Archived: Bellevue Court

We spent time on both floors of the home where people with dementia live. We observed reactions from a group of people and observed interactions between them and staff. We saw that people seated in a lounge on the top floor, had staff seated near them. One staff member was actively supporting two people to take part in a board game. Another staff member was supporting a person with a colouring activity. Other people in the lounge were dozing in the morning although were more active in the afternoon. We saw that when they woke or looked up, staff would engage them in discussions. We saw similar interaction in the afternoon and found staff interactions to be positive.

We also spent time in the lounge on the ground floor during the morning, where we found staff to be less skilled in their interactions. One person seemed to have more interaction from staff. We saw other people were watching and looking at staff but staff said and did very little with them. We saw when each member of staff came into the room they would briefly say 'are you alright' and then walk away. We saw one person watching staff when they came into the room. Staff did not interact or say anything to this person for twenty minutes. A staff member then sat down and spoke with them. We did not see any meaningful activity. We spoke with the manager and were informed that staff that provide activities had gone out for the day with some of the people who live in the home. However, other staff should have the skills and abilities to engage positively with people and promote their social well-being. A performance from an external entertainer on the afternoon was well received by people.

In summary we saw some very good interaction that highlighted that staff have appropriate knowledge and skill, this tempered by the fact other staff were not so skilled at engaging with people living at Bellevue.

We saw an example of staff assisting to transfer a person that resulted in the use of underarm lifting, as the individual became unsteady. Whilst this was judged as a reaction by staff to prevent the person from falling to the floor it meant use of methods that can cause people damage. It also indicated that moving and handling guidance for staff in assisting this person was not robust enough to allow for their fluctuating needs. We saw staff assist other people to stand or transfer safely and observed use of appropriate equipment to ensure this was safe.

We saw that people's views were considered in care plans. These showed us some recording of people's preferences and choices, which we saw to be accurate from observation, or from what some people told us. We saw in some instances that staff did offer people choices through giving them differing options and judging their reactions.

We saw that staff are implementing appropriate care so as to ensure people are at less risk of pressure areas, with regular turns and use of equipment to prevent this. We saw and heard from people that this has resulted in positive outcomes in that intervention has led to pressure areas healing.

We have heard concerns from some professionals about people leaving the home in an unkempt state. From observation during the course of our visit most people we met were well presented and clean, with the exception of a small number that had minor food stains on their clothing.

Through observation we saw little to indicate that people are overtly restricted, with those able to, free to move around the home, or the unit they resided on. We saw that some people have more freedom to move around the home and go out unsupervised, this dependent on individual ability and safety.

We observed a staff member give people medication at lunch time. We saw they wore a 'do not disturb' tabard and transferred medication in a drugs trolley to people's living areas, making sure this was secure when away from this. We saw staff offer choice to people as to whether or not they wished to take medication such as pain killers. Staff gave reassurance and discussion took place so as to ensure people consented to their medication. We saw staff offer people drinks to take their medication. The staff member was seen to take time to check medication records so as to ensure the correct medication was given to people. We saw that medication was signed as given at the point of administration. Care was taken to avoid handling medication through use of plastic cups with tablets popped from blister packs straight into these.

We observed the communication between staff in respect of the need to administer medication later, when a person expressed the choice not to have it at that time.

We spoke with the manager about whether the home uses a formal approach to help measure the quality of the experiences of people who have dementia. This would allow their experiences at the home to be measured, when they are not able to easily express their views. The manager was not aware of this taking place, but told us they intend to undertake additional training in supporting people with dementia, which should equip them with further skills to monitor the quality and experiences of all people living at the home.