Care service inspection report

Transcription

1 Care service inspection report Full inspection Leonard Cheshire - Dysart Day Support Support Service 91d High Street Dysart Kirkcaldy Inspection completed on 19 May 2016

2 Service provided by: Leonard Cheshire Disability 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 32

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 5 Quality of environment Quality of staffing 5 Quality of management and leadership Very Good N/A Very Good N/A What the service does well The staff in the service work hard at ensuring that the people who use the service and their families are involved in developing the support provided to meet their individual needs. In addition the staff had also developed effective links with health professionals to ensure people's health and wellbeing needs were met. What the service could do better The provider and staff in the service to continue to improve the recording of staff training. This will enable the team leader to be able to monitor what training staff have attended to ensure that they have access to all the training they need and any necessary refreshers within appropriate timescales. The provider and staff in the service to continue to support staff in developing their knowledge and skills in effective communication. page 3 of 32

4 What the service has done since the last inspection Inspection report The team leader and staff had worked effectively with families, health professionals and other agencies to ensure that the people they support received a high standard of person centred support, based upon their individual needs, choices and wishes. Conclusion The service provided high quality care and support. There was a strong focus on supporting people to participate in meaningful activities in their local community. page 4 of 32

5 1 About the service we inspected Inspection report Leonard Cheshire - Dysart Day Support opened in December It is registered to provide a service to adults with learning disability and/or physical and sensory impairment. It has a staffing: service user ratio of 1:1. The Care Inspectorate regulates care services in Scotland. Information in relation to 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 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. 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: page 5 of 32

6 Quality of care and support - Grade 5 - Very Good Quality of environment - N/A Quality of staffing - Grade 5 - Very Good Quality of management and leadership - N/A 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 32

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 The service was inspected during an unannounced visit on the 18 May 2016 and a further announced short notice visit on 19 May From the 1 April 2016 the way in which we carry out an inspection has changed. We choose which quality themes and statements are inspected for better performing services, to be more proportionate and targeted in our work. In highly performing services, inspections will consider Quality Theme 1: Quality of Care and support, Quality Theme 1, Statement 3 "We ensure that service user's health and wellbeing needs are met" will be considered during all inspections. We will also look at one other quality theme. This service is eligible for this type of inspection and based on our knowledge and intelligence of the service we looked at Quality Theme 1, Statement 5 "We respond to service user's care and support needs using person centred values". We chose this based on our knowledge of the service and the importance of service users being supported in a person centred manner and that staff have a good understanding of this. We also considered Quality Theme 3, Statement 3 "We have a professional, trained and motivated workforce which operates to National Care Standards, legislation and best practice" to follow up on a recommendation made at the last inspection. Statement 4 "We ensure that everyone working within the service has an ethos of respect towards service users and each other" was chosen by taking into account the varying roles of each team member and the importance of collaborative team work to promote positive outcomes for service users. This inspection was carried out by two Care Inspectorate inspectors. page 7 of 32

8 Evidence During the inspection, evidence was gathered from a number of sources including: A review of a range of policies, procedures, records and other documentation, including the following: Examination of a range of documentation which included: - certificate of registration - staffing schedule - aims and objectives of the service - complaints records - care files - accident and incident records - adult protection procedure - medication records and audits - staff training records - training plan - risk assessments. Discussion took place with a range of care staff including: - team leader - senior support worker - support workers. Observation of staff practices. Observation of the environment. All of the above information was taken into account and included within the body of the report. page 8 of 32

9 Feedback was provided to the team leader, service manager and acting care supervisor on 19 May 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 32

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. The manager had submitted a self assessment prior to this inspection. The document contained comprehensive information and identified areas for further development. Taking the views of people using the care service into account Directly observing care is an important way to help us judge whether a service complies with the regulations and meets outcomes for people. The people who received support were seen to be happy and relaxed with staff and staff demonstrated that they knew each individual's support needs and how to meet these. We observed some very positive interactions between staff and the people they supported using MAKATON a kind of sign language and PECS picture exchange communication. Taking carers' views into account Prior to the inspection we received four completed Care Standards Questionnaires (CSQs) from relatives, of these two strongly agreed that they were overall happy with the care and support provided and the other two agreed. Comments included: page 10 of 32

