Care service inspection report

Transcription

1 Care service inspection report Full inspection Carolton Care Care Home Service 53 Seabank Road Nairn Inspection completed on 05 May 2016

2 Service provided by: Carolton Care Ltd Service provider number: SP Care service number: CS Inspection Visit Type: Unannounced Care services in Scotland cannot operate unless they are registered with the Care Inspectorate. We inspect, award grades and set out improvements that must be made. We also investigate complaints about care services and take action when things aren't good enough. Please get in touch with us if you would like more information or have any concerns about a care service. Contact Us Care Inspectorate Compass House 11 Riverside Drive Dundee DD1 4NY enquiries@careinspectorate.com page 2 of 30

3 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 4 Quality of environment Quality of staffing Quality of management and leadership 4 Good N/A N/A Good What the service does well Carolton Care is a care home for older people, which stands in pleasant grounds in the town of Nairn. The home provides a pleasant, comfortable environment for people who live there. The provider, management and staff continue to look for ways to encourage people who use the service to give their views and be involved in the service. Service users spoke positively about the quality of service they received at Carolton Care. The service manager and staff were approachable and continued to show a commitment to making improvements to the service. What the service could do better Work needs to continue on care plans to ensure that they are all a current reflection of service users health and wellbeing needs. See Quality Theme 1, Statement 3. page 3 of 30

4 Care documentation for example pressure care management records need to be accurately and consistently kept by staff. See Quality Theme 1, Statement 3. Training for staff needs to continue to enable staff to progress and take leadership roles in the home. See Quality Theme 4, Statement 4. Work needs to continue to ensure that systems and processes in place for quality assurance are effective in bringing about improvements to the service. See Quality Theme 4, Statement 4. What the service has done since the last inspection Management had carried out a review of the service policies and procedures since the last inspection. See Quality Theme 4, Statement 3 and Quality Theme 4, Statement 4. Improvements were noted in some of the care documentation. See Quality Theme 1, Statement 3. Some improvements were noted in the medication system. See Quality Theme 1, Statement 3. Hand rails had been fitted to areas of the home where this had been highlighted as necessary. See Quality Theme 1, Statement 3. Conclusion Carolton Care is located in pleasant grounds in Nairn. The provider/manager and staff at Carolton Care continue to show a commitment to improving the service and to providing a good standard of care for all who use the service. page 4 of 30

5 1 About the service we inspected Inspection report The Care Inspectorate regulates care services in Scotland. Information about all care services is available on our website at This service was previously registered with the Care Commission and transferred its registration to the Care Inspectorate on 1 April Carolton Care is a care home for up to 20 older people. The provider is Carolton Care, which also owns Bruach House, a similar sized care home in Nairn. The owner is also the manager of the two homes, supported by an assistant manager. Carolton Care operates from a large, two storey Victorian house, which has been extended and modernised though retains some period features. It is situated in a quiet residential area, close to the town centre of Nairn. There are mature gardens to both front and rear. There are 16 single rooms and two double rooms, with a variety of ensuite toilet and shower provision and additional bathing and showering facilities on each floor. There are three lounges and a modern dining room. Access to the first floor is by stairs or chair lift. Staff and management at Carolton Care work closely with community nursing staff and other health care professionals who take the lead in directing and monitoring any specific nursing care. The aims of the service include the two statements below:- 'To provide all service users with a standard of excellence, which embraces fundamental principles of good care practice' and 'Staff shall be responsive to the individual needs of service users and will provide the appropriate degree of care to assure the highest quality of life within the home.' 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 page 5 of 30

6 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. 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 Public Services Reform (Scotland) Act 2010 (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 4 - Good Quality of environment - N/A Quality of staffing - N/A Quality of management and leadership - Grade 4 - 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 or by calling us on or visiting one of our offices. page 6 of 30

7 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 who was supported by an inspection volunteer. The inspection took place on 4 and 5 May 2016 between the hours of 10am and 6pm. We gave feedback to the manager and a member of the care team at the end of the inspection visit on 5 May A member of NHS contracts was also present for the feedback. The inspection volunteer was present on the first day of the inspection and spoke with some residents and relatives. The comments and observations of the inspection volunteer have been incorporated in this report An inspection volunteer is a member of the public who volunteers to work alongside Care Inspectorate Inspectors during the Inspection process. Inspection volunteers have a unique experience of either being a service user themselves or being a carer for someone who uses, or has used services. The inspection volunteer's role is to speak with people using the service (and potentially their family carers, friends or representatives) being inspected and gathering their views. In addition, where the inspection volunteer makes their own observations from their perspective as a recipient or a carer, these may also be recorded. As part of the inspection, we took account of the completed annual return forms that we asked the provider to complete and submit to us. We sent ten care standard questionnaires to the manager of the service to distribute to residents. We received five completed questionnaires back. We also sent ten care standard questionnaires to the manager to distribute to relatives and carers. We received four completed questionnaires prior to the inspection. page 7 of 30

