Bellevue Nursing Home Care Home Service Adults 15 Racecourse Road Ayr KA7 2DQ Telephone: 01292 610766 Type of inspection: Unannounced Inspection completed on: 28 April 2015
Contents Page No Summary 3 1 About the service we inspected 5 2 How we inspected this service 7 3 The inspection 14 4 Other information 32 5 Summary of grades 33 6 Inspection and grading history 33 Service provided by: Bellevue Nursing Home Service provider number: SP2003002257 Care service number: CS2003010254 If you wish to contact the Care Inspectorate about this inspection report, please call us on 0345 600 9527 or email us at enquiries@careinspectorate.com Bellevue Nursing Home, page 2 of 35
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 4 Good Quality of Staffing 5 Very Good Quality of Management and Leadership 5 Very Good What the service does well Staff were welcoming and friendly and we observed residents to be well cared for. There was good provision of meaningful activities including opportunities to maintain connections with the wider community. Overall, residents and relatives told us that they were very happy with the quality of care and support provided at this home. What the service could do better Systems to improve how feedback is shared should be reviewed. Recording and information systems such as care plans and action plans from meetings should reflect the outcomes desired and how these are to be achieved. The service was operating to a high standard with the providers and management aware that areas of the environment require attention. A planned refurbishment was scheduled and is on-going. We identified areas to the manager where more improvements could be made to the environment. What the service has done since the last inspection The service has continued to develop the high standards identified at the last inspection. Bellevue Nursing Home, page 3 of 35
Conclusion Inspection report continued The service has continued to build on the high standards identified at the last inspection. Bellevue continued to be responsive to meeting the needs of residents. This is evidenced through the investment in on-going consultation with residents and carers and staff training. The service continued to provide very good individualised support which was monitored through effective quality assurance systems. We were satisfied that the care home was being managed well, and that residents were being well cared for. Bellevue Nursing Home, page 4 of 35
1 About the service we inspected The Care Inspectorate regulates care services in Scotland. Information about all care services is available on our website at www.careinspectorate.com This service was previously registered with the Care Commission and transferred its registration to the Care Inspectorate on 1 April 2011. 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 twelve bedrooms, three single and nine shared; nine bedrooms are en-suite. At the time of the inspection there were seventeen 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. Recommendations A recommendation is a statement that sets out actions that a care service provider should take to improve or develop the quality of the service, but where failure to do so would not directly result in enforcement. Recommendations are based on the National Care Standards, SSSC codes of practice and recognised good practice. These must also be outcomes-based and if the provider meets the recommendation this would improve outcomes for people receiving the service. Bellevue Nursing Home, page 5 of 35
Requirements A requirement is a statement which sets out what a care service must do to improve outcomes for people who use services and must be linked to a breach in the Act, its regulations, or orders made under the Act, or a condition of registration. Requirements are enforceable in law. We make requirements where (a) there is evidence of poor outcomes for people using the service or (b) there is the potential for poor outcomes which would affect people's health, safety or welfare. 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 4 - 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. 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 0345 600 9527 or visiting one of our offices. Bellevue Nursing Home, page 6 of 35
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 following an unannounced inspection. This was carried out by one inspector. The inspection took place on 23 April from 11.15am until 3pm, 27 April from 9.40am until 7pm and on 28 April from 3pm until 5.30pm. As part of the inspection, we took account of the completed annual return and self assessment forms that we ask the provider to complete and submit to us. We sent care standards questionnaires to the manager to distribute to residents. We did not receive any questionnaire returns from residents. We also sent twenty-five care standards questionnaires to distribute to relatives and carers. Relatives and carers returned twelve completed questionnaires before the inspection. We also asked the manager to give out twenty questionnaires to staff and we received nine completed questionnaires. During this inspection process, we gathered evidence from various sources, including the following: We spoke with: - 14 residents - 4 carers - nursing and care staff - maintenance person - the manager - administrator - provider We looked at: - service user guide/ brochure - a sample of personal plans and review records of people who use the service - risk assessments Bellevue Nursing Home, page 7 of 35