11 - "Reviews happen on a regular basis now. Welcome in the service at any time. Not always told about staff changes, maybe a short or newsletter would address this. Feel more confident about the service with new manager and senior in post everything seems more settled" - "I consider the service does their best to care for and care about my daughter despite what can be challenging behaviour and her inability to communicate verbally. I am kept appraised of any difficulties she is experiencing, whether they are social, emotional, physical or medical and am consulted on most issues. Contact is regular and consistent as well as constructive. I feel that I am included in the decision making process and that my views are valued. My only major reservation relates to the property itself which I feel is small and cramped for the number of service users who live there and the number of support staff required" - "Service more settled now and seems to be running well under the new management". Four relatives were spoken with either face to face or by telephone. They told us that they were happy with the support provided to their loved ones, and that they felt involved and included. Comments included: - "Brilliant communication with service, I service up and they will respond" - "We get a letter or phone call re any changes" Inspection report - "X uses pictures and symbols, as this best for her to set out what she is doing with daily planner X would get uptight if changes happen and this helps with daily planner" - "X chooses what she would like to do - loves music therapy, swimming and disco" - "I am really happy and X is happy. Never a time when she says she doesn't want to go" page 11 of 32

12 - "Communication with the service is really good. The manager will phone me with any changes. X doesn't like even small changes, the manager lets me know if X has coped with change" - "Letters to tell me of changes and daily diary tells me where he has been, what he has eaten" - "The manager gives me detail of who will support X each week. When X doesn't know who is coming he has difficulty coping and we get all sorts of issues" - "Previously management didn't listen, now structure and routine are working well and X is much better physically and his behaviour" - "Review meetings more frequently when things weren't working well now six monthly" - "Had a letter about fund day recently and staff speak to me when picking X up" - "In the past year service much better" - "Staff all doing a good job" - "X has specific staff, he has been involved in choosing his team. Previously he didn't cope with new staff, now he has chosen new staff members to work with him" - "Staff are good at looking at triggers for his anxiety and can avoid behaviour getting worse, staff will talk to me and we can work out what has caused anxiety" - "We know staff very well" - "If unhappy would contact the manager, never had to do that" page 12 of 32

13 - "If I have a concern I feel perfectly confident to speak to the manager and this would be resolved" - "The manager will come up with ideas, very good frequent fruitful discussions about activities" - "Twice per year meetings with the manager and keyworker. Good at involving other groups, attends Leonard Cheshire respite, central Fife support services, good interchange of opinions and ideas" - "One thing I appreciate is they have continuity of staff" - "Quality of staff depends on commitment of services, this service has really positive commitment" - "Regularly in touch with service, call in twice per week and speak to staff" - "They have a keyworker I speak to her regularly" - "Will come along to joint meetings with other provider, Kingdom housing, they communicate with each other regularly" - "We get together for epilepsy clinic - often issues around medication, we discuss every three months" - "I had opportunity to observe X with staff at music therapy Leonard Cheshire have now built this in to her week, have noticed difference in X's confidence" - "Since the new manager there is now an openness to try different and new things" - "I am very happy with the service" Inspection report - "Have review meetings with manager, keyworker, Kingdom and social worker. Everything is recorded and anything needed to be taken up is resolved. Often issues are reviewed as we go along" page 13 of 32

14 - "Communication diary notes on a daily basis, all know at any given time what is happening". page 14 of 32

15 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 3 We ensure that service users' health and wellbeing needs are met. Service Strengths The manager presented very good evidence of how they ensured that the health and wellbeing needs of the people who received the service were met. Care files showed that where appropriate, people who use the service were supported to access a range of other professional people to meet their health and wellbeing needs. There was strong evidence of how the staff in the service had developed effective working relationships with members of the multidisciplinary health team and other agencies to ensure that customers where appropriate had their health needs assessed and met. Health professionals spoken with as part of the inspection said: - "Have been called upon to re-assess individual eating and drinking protocols and guidance re dysphagia - staff receptive and have observed staff practice" - "I have directed training and presentations around what is communication and what are some common difficulties staff might come across" page 15 of 32