8 During the inspection process we gathered evidence from various sources, including the following: We spoke with: - The service manager - The team leader - Three carers - One domestic staff. We also spoke with relatives, visitors and residents. We looked at: - Minutes of meetings - Information about the service - Sample of staff files - Training records - A sample of care plans and personal care records - Menus - Accidents and incident records - Medication records - Staff rotas - Policies and procedures. Inspection report page 8 of 30

9 We toured the premises and made observations in different areas of the home. 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 page 9 of 30

10 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. We received a self assessment for the service and this contained information on areas where the service felt they were doing well and also identified areas where further improvements could be made. Taking the views of people using the care service into account The inspection volunteer spoke with service users during the inspection. They all spoke positively about the quality of care they received. There were good comments made about the quality of the food. Service users told us that the staff were kind and caring. There were some positive comments made about the management, however, some people did say that they did not see much of them. Service users spoke positively about the chef and how they enjoyed his baking and also the activities that he arranged and took part in. Taking carers' views into account The inspection volunteer spoke with two relatives/carers and we spoke with three. Comments from these discussions were a mix of positive and negative. There were positive comments made about some of the staff. We were told that some relatives found that the care was better through the week than at the weekend as they felt there was not always enough trained staff to meet the needs of service users. We received positive comments about the quality of the food provided in the home. Some relatives stated that they thought the quality page 10 of 30

11 of care provided by the staff and management in the home was of a very good standard. page 11 of 30

12 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: 4 - Good Statement 3 We ensure that service users' health and wellbeing needs are met. Service strengths At this inspection, we found the service's performance was good in the areas covered by this quality statement. We examined a sample of care plans and associated care documentation, review notes, medication records, minutes of meetings, policies and information about the service. The service had made some progress with developing residents' care plans. See areas for improvement. We found that there was more evidence of care reviews taking place at this inspection. There was a review planner in place. Staff invited families to attend where residents expressed a wish for this. We found that improvements had been made to the medication system since the last inspection. Handrails had been fitted to the wall in the ground floor corridor. page 12 of 30

13 Areas for improvement Work needs to continue on the care plans to ensure that they are a current reflection of service users' health and wellbeing needs. Care plans for dementia, pressure care, pain and palliative care/end of life still need to be developed for some people. See recommendation 1. Staff need to ensure that care documentation such as pressure care recording is accurately and consistently kept. See recommendation 2. The provider should give consideration to introducing 'show and tell' and pictorial menus at meal times to make life easier for those people who live with dementia or have communications difficulties. See recommendation 3. Although we found that some improvements had been made to the medication system, there were still some areas where further improvements were necessary. For example - all medications that have been dispensed should be signed for. There should be evidence that where 'as required' medications are being given, these are regularly evaluated to ensure that they are/continue to be effective. See recommendation 4. The provision of activities in the home needs to improve. There should be information in the home as to what activities are planned for the week. People who use the service should have regular access to fresh air and be supported to go on trips and outings. See recommendation 5. The provider should access more dementia friendly signage for around the home. See recommendation 6. It was noted at the time of the inspection that the provider had not progressed with the risk assessment for the issue highlighted at the last inspection e.g. the laundry and sluice being a shared facility. (This recommendation will be repeated in this report to allow progress to be monitored in this area). See recommendation 7. Grade 4 - Good Number of requirements - 0 Inspection report page 13 of 30

14 Recommendations Number of recommendations The provider should ensure that work continue on care plans for people who use the service. This is to ensure that they remain a current reflection of people's health and wellbeing needs. Where it has been assessed that someone has needs in relation to pressure care, dementia or palliative care, specific care plans should be developed to give staff guidance on the level of support required to meet those needs. National Care Standards Care Homes for Older People. Standard 6: Support arrangments. 2. The provider should ensure that where care documentation for example, for recording pressure care management, this should be accurately and consistently kept by staff. National Care Standards Care Homes for Older People. Standard 6: Support arrangements. 3. The provider should ensure they give consideration to introducing 'show and tell' and pictorial menus at meal times, to make life easier for those people who live with dementia or have communications difficulties. National Care Standards Care Homes for Older People. Standard 8: Making choices and Standard 13: Eating well. 4. The provider should ensure they continue to make further improvements to the medication system. In order to do this they should:- a) improve the way they record PRN medications. They should be positively recording and documenting whether medication has been effective. b) sign for all medications that have been dispensed and administered. page 14 of 30