- information about how the service involves people - the complaints procedure and records - staff training records - staff meeting minutes - staff rotas - activity records and photographic evidence of activities/events taking place - medication records - maintenance records - accident/incident records - quality assurance information, for example what the service does to check things are working well - the registration and insurance certificates - policies and procedures including recruitment, supervision, adult support and protection - observed how staff worked - observed the environment and equipment We used the Short Observational Framework for Inspection (SOFI2) to directly observe the experience and outcomes for people who were unable to tell us their views. 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 35
What the service has done to meet any requirements we made at our last inspection The requirement 1) The provider should implement an action plan detailing how the care service intends to comply with National Care Standards in respect of offering all service users a single bedroom and restricting shared occupancy to situations of positive choice and expressed consent. This action plan should outline how privacy and dignity are promoted within a shared context. This is to comply with: SSI 2010/210 Regulation 4(1)(b) a regulation that requires provider to provide services in a manner which respects the privacy and dignity of service users. This also takes into account the National Care Standards for Older people: Standard 4 - Your environment. Timescale for compliance: Within six months of receipt of this report. What the service did to meet the requirement The provider had sought advice from planning and architects on how to improve the shared occupancy situation within the home. Whilst this situation remains on-going, discussions are regularly facilitated during the six monthly review process between residents, families and the management re the signed shared rooms agreement. Documented evidence demonstrates outcomes of discussions and signed consent on continuation of shared bedrooms or requests for the first available single bedroom to be made available as requested. General feedback from families indicates they have accepted the shared bedrooms and feel their relative benefits from the company of another resident. This requirement is: MET The requirement is: Met - Within Timescales What the service has done to meet any recommendations we made at our last inspection Action taken on outstanding recommendations: Bellevue Nursing Home, page 9 of 35
1) Information and communication should be provided to residents in a format that is appropriate for their needs. Action taken We saw how the participation strategy had been reviewed and was being implemented. This had become a bit more outcome focussed yet lacked clear direction on how stakeholders would be involved and how feedback would be provided on improvements made as a result of feedback. There had been some improvement in the use of pictures and text sizes to support residents understanding written documentation. However, consideration should be given to providing support for residents with other sensory impairments to improve their quality of life. An example could be use of a loop system for residents with a hearing impairment. This recommendation is: NOT MET 2) The service should keep up to date records of medications administered, ordered, taken or not taken and disposed of. Accurate records of reason for administration or refusal should be detailed on the back of the Medication Administration Record (MAR). Action taken: Improvements on completion of information recorded on the MAR charts were evident. There was monitoring of stock balances, recording of reason for use of medications and improvements in use of protocols for when to administer as required medications. This recommendation is: MET 3) Service users should be regularly consulted about their environment in a meaningful way which promotes their rights to choice, privacy and dignity and enhances their quality of life. Action taken: Discussion at service user meetings and during six monthly reviews enables residents to be consulted in making decisions about their physical environment. Whilst here is limited space available within the home where families or visitors can speak privately with their relative, families make effective use of the space available. At present, the choice is restricted to resident bedrooms or the conservatory. Bellevue Nursing Home, page 10 of 35
There are a limited number of individual bedrooms available within Bellevue. This has had an impact on the availability of private space for residents to meet with visitors. However, the provider has actively been seeking advice from appropriate authorities on how space can be created within the home to make private space more available. This recommendation is: NOT MET 4) The provider should implement an action plan detailing how the care service intends to comply with National Care Standards in respect of offering all service users a single bedroom and restricting shared occupancy to situations of positive choice and expressed consent. Action taken The provider had sought advice from planning and architects on how to improve the shared occupancy situation within the home. Whilst this situation remains on-going, discussions are regularly facilitated during the six monthly review process between residents, families and the management re the signed shared rooms agreement. Documented evidence demonstrates outcomes of discussions and signed consent on continuation of shared bedrooms or requests for the first available single bedroom to be made available as requested. General feedback from families is they have accepted the shared bedrooms and feel their relative benefits from the company of another resident. This recommendation was linked with a requirement. The requirement is met but the recommendation will be repeated for monitoring on progress of the development towards increasing single rooms and increasing available space. This recommendation is: NOT MET 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 Bellevue Nursing Home, page 11 of 35