16 - "The service will refer appropriately to Community Learning Disability service" - "The service will always follow through on advice, staff very positive and do as much as they can" - "Our experience of the service is very positive, no concerns". People's support plans were seen to be very person centred and contained relevant and detailed information in relation to customers health and wellbeing needs and how these were to be met (see areas for improvement). Accident and incident records were monitored and analysed and where necessary these would trigger further intervention and assessments by relevant members of the multidisciplinary team. The files were also seen to contain risk assessments which looked at reducing the hazards for customers accessing activities in the local and wider community (see areas for improvement). Staff had received specific training to equip them to support people with health conditions such as dysphagia, dementia, epilepsy, emergency first aid, and gastrostomy (see also quality theme 3, statement 3). Staff with the input of Speech and Language Therapists (SALT) were working hard to improve their communication skills and there was some very good examples of staff using these observed during the inspection. A member of the SALT team told us: - "I have had two direct sessions which Dysart staff have attended. Following up with two staff members at the moment who have been asked to do two functional observations re level of engagement. They will look at strategies as to how people can be more involved" - "Client specific stuff for one person - key word signing, visual planner, provided modelling and support for staff" page 16 of 32

17 - "Staff have been receptive and motivated, staff have taken on board strategies" - "As a service more scope for staff to develop knowledge of learning disability and communication its work in progress" - "I need to work with wider staff group looking at a way of supporting a meaningful environment for communication". People using the service were supported to access activities which helped them to remain healthy such as, exercises, dancing, walking, swimming, bowling, music therapy and snoezellen. Staffing ratios were on a one to one basis which meant that people received flexible support to get out and about. Care files contained individual risk profiles for each service user for activities that they undertook both inside and outside of the home (see areas for improvement). There was very good evidence observed during the inspection through documentation, and discussion with relatives and health professionals that staff were aware of each individual's health needs and, where appropriate they worked well with other health professionals to ensure that these were assessed regularly and addressed. When asked about what they thought about the quality of care and support provided, relatives said: - "Brilliant communication with service, I call the service up and they will respond" - "We get a letter or phone call re any changes" - "X uses pictures and symbols, as this best for her to set out what she is doing with daily planner X would get uptight if changes happen and this helps with daily planner" page 17 of 32

18 - "X chooses what she would like to do - loves music therapy, swimming and disco" - "I am really happy and X is happy. Never a time when she says she doesn't want to go" - "Communication with the service is really good. The manager will phone me with any changes. X doesn't like even small changes, the manager lets me know if X has coped with change" - "Letters to tell me of changes and daily diary tells me where he has been, what he has eaten" - "Review meetings more frequently when things weren't working well now six monthly" - "If unhappy would contact the manager, never had to do that" Inspection report - "If I have a concern I feel perfectly confident to speak to the manager and this would be resolved" - "The manager will come up with ideas, very good frequent fruitful discussions about activities" - "Twice per year meetings with the manager and keyworker. Good at involving other groups, attends Leonard Cheshire respite, central Fife support services, good interchange of opinions and ideas" - "Will come along to joint meetings with other provider, Kingdom housing, they communicate with each other regularly" - "We get together for epilepsy clinic - often issues around medication, we discuss every three months" - "I had opportunity to observe X with staff at music therapy Leonard Cheshire have now built this in to her week, have noticed difference in X's confidence" page 18 of 32