15 National Care Standards Care Homes for Older People. Standard 15: Keeping well - medication. 5. The provider should ensure they make improvements to the activity provision in the home. There should be information in the home as to what activities are planned for the week. People who use the service should have regular access to fresh air and be supported to go on trips and outings. National Care Standards Care Homes for Older People. Standard 8: Making choices and Standard 12: Lifestyle - social, cultural and religious belief or faith. 6. The provider should ensure they access more dementia friendly signage for around the home. National Care Standards Care Homes for Older People. Standard 4: Your environment. 7. The provider should ensure they carry out an infection control, risk assessment for the home, which should include the laundry/sluice. A plan should be developed to evidence how the home will provide appropriate facilities for the disposing of incontinence waste and the washing of associated equipment. The laundry and sluice should not be a shared facility. National Care Standards Care Homes for Older People. Standard 4: Your environment. Statement 6 People who use, or would like to use the service, and those who are ceasing the service, are fully informed as to what the service provide. page 15 of 30

16 Service strengths At this inspection, we found the service's performance was very good in the areas covered by this quality statement. We found this by looking at the care home introductory pack, exit policy, and speaking to the manager, staff, people who use the service and their relatives/carers. There was an introductory pack, which gave prospective users of the service some information on the service and how it was run. There was an assessment policy in place and this gave details on the process of assessment prior to admission to the home. The manager explained that they encouraged people to visit the service and have an informal chat with herself, the deputy or team leader. The manager also explained that they could visit people in their own homes or in hospital to discuss aspects of the service and to assess whether they could meet the person's needs. There was an exit policy in place. Areas for improvement The provider could add a copy of their participation policy to the introductory pack. This would give prospective users of the service information on how they would be able to be involved in assessing and making improvements to the service. Grade 5 - Very Good Number of requirements - 0 Number of recommendations - 0 Inspection report page 16 of 30

17 Quality Theme 2: Quality of environment Quality theme not assessed page 17 of 30

18 Quality Theme 3: Quality of staffing Quality theme not assessed page 18 of 30

19 Quality Theme 4: Quality of management and leadership Grade awarded for this theme: 4 - Good Statement 3 To encourage good quality care, we promote leadership values throughout the workforce. Service strengths At this inspection, we found the service's performance to good for this quality statement. We concluded this after we looked at staff training, supervision and appraisal records, spoke with people who use the service, staff and management. The service had a training and development policy in place and staff were encouraged to undertake a Scottish vocational qualification, appropriate to the role they performed. We could see that staff were encouraged to develop and some were undertaking training to allow them to take on senior roles in the home. See areas for improvement. There was evidence to support that staff were offered regular supervision and a yearly appraisal. Staff spoken with stated that they found this helpful and felt comfortable bringing up any issues they had. We could see that there had been staff meetings taking place since the last inspection. Staff told us that they attended these where they could. Areas for improvement We noted that there were times where there were staff working in senior roles and carrying out tasks such as, dispensing medications and taking responsibility for shift lead, where they did not have the appropriate qualifications to do so. The manager stated that the staff had received inhouse training in relation to medication, however, there was no formal evidence of this. The manager page 19 of 30

20 agreed that she would make alternative arrangements until these staff had completed the appropriate qualification, to enable them to take charge of the shift and safely dispense medication. See recommendation 1. The manager also agreed to carry out a check to ensure that staff who were taking charge of the home were on the appropriate part of the Scottish Social Services Council (SSSC) register. We looked at the training records for staff and we could see that there was a need for night shift staff to receive first aid training as soon as this could be arranged. See recommendation 2. We looked at the service job descriptions for carers and noted that they did not identify the qualification appropriate to each role. These documents should be reviewed and updated to ensure that they contain all the necessary information on the qualification requirements for each level of carer. See recommendation 3. Grade 4 - Good Number of requirements - 0 Recommendations Number of recommendations - 3 Inspection report 1. The provider should ensure that carers do not undertake unsupervised senior roles in the home until such times as they are qualified to do so. National Care Standards Care Homes for Older People. Standard 5: Management and staffing arrangements. 2. The provider should ensure that there are sufficient staff on each shift with a qualification in first aid. National Care Standards Care Homes for Older People. Standard 5: Management and staffing arrangements. page 20 of 30