Comments on Self Assessment Inspection report continued 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. We received a fully completed self assessment which supported some of the findings of this inspection. Taking the views of people using the care service into account Residents were observed to be responsive and welcoming to interaction with staff. Residents who were able told us they enjoyed living in the home and staff looked after them. Taking carers' views into account Carers were complimentary about the service provided by Bellevue staff and management. Comments included: "Our relative has been resident within Bellevue for (several) years. We have been absolutely delighted with the quality of care delivered during this time. Staff and management are very efficient yet sensitive to all their ladies needs. Our family enjoy a high level of contentment in the knowledge that mum is safe and secure within the Bellevue environment". "The Bellevue has a great balance of care, friendliness and professionalism". "Totally satisfied with choice of home. Owner and family are excellent". "I have experience (sadly) of visiting other care homes in (other areas) and obviously before we looked at others in Prestwick and Ayr. I have never come across a more homely, welcoming care home as Bellevue is. It stands a mile above every other one I know, run by a lovely family and ALL staff have been hand-picked for their 'niceness and caring'. There is absolutely nothing to fault it and if you have a better one in your whole area you are very, very lucky as I could write a book about the ones I know!!! so I was over the moon to find Bellevue". "My relative has been resident at Bellevue for (several) years and during the time, my family and I have always been confident and relaxed about the superb care she receives. I don't believe any Nursing Home is absolutely perfect but Bellevue is the closest to perfect we could find". Bellevue Nursing Home, page 12 of 35
"This home has a warm, friendly and happy atmosphere and is also quietly efficient at all times. i.e I mean weekends as well as during the week". "My relative is very happy in Bellevue. Any time we have her out for the day, she is very happy to return as she classes Bellevue as home". "... If it hadn't been for the wonderful care and support of everyone in Bellevue, we know for a fact that our amazing relative would not be with us today...". Bellevue Nursing Home, page 13 of 35
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 statement during the previous inspection was 5 - Very Good. The evidence that we sampled at this inspection maintained the grade of 5 - Very Good. The involvement/participation strategy of the service was implemented to ensure feedback is sought from residents and relatives. Recent involvement feedback led to the choice of new carpeting within the entrance area of Bellevue. Involvement of residents and carers was embedded within the culture of this service. Residents and carers were routinely consulted and involved in assessing and improving the quality of the service provided. Photos of organised events and outings were on display throughout the home. As the boards were updated, photos were placed in the record of activities book, which was used as a basis for reflection with residents. Appropriate consent allowed the display of the pictures. An example of how feedback was obtained from residents and relatives was through meetings. This information was used to plan changes in the service and improvements in areas such as the activity schedules for residents, which relate to their choices, wishes and preferences. Volunteers led on activities, with staff providing additional support. Themed taster sessions to facilitate residents trying new meals had been positive. New menus had been devised on the feedback as a result of these events. Bellevue Nursing Home, page 14 of 35
To promote positive mental health, coordination, agility and mobility for residents, exercise routines were demonstrated by staff who took part to encourage to residents to take part. Six monthly reviews of plans of care and service provision were completed, to ensure residents received appropriate and relevant care. As part of encouraging residents to fulfil their rights as citizens, support was given to residents to use their vote in the General Election through postal votes. To promote inclusion in society, celebrations were held within the home for national events such as Burns Day and Easter. Personal celebrations such as resident birthdays were honoured with home made cake and special meals which family were invited to attend. As the management promoted an open door policy, this supported the complaints/ compliments/ suggestions procedure was implemented with all concerns immediately addressed. Complaints procedure documentation was prominently displayed with contact details of people to whom complaints or concerns could be raised. The service had not had any formal complaints. A good range of information was available throughout the home to keep residents and relatives informed about the service provided. This included DVD information about best practice in care and information about advocacy. The advocacy service was available to support individual residents within the home. Spiritual needs of residents were supported through attendance at church services. Visits were made by local clergy of all denominations as relevant to residents. Keyworkers encouraged residents to identify a wish they would like to make which would make their life better. This wish was then hung on the wish tree which had a timeframe for this wish to come true for each individual resident. An example relates to contact with younger family members where the use of Skype was facilitated to enable contact to be initiated and maintained. Areas for improvement A recommendation was made during the previous inspection which stated: Information and communication should be provided to residents in a format that is appropriate for their needs. Action taken Bellevue Nursing Home, page 15 of 35
