We reached this decision after we had spoken with the manager, provider, staff members, resident and relatives/friends. We also reviewed a number of relevant documents and records. We also observed practice. We saw evidence that staff are appropriately registered with either Nursing Midwifery Council or Scottish Social Services Council where they can be regulated and, are Bellevue Nursing Home, page 16 of 24

required to keep up to date with best practice through continuing professional development. Staff training is scheduled in advance and staff are supported and encouraged to attend. This includes both mandatory and requested training. This allowed implementation of best practice guidance to care for residents. We were told by staff and management how supervision is carried out regularly. Staff understood the formal and informal nature of supervision. Staff told us that training needs or requests are discussed during supervision to ensure skills are kept up to date with best practice. Staff also told us how training requests can often be made in response to the changing needs of residents to ensure care delivery is safe and appropriate. We spoke to staff who demonstrated a clear understanding of the needs of all residents. They spoke with due care and respect during the discussions with ideas on how they feel the service delivery could be improved to benefit the residents. We heard from residents, relatives and staff surrounding the familial environment within Bellevue where the family are supported alongside the residents. Areas for improvement The service should develop a more formalised structure for supervision recording and scheduling. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0 Inspection report continued Bellevue Nursing Home, page 17 of 24

Quality Theme 4: Quality of Management and Leadership Grade awarded for this theme: 5 - Very Good Statement 1 We ensure that service users and carers participate in assessing and improving the quality of the management and leadership of the service. Service strengths The grade awarded for this Quality Theme is 5 - Very Good. We reached this decision after we had spoken with the manager, provider, staff members, resident and relatives/friends. We also reviewed a number of relevant documents and records. The strengths for this statement already include those already mentioned in Statement 1.1, 2.1 and 3.1. The service had an effective Quality Assurance system in place. The Manager continued to seek views from residents, relatives and staff to improve service delivery. The service submitted an appropriately detailed self assessment which demonstrated clear evidence of involvement through feedback from residents, families and staff. There was clear evidence of regular and productive staff meetings with action points arising which were addressed within a set timescale. There was very good evidence of consultation with residents, family and staff. This allowed the sharing of information, promoting service improvement through formal systems such as questionnaires, review meetings and informal systems such as chats during visiting time. The manager recently completed a charity event along the West Highland Way. Prior to the manager setting off, residents had asked how they would hear of her travels. We saw how the manager had submitted a daily blog with photographs of her travels. Staff created posters of the blog, which generated discussion, to allow the residents and their families to be kept up to date as they requested. Bellevue Nursing Home, page 18 of 24

Areas for improvement The service should continue to monitor and explore the many different ways in which information is gained and provide opportunities for improving the quality of management and leadership within the service. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0 Inspection report continued Statement 4 We use quality assurance systems and processes which involve service users, carers, staff and stakeholders to assess the quality of service we provide. Service strengths The grade awarded for this Quality Theme is 5 - Very Good. We reached this decision after we had spoken with the manager, provider, staff members, resident and relatives/friends. We also reviewed a number of relevant documents and records. We also spoke with staff, residents and families and we observed practice and interactions. The manager and her team had completed a comprehensive and reflective self assessment of the service. We found that a variety of quality assurance processes and systems are used to assess and improve the quality of the service. We observed how care provided within the home was in agreement with what was stated in the aims and objectives of the service. The manager of the service is highly responsive to the needs and wishes of the residents and families/friends and actively seeks to consult with all residents, families, staff and external stakeholders. The service has an ongoing development plan which is regularly updated. We reviewed the service development plan which detailed the priorities identified by the manager(s) and the staff team. These were consistent with the ongoing development of the service and mindful of the shared accommodation. The manager actively attempted to develop further means in which to extend consultation with stakeholders. This included external health professionals involved with Bellevue, providing care to residents. This would actively allow them to recognise the importance of their input into the quality assurance systems and processes. Bellevue Nursing Home, page 19 of 24

Audits were carried out by the manager and any issues raised were addressed in a timely manner to improve practice and enhance the quality of care for residents. Residents and their families told us how the service provided at Bellevue was very good. They told us how the range of communication systems allowed issues to be brought to the attention of the management and feedback provided where applicable. This ensured people's needs were being understood and responded to. Areas for improvement The service should continue to review and assess the effectiveness of the quality assurance system and amend and upgrade as required. This should include participation from external health professionals by actively allowing them to input into the quality assurance systems and processes. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0 Bellevue Nursing Home, page 20 of 24

4 Other information Complaints No complaints have been upheld, or partially upheld, since the last inspection. Enforcements We have taken no enforcement action against this care service since the last inspection. Additional Information Action Plan Failure to submit an appropriate action plan within the required timescale, including any agreed extension, where requirements and recommendations have been made, will result in SCSWIS re-grading the Quality Statement within the Management and Leadership Theme as unsatisfactory (1). This will result in the Quality Theme for Management and Leadership being re-graded as Unsatisfactory (1). Bellevue Nursing Home, page 21 of 24

5 Summary of grades Quality of Care and Support - 5 - Very Good Statement 1 Statement 3 5 - Very Good 5 - Very Good Quality of Environment - 5 - Very Good Statement 1 Statement 2 5 - Very Good 5 - Very Good Quality of Staffing - 5 - Very Good Statement 1 Statement 3 5 - Very Good 5 - Very Good Quality of Management and Leadership - 5 - Very Good Statement 1 Statement 4 5 - Very Good 5 - Very Good 6 Inspection and grading history Date Type Gradings 24 Nov 2010 Unannounced Care and support 5 - Very Good Environment Not Assessed Staffing Not Assessed Management and Leadership Not Assessed 17 May 2010 Announced Care and support 5 - Very Good Environment Not Assessed Staffing Not Assessed Management and Leadership 5 - Very Good 12 Nov 2009 Unannounced Care and support 5 - Very Good Environment 4 - Good Staffing 4 - Good Management and Leadership 4 - Good Bellevue Nursing Home, page 22 of 24

13 May 2009 Announced Care and support 5 - Very Good Environment 4 - Good Staffing 4 - Good Management and Leadership 4 - Good 9 Dec 2008 Unannounced Care and support 5 - Very Good Environment 4 - Good Staffing 4 - Good Management and Leadership 4 - Good 27 May 2008 Announced Care and support 4 - Good Environment 4 - Good Staffing 4 - Good Management and Leadership 4 - Good All inspections and grades before 1 April 2011 are those reported by the former regulator of care services, the Care Commission. Bellevue Nursing Home, page 23 of 24

To find out more about our inspections and inspection reports Read our leaflet 'How we inspect'. You can download it from our website or ask us to send you a copy by telephoning us on 0845 600 9527. This inspection report is published by the Care Inspectorate. You can get more copies of this report and others by downloading it from our website: www.careinspectorate.com or by telephoning 0845 600 9527. Translations and alternative formats This inspection report is available in other languages and formats on request. Telephone: 0845 600 9527 Email: enquiries@careinspectorate.com Web: www.careinspectorate.com Bellevue Nursing Home, page 24 of 24