21 3. The provider should ensure they carry out a review of the job descriptions for care staff, to ensure that they include the necessary qualification requirements for each level. National Care Standards Care Homes for Older People. Standard 5: Management and staffing arrangements. 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 At this inspection, we found the service's performance to good for this quality statement. We concluded this after we spoke with management, staff, looked at records and audits, minutes of meetings, questionnaire responses, reports, care documentation and reviews. We also spoke with residents and relatives and staff. The provider had carried out a review of the service policies. This had been highlighted as necessary at the last inspection. See areas for improvement. There was a quality assurance policy in place and staff had made some efforts to carry out internal audits of some of the systems in the home. See areas for improvement. There was evidence to support that there had been an external audit of the medication system in April An action plan had been developed and we could see that staff had followed through with the issues highlighted in the audit. Areas for improvement The provider had carried out a review of the service policies. However, we noted that some of the policies related to the service nurses carrying out certain tasks. These policies should be updated to reflect that the home does not page 21 of 30

22 employ nurses. Progress will be monitored on this at the next inspection. Although the provider had some informal audits being carried out, we noted that these were not always found to be effective. In some of the audits we noted that it had been documented that actions had been taken, however when we checked this was not always the case. The provider should ensure there are effective quality assurance systems and processes in place, to assess the quality of the service they provide. Suitable arrangements should be in place, to ensure that action planned to make improvements is carried out and that the action is effective in improving the outcomes for people using the service. See recommendation 1. Grade 4 - Good Number of requirements - 0 Recommendations Number of recommendations - 1 Inspection report 1. The provider should ensure there are effective quality assurance systems and processes in place, to assess the quality of the service they provide. Suitable arrangements should be in place, to ensure that action planned to make improvements is carried out and that the action is effective in improving the outcomes for people using the service. National Care Standards Care Homes for Older People. Standard 11: Expressing your views. page 22 of 30

23 4 What the service has done to meet any requirements we made at our last inspection Previous requirements There are no outstanding requirements. 5 What the service has done to meet any recommendations we made at our last inspection Previous recommendations 1. The provider should ensure that work continues on care plans for service users in relation to dementia, pressure care, end of life and social activities. Each service user should have a care plan in place, which details their health and well being needs and how these are to be met with the support of staff. Care documentation held in service users' bedrooms should be consistently and accurately kept. For example, personal care, SSKIN bundles, oral hygiene and prescribed creams. National Care Standards Care Homes for Older People. Standard 6: Support arrangements. This recommendation was made on 16 June 2015 Some work had been carried out in this area, however there were still areas where further improvements were necessary. Please see Quality Theme 1, Statement 3 for further details. 2. The provider should ensure that each service user be offered a minimum of two reviews in each year, with family involvement, where appropriate. Actions should be taken on any issues highlighted at the review and the care page 23 of 30

24 plan should be updated as a result of the review process. National Care Standards Care Homes for Older People. Standard 6: Support arrangements. This recommendation was made on 16 June 2015 Improvements were noted in this area since the last inspection. There was a review planner in place and in the sample of care plans we looked at we could see that everyone had received a recent review with their family present if appropriate. This recommendation has now been met. 3. The provider should ensure they review the dining arrangements to ensure that there are sufficient staff present in the dining room at each meal time. This is to ensure that service users receive appropriate support to enjoy their meal and have a pleasant meal time experience. National Care Standards Care Homes for Older People. Standard 5: Management and staffing arrangements. This recommendation was made on 16 June 2015 We carried out an observation at a meal time during this inspection. We noted some improvements. Residents were offered support where necessary and this was carried out in a relaxed manner. No one was rushed and there appeared to be sufficient staff in the dining area to meet people's needs. This recommendation has now been met. 4. The provider should ensure that the way service users' medication is managed improves. In order to do this:- a) Staff need to document whether they administer one or two tablets where a prescription states this. b) Controlled drug keys should be kept separate from the main bunch of medication keys and kept with the shift leader. c) Staff need to improve the way they record PRN medications. They should be positively recording and documenting whether medication has been effective. d) Topical medication administration records (TMARs) held in service users' page 24 of 30

25 bedrooms should be formalised and completed at every administration. e) The manager should ensure that there is a complete audit trail of all medications kept in the home. National Care Standards Care Homes for Older People. Standard 5: Management and staffing arrangements and Standard 15: Keeping well - medication. This recommendation was made on 16 June 2015 We could see that work had been carried out in this area since the last inspection. Generally the medication system was found to be in good order. Part a, b), d) and e) of the above recommendation were found to be met. Another recommendation has been made in this inspection to cover part c). See Quality Theme 1, Statement 3 for further details. 5. The provider should ensure they carry out a review of the environmental risk assessments and include the risk assessment for the ground floor corridor of the home. Appropriate action should be taken in relation to providing appropriate hand rails to lower the risk of falls and to help ensure the safety of service users. National Care Standards Care Homes for Older People. Standard 4: Your environment. This recommendation was made on 16 June 2015 Hand rails had been fitted to the ground floor corridor since the last inspection. This recommendation has now been met. 6. The provider should ensure they access appropriate dementia friendly signage for areas of the home such as, bathrooms, toilets, dining rooms, lounges etc., to make life easier for those service users who live with dementia. National Care Standards Care Homes for Older People. Standard 4: Your environment. This recommendation was made on 16 June 2015 Inspection report We could see that there was some signage around the home, however there were areas of the home where this was still needed. This recommendation will be page 25 of 30