We saw how the participation strategy had been reviewed and was being implemented. This had become a bit more outcome focussed yet lacked clear direction on how stakeholders would be involved and how feedback would be provided on improvements made as a result of feedback. There had been some improvement in the use of pictures and text sizes to support residents understanding written documentation. However, consideration should be given to providing support for residents with other sensory impairments to improve their quality of life. An example could be use of a loop system for residents with a hearing impairment. This recommendation is NOT MET (See Recommendation 1 of this Quality Statement) Whilst each residents had an identified keyworker, this role had not been fully developed to allow responsibility of carers to undertake the link coordinating role which supports the named nurses. (See Recommendation 2 of this Quality Statement) To allow follow up and reflect on outcomes from meetings, consideration should be given to how the meetings are advertised and the information content of discussions are recorded. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 2 Recommendations Inspection report continued 1. Information and communication should be provided to residents in a format that is appropriate for their needs. National Care Standards Older People, standard 18: Staying in touch 2. Development of the keyworker role should be undertaken. This would utilise the skills and knowledge of staff to support improvement of information contained within the care plans, to direct how care is provided in accordance with resident needs and wishes. National Care Standards Care Homes for Older People, Standard 5, Management and staffing arrangements Bellevue Nursing Home, page 16 of 35
Statement 7 Not applicable Statement 8 Living with life limiting conditions is viewed as an integral part of life in this care home. Service strengths The evidence we sampled during this inspection awarded the grade of 5 - Very Good. A recommendation was made during the previous inspection under Quality Theme 1 Statement 3 but is relevant to this quality statement which stated: The service should keep up to date records of medications administered, ordered, taken or not taken and disposed of. Accurate records of reason for administration or refusal should be detailed on the back of the Medication Administration Record (MAR). Action taken: Improvements on completion of information recorded on the MAR charts were evident. There was monitoring of stock balances, recording of reason for use of medications and improvements in use of protocols for when to administer as required medications. This recommendation is: MET Medication was prescribed in accordance with appropriate treatment for each resident as detailed within their anticipatory care plan. Anticipatory care plans were being implemented within the service using their own devised documentation. These documents included and reflected the wishes of the resident including treatment options and funeral arrangements. The use of Do Not Resuscitate orders, adults with incapacity certificates and any power of attorney or guardianship orders which identified who was eligible to make decisions relating to the care of each resident was detailed within the care plan to minimise distress by having clear direction on actions to be taken. A policy on death and dying reflected best practice guidance. This was reviewed by the manager to ensure appropriate information provided guidance for staff in meeting the needs of residents. Bellevue Nursing Home, page 17 of 35
Links were in place with the hospice for support and guidance to staff when caring for residents through end of life care. Multidisciplinary teams visited the home where required to provide support and direction to the nursing staff and care staff within the home. These professionals included GPS and district nurses. Staff had all received training in palliative care to ensure they had appropriate knowledge from which to provide supports to residents and their families. This included understanding the National Care Standards and the person centred approach which was extended to entire families to embrace the resident. We spoke with bereaved families who continued to visit the service who spoke very highly of their experience when their loved one received end of life care. Families told us the support they received was appropriate and appreciated. They felt able to trust the staff team as they were kept fully involved in the process of care for their relative. Whilst families were accommodated to stay in the home to spend time with their relative, one comment stated "They took care of everything. They fed me and looked after me as well as my relative. I did not have to do anything except be a family member who was having to say goodbye. I thank them for that". Information was provided to relatives on support groups within their local area if they felt they wanted to attend. Clergy from different faiths were contacted to provide spiritual support, where requested to residents and relatives, in accordance with their beliefs. Staff received support and supervision from the provider and manager to allow them to discuss their thoughts and feelings surrounding the passing of a resident. Areas for improvement The management should continue to develop staff in the provision of palliative care. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0 Inspection report continued Bellevue Nursing Home, page 18 of 35