19 - "I am very happy with the service" - "Have review meetings with manager, keyworker, Kingdom and social worker. Everything is recorded and anything needed to be taken up is resolved. Often issues are reviewed as we go along" - "Communication diary notes on a daily basis, all know at any given time what is happening". Areas for improvement We found that support plans and care files contained a lot of detailed information, particularly in relation to customers health and wellbeing needs, and that staff had worked hard to keep these current. In order to make these better, the manager and staff should ensure that risk assessments are more person centred and reflect the risks and control measures for each person on an individual basis. These should also take into account not just the activity that people are involved in but also the premises and any potential hazards in accessing these for people. The service should make a record of any changes to an individual's medication and the reasons for this. This would also help to make sure that this information is effectively communicated to staff. Action plans following reviews detailing what works well and what doesn't should always be fully completed signed and dated. Grade 5 - Very Good Number of requirements - 0 Number of recommendations - 0 Statement 5 We respond to service users' care and support needs using person centered values. page 19 of 32

20 Service Strengths The manager presented very good evidence of how they responded to service users care and support needs using person centred values. Support plans and care files were set out in a person centred format, and there was strong evidence of how people being supported and their families were involved in developing and reviewing these. Staff received training in person centred planning, and staff were very knowledgeable about the people they supported and their individual needs. People's likes and dislikes were clearly recorded in their support plans and importantly what staff needed to know about them individually in order to be able to support them effectively. Examples of this included communication where information about how people liked to communicate and what different facial expressions, gestures and sounds may mean. Staff were seen to work hard to engage, interact and involve the people they supported in making their own choices and decisions by working with the multidisciplinary team to improve their communication skills. Progress towards achieving outcomes for each person were reviewed regularly and records kept of this (see areas for improvement). Examination of support plans, discussion with staff, and families showed how all of these processes were used to support people in a person centred way. A particular strength of the service was the hard work the manager and staff undertook to ensure that they were continually reviewing the activities and opportunities available, to ensure that the people using the service and their families found using the service as positive an experience as possible. Staff clearly knew the individual's they supported very well and worked hard to help them have their support needs met. Areas for improvement The provider should work with staff to raise their awareness in relation to identifying what meaningful outcomes are for each person. Some of the page 20 of 32

21 outcomes recorded were seen to be generic and not reflect what the outcome would be for them individually. An example of this discussed during feedback was in relation to administering medication safely to people and that the outcome would be staff adhering to the providers medication policy. The manager and staff to continue to work with customers and families to identify person centred activities which support them to actively engage with their local communities. Grade 5 - Very Good Number of requirements - 0 Number of recommendations - 0 Inspection report page 21 of 32

22 Quality Theme 2: Quality of Environment Quality theme not assessed page 22 of 32

23 Quality Theme 3: Quality of Staffing Grade awarded for this theme: 5 - Very Good Statement 3 We have a professional, trained and motivated workforce which operates to National Care Standards, legislation and best practice. Service Strengths The manager provided very good evidence that they have a professional, trained and motivated workforce which operates to National Care Standards, legislation and best practice. Staff said that the team leader and senior support worker worked in partnership with them providing support, offering guidance, and monitoring practice. Staff were aware of the need to register with the Scottish Social Services Council (SSSC). Staff were also supported to access relevant Scottish Vocational Qualifications (SVQ) for their roles. The service had a training plan. There was flexibility in the courses provided so as not only to meet the core training requirements, but also to allow staff to access relevant training to meet the changing needs of the people they supported, for example, staff were accessing training from the multidisciplinary team to improve their abilities to communicate effectively with the people they supported (see areas for improvement). Staff training records and training trackers showed that staff had access to a wide range of training to equip them for their roles, these included adult support and protection/safeguarding, bed rails/safety awareness, behaviour support awareness, buccal midazolam/epilepsy, choking, communication focus, customer focus, data protection, dementia awareness, emergency first aid, fire marshal, food allergy, food hygiene, fire safety, gastrostomy, health and safety page 23 of 32

24 infection control, induction, moving and handling, mental capacity act, person centred planning, PEG feeding, risk assessment, safer medication, tissue viability/pressure area care, whistleblowing and working in an empowering way (see areas for improvement). Staff said that they thought that the quality of training was good and helped to equip them for their roles. They also said they were encouraged to discuss their training needs during supervision. Staff received training in adult support and protection and all staff spoken with