26 repeated in this report to allow progress to be monitored in this area. See Quality Theme 1, Statement 3 for further details. 7. The provider should ensure they carry out an infection control, risk assessment for the home, which should include the laundry/sluice. A plan should be developed to evidence how the home will provide appropriate facilities for the disposing of incontinence waste and the washing of associated equipment. The laundry and sluice should not be a shared facility. National Care Standards Care Homes for Older People. Standard 4: Your environment This recommendation was made on 16 June 2015 The home had not made any progress in this area since the last inspection. This recommendation will be repeated in this report to allow progress to be monitored in this area. See Quality Theme 1, Statement 3 for further details. 8. The provider should ensure they carry out a review of the service's policies and procedures to ensure that staff have access to information that is current, up-to-date and reflects best practice guidance. National Care Standards Care Homes for Older People. Standard 5: Management and staffing arrangements. This recommendation was made on 16 June 2015 The provider had reviewed and updated the service policies since the last inspection. This recommendation has now been met. 9. The provider should ensure there are effective quality assurance systems and processes in place, to assess the quality of the service they provide. Suitable arrangements should be in place, to ensure that action planned to make improvements is carried out and that the action is effective in improving the outcomes for people using the service. National Care Standards Care Homes for Older People. Standard 11: Expressing your views. This recommendation was made on 16 June 2015 Inspection report Some work had been carried out in relation to this recommendation. Some internal audits were being carried out by staff, however these were not always found to be page 26 of 30

27 effective. This recommendation will be repeated in this report to allow progress to be monitored in this area. See Quality Theme 4, Statement 4 for further details. 6 Complaints No complaints have been upheld, or partially upheld, since the last inspection. 7 Enforcements We have taken no enforcement action against this care service since the last inspection. 8 Additional Information There is no additional information. 9 Inspection and grading history Date Type Gradings 16 Jun 2015 Unannounced Care and support 4 - Good Environment 4 - Good Staffing 5 - Very Good Management and Leadership 4 - Good 18 Jun 2014 Unannounced Care and support 4 - Good Environment 4 - Good Staffing 4 - Good Management and Leadership 4 - Good 25 Jun 2013 Unannounced Care and support 4 - Good Environment 5 - Very Good page 27 of 30

28 Staffing Management and Leadership 5 - Very Good 4 - Good 5 Jul 2012 Unannounced Care and support 5 - Very Good Environment 6 - Excellent Staffing 5 - Very Good Management and Leadership 6 - Excellent 21 Oct 2011 Unannounced Care and support 5 - Very Good Environment Not Assessed Staffing Not Assessed Management and Leadership 5 - Very Good 6 Dec 2010 Unannounced Care and support 5 - Very Good Environment Not Assessed Staffing Not Assessed Management and Leadership Not Assessed 18 May 2010 Announced Care and support 5 - Very Good Environment 5 - Very Good Staffing Not Assessed Management and Leadership Not Assessed 12 Jan 2010 Unannounced Care and support 3 - Adequate Environment 4 - Good Staffing Not Assessed Management and Leadership Not Assessed 24 Jun 2009 Announced Care and support 3 - Adequate Environment 4 - Good Staffing 4 - Good Management and Leadership 4 - Good 15 Dec 2008 Unannounced Care and support 4 - Good Environment 4 - Good Staffing Not Assessed Management and Leadership Not Assessed page 28 of 30

29 26 May 2008 Announced Care and support 4 - Good Environment 4 - Good Staffing 4 - Good Management and Leadership 4 - Good Inspection report page 29 of 30

30 To find out more This inspection report is published by the Care Inspectorate. You can download this report and others from our website. You can also read more about our work online. Contact Us Care Inspectorate Compass House 11 Riverside Drive Dundee DD1 4NY Other languages and formats This report is available in other languages and formats on request. Inspection report Tha am foillseachadh seo ri fhaighinn ann an cruthannan is c?nain eile ma nithear iarrtas. page 30 of 30