Quality Theme 2: Quality of Environment Grade awarded for this theme: 4 - Good Statement 3 The environment allows service users to have as positive a quality of life as possible. Service strengths The evidence we sampled during this inspection achieved the grade of 4 - Good. Residents were involved in providing feedback on all aspects of life within Bellevue through the implementation of the participation strategy. This incorporates effective use of meetings, reviews and general discussions as systems through which to be able to feed back. Activities were discussed with a schedule being devised to consider the varied needs and wishes of residents. This allows residents to try new opportunities to broaden their experiences within the care home. An open door policy supported families to visit where relationships were successfully maintained with their relative. The physical environment was supported by the maintenance man and housekeeping staff who worked hard to promote good infection control practices through good cleaning and general safety. This included a secure garden area. Risk assessments were in place with daily environmental checks to promote a safe environment and protect the residents. Personal risk assessments enabled appropriate supports to be provided to individual residents to be involved in activities and outings as they wished. A combination of internal and external activities were facilitated for residents to promote community involvement. External activities included outings to the theatre, out for coffee/lunch and to garden centres. Internal activities included entertainers, games, knitting and craft events. To support resident freedom to move around the environment, the use of SMART technology alerted staff when assistance may be required for a resident. An example of this relates to the use of infra-red light beams which were used over night if a resident arose from their bed. Bellevue Nursing Home, page 19 of 35
Six monthly reviews were held as an opportunity to review the care and general service provision, whilst identifying positives and areas for improvement. Within resident bedrooms there was good evidence of some personal effects to promote a more homely feel. Areas for improvement Two recommendations were made during the previous inspection under Quality Theme 2 Statement 2 which stated: 1) Service users should be regularly consulted about their environment in a meaningful way which promotes their rights to choice, privacy and dignity and enhances their quality of life. Action taken: Discussion at service user meetings and during six monthly reviews enables residents to be consulted in making decisions about their physical environment. Whilst here is limited space available within the home where families or visitors can speak privately with their relative, families make effective use of the space available. At present, the choice is restricted to resident bedrooms or the conservatory. There are a limited number of individual bedrooms available within Bellevue. This has had an impact on the availability of private space for residents to meet with visitors. However, the provider has actively been seeking advice from appropriate authorities on how space can be created within the home to make private space more available. (See Recommendation 1 of this Quality Statement) This recommendation is: NOT MET 2) The provider should implement an action plan detailing how the care service intends to comply with National Care Standards in respect of offering all service users a single bedroom and restricting shared occupancy to situations of positive choice and expressed consent. Action taken: The provider had sought advice from planning and architects on how to improve the shared occupancy situation within the home. Whilst this situation remains on-going, discussions are regularly facilitated during the six monthly review process between residents, families and the management re the signed shared rooms agreement. Documented evidence demonstrates outcomes of discussions and signed consent on Bellevue Nursing Home, page 20 of 35
continuation of shared bedrooms or requests for the first available single bedroom to be made available as requested. General feedback from families is they have accepted the shared bedrooms and feel their relative benefits from the company of another resident. This recommendation will be repeated for monitoring on progress of the development towards increasing single rooms and increasing available space. This recommendation is: NOT MET (See recommendation 2 of this Quality Statement) Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 2 Recommendations 1. Service users should be regularly consulted about their environment in a meaningful way which promotes their rights to choice, privacy and dignity and enhances their quality of life. National Care Standard for Older People - 4 - Your Environment. Inspection report continued 2. The provider should continue to progress the action plan to comply with National Care Standards in respect of offering all service users a single bedroom and restricting shared occupancy to situations of positive choice and expressed consent. National Care Standards for Older People: Standard 4 - Your Environment. Bellevue Nursing Home, page 21 of 35
Statement 4 The accommodation we provide ensures that the privacy of service users is respected. Service strengths The evidence sampled during this inspection provided the grade of 4 - Good. A requirement was made during the previous inspection which stated: The provider must implement an action plan detailing how the care service intends to comply with National Care Standards in respect of offering all service users a single bedroom and restricting shared occupancy to situations of positive choice and expressed consent. Action taken: The provider had sought advice from planning and architects on how to improve the shared occupancy in relation to shared bedroom accommodation within the home. Whilst this situation remains on-going, discussions are regularly facilitated during the six monthly review process between residents, families and the management re the signed shared rooms agreement. Documented evidence demonstrates outcomes of discussions and signed consent on continuation of shared bedrooms or requests for the first available single bedroom to be made available as requested. General feedback from families is they have accepted the shared bedrooms and feel their relative benefits from the company of another resident. This requirement is: MET Despite this requirement being met, there is monitoring of development of the environment under Quality Theme 2, Statement 3. (See Recommendation 2 of Quality Theme 2 Statement 3) Use of SMART technology to alert staff to respond to resident movement within bedroom areas overnight promoted dignity and safety of residents. Resident laundry was washed and returned to wardrobes by the laundry assistant to who used the labels to identify clothing of individual residents. A written agreement was signed by residents or relatives which identified the level of service they could expect to receive within Bellevue. Bellevue Nursing Home, page 22 of 35
To promote the safety of residents, the maintenance man conducted physical environmental checks and any relevant electrical items of residents. Staff rotas ensured appropriate deployment staff on duty to attend to the needs of residents in a dignified manner, respecting each person whether within a group or on an individual basis. Residents and relatives were involved in discussions to make changes to the environment, including introduction of dementia friendly signage with their feedback considered in a development. Use of pressure mats and sensor beams within bedrooms promoted the privacy and dignity of residents whilst supporting monitoring of their safety. Wheelchair access to access Bellevue and also within the home via the lift, ensures residents are able to access different areas inside the home and the secure, landscaped garden area as they choose. Areas for improvement Whilst privacy screens were used within the shared bedrooms to promote the privacy and dignity of residents, these could be refurbished to ensure appropriate and dementia friendly cover protection. We saw how the provider had been actively seeking ideas on how to improve the premises in accordance with the National Care Standards guidance for residents.the provider should continue to proactively consider alternatives to improving the shared accommodation which could enhance the privacy and dignity of residents. Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 0 Bellevue Nursing Home, page 23 of 35
Quality Theme 3: Quality of Staffing Grade awarded for this theme: 5 - Very Good Statement 2 We are confident that our staff have been recruited, and inducted, in a safe and robust manner to protect service users and staff. Service strengths The evidence we sampled during this inspection provided the grade of 5 - Very Good. The policy within the service was reflective of the contents in the guidance as detailed within the Scottish Executive document "Safer Recruitment through Better Recruitment". Two references were obtained and verified to ensure appropriate organisational references were sought. One reference was form a previous employer to ascertain previous working practices and attitude. The PVG (Protection of Vulnerable Groups) certificate which replaced Disclosure Scotland, was obtained to highlight any issues with risk to promote the safety of residents. An induction checklist was implemented to support new staff working within the service to care for residents. New staff received probationary assessments to determine their level of competence in their role before being confirmed in position. Checks were made with relevant professional bodies such as Nursing and Midwifery Council or Scottish Social Services Council to ensure they are appropriately registered to be able to work with vulnerable residents. Policies and procedures were in situ to guide and direct staff including adult and child protection policies which are discussed through induction and at staff meetings. Staff are interviewed with use of competency based questions which provided the manager some insight into how staff had performed in previous roles but also their value base to allow assessment of their suitability to work in Bellevue. Residents and families had been requested to take part in the interview process however, they felt the formal procedure should be undertaken by the manager. The Bellevue Nursing Home, page 24 of 35
interviewer observed interaction between the prospective employee and residents as part of the interview process. Areas for improvement Whilst we saw how the interview process was conducted, the provider should consider how a more structured record of the interview could be recorded. Storage of information relating to recruitment was securely stored although not within the staff personnel file. Consideration should be given to review how this information is stored. The recording structure for reviewing staff as part of the probationary assessment was inconsistent. The provider should introduce a more formalised procedure to ensure his process is completed to allow evidence of practice to be monitored with review of progress. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0 Inspection report continued Bellevue Nursing Home, page 25 of 35
Statement 4 We ensure that everyone working in the service has an ethos of respect towards service users and each other. Service strengths The evidence we sampled during this inspection provided the grade of 5 - Very Good. The management regularly reviewed their involvement strategy to ensure it continued to meet the changing needs of residents and relatives. This review included development of methods including staff training on sensory impairment which allowed resident communications to be supported. We observed practice which demonstrated staff had a good understanding of the National Care Standards which ensured the residents received appropriate, individualised care. Examples relate to assistance being provided at mealtimes, with all residents being involved in a positive mealtime experience. Interactions between residents and staff were respectful but playful. Residents responded warmly to staff who demonstrated a good understanding of any communication difficulties that may be evident and provided responses which indicated their knowledge of residents and how to meet their expressed need. Families spoke with high regard of staff, their knowledge and professionalism in all interactions. A robust training plan supported staff to have appropriate knowledge in best practice guidance and this supported them in the assistance they provided in their role. Staff received supervision on a 1:1 basis with the manager where discussion took place on their role and training needs were identified to ensure the needs of residents would be met. Communications between staff were supported through team meetings which recorded discussions and actions to be taken. Codes of conduct for care staff through the Scottish Social Services Council were discussed during the meetings to ensure staff were aware of boundaries and expectations of their role. Discussions between staff in relation to the needs of residents were facilitated in an appropriate environment, not in front of other residents. This ensured all staff were aware of resident needs and the privacy of residents was promoted. Bellevue Nursing Home, page 26 of 35
Areas for improvement Whilst we saw that supervision took place in accordance with organisational policy, the manager should consider how more effective reflective practice could identify areas for improvement. This could identify more specific training needs for individual staff and share positive elements of practice. (See Recommendation 1 of this Quality Statement) Staff had a range of skills which could enable them to undertake an increased role and more effectively support the nursing role within the service. This could be considered in the form of health champions e.g continence, oral health for which staff have received specific training and have an area of interest. (See Recommendation 2 of this Quality Statement) Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 2 Recommendations Inspection report continued 1. Supervision should be used more as a developmental tool with reflective practice to enhance staff skills through identification of training opportunities. National Care Standards Care Homes for Older People, Standard 5: Management and Staffing arrangements 2. The provider should consider how the use of health champions to further improve the outcomes for residents through staff having more detailed understanding of areas of health. National Care Standards Care Homes for Older People, Standard 5: Management and Staffing arrangements Bellevue Nursing Home, page 27 of 35
Quality Theme 4: Quality of Management and Leadership Grade awarded for this theme: 5 - Very Good Statement 2 We involve our workforce in determining the direction and future objectives of the service. Service strengths The evidence we sampled during this inspection provided the grade of 5 - Very Good. Information was freely shared at all times informally between management and staff. To ensure all staff received the same information consistently and could discuss new ideas and influence how care is delivered to residents, formal staff meetings were facilitated. Information was freely shared at all times informally An open door policy is promoted by the provider and management where staff report they feel comfortable to discuss any issues or concerns with the management, leading to opportunities for change. We observed effective open communication which supported residents to receive appropriate care in accordance with changes to their health or wellbeing. Staff spoke with respect to residents and visitors where they received a warm response. All staff receive supervision and an annual appraisal to provide support and identify development opportunities to improve their practice. Feedback was also obtained from staff through questionnaires and discussions on a daily basis. Staff report they feel the manager provided effective leadership through demonstrating expectations on the level of care residents should receive by working alongside staff. Ongoing training for staff included both mandatory training which was updated annually and opportunities to attend external courses where staff could develop their areas of interest. Information on training courses and conferences were discussed during meeting and through the staff notice board. Staff described they all worked to achieve the aims and objectives of Bellevue in providing appropriate care and support to residents. Staff state that residents are at the heart of Bellevue and that their value base. Bellevue Nursing Home, page 28 of 35
Areas for improvement Whilst there were informal discussions which took place to inform staff of changes within the service, consideration should be given to how a record of these discussions could be recorded. This would allow monitoring of implementation of significant changes. Staff meetings were scheduled where staff received and shared appropriate information. However, there were times when informal discussions shared information which meant not all staff received in the same manner. The management should review the frequency of staff meetings to ensure consistency in the approach to information sharing. There was an understanding between the staff team on how the service developed with the changing needs of residents and within the changing landscape of social care. This could be reflected in a written development strategy for the service to allow progress to me measured. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 1 Recommendations Inspection report continued 1. A written development strategy would provide guidance to stakeholders in how the service plans to continue to respond to internal and external demands to meet the needs of residents. National Care Standards for Older People, Standard 5: Management and staffing arrangements. Bellevue Nursing Home, page 29 of 35
Statement 3 To encourage good quality care, we promote leadership values throughout the workforce. Service strengths The evidence we sampled during this inspection provided the grade of 5 - Very Good. All staff had actively achieved or had applied to register with Nursing and Midwifery Council (NMC) or Scottish Social Services Council (SSSC) which is the regulatory body for care staff. This registration promoted accountability of staff in relation to upholding good standard of care. Staff support was provided through scheduled supervision and development opportunities identified through appraisal. This development regularly related to changes within the needs of residents where staff received training to meet their needs. Questionnaires were completed by staff to obtain feedback on their thoughts of the service with further discussion opportunities available during staff meetings. A range of training was available which staff attended to ensure they are appropriately skilled to their job role in meeting the needs of residents. Staff meetings and informal discussions ensured all staff were clear in their understanding of the ethos of respect and expectations of care to be provided at Bellevue. Although staff were deployed within the service promote the needs of residents, any changes were readily supported by the flexibility of the staff team. Staff stated they were at work to mae sure the health and wellbeing of residents were attended to. One staff member commented: "I really enjoy working at Bellevue and am given training opportunities on a regular basis and sometimes contribute to menus and dietary requirements. I interact with all the staff on a regular basis and I keep up to date with any new legislation that has been brought in... the (line manager) shows me new skills or helps me update my skill set... ". Bellevue Nursing Home, page 30 of 35
Areas for improvement As discussed in Quality Theme 1 Statement 1, the role of the keyworker should be developed to improve personal outcomes for each resident and allow staff to demonstrate their skill base more effectively. Whilst nursing staff have clearly identified role as named nurse, care staff have received significant training which could be more fully utilised. Consideration should be given to the development of health champion roles which could be supported by named nurses in meeting the needs of all residents. As described in Quality Theme 4 Statement 2, a more formal development strategy could be more introduced and reviewed to facilitate discussion and involvement of the staff team and other stakeholders. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0 Inspection report continued Bellevue Nursing Home, page 31 of 35
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 the Care Inspectorate re-grading a Quality Statement within the Quality of Management and Leadership Theme (or for childminders, Quality of Staffing Theme) as unsatisfactory (1). This will result in the Quality Theme being re-graded as unsatisfactory (1). Bellevue Nursing Home, page 32 of 35
5 Summary of grades Quality of Care and Support - 5 - Very Good Statement 1 Statement 8 5 - Very Good 5 - Very Good Quality of Environment - 4 - Good Statement 3 Statement 4 4 - Good 4 - Good Quality of Staffing - 5 - Very Good Statement 2 Statement 4 5 - Very Good 5 - Very Good Quality of Management and Leadership - 5 - Very Good Statement 2 Statement 3 5 - Very Good 5 - Very Good 6 Inspection and grading history Date Type Gradings 2 May 2014 Unannounced Care and support 5 - Very Good Environment 4 - Good Staffing 5 - Very Good Management and Leadership 5 - Very Good 25 Jun 2013 Unannounced Care and support 5 - Very Good Environment 4 - Good Staffing 5 - Very Good Management and Leadership 5 - Very Good 19 Jul 2012 Unannounced Care and support 5 - Very Good Environment 5 - Very Good Staffing 5 - Very Good Management and Leadership 5 - Very Good Bellevue Nursing Home, page 33 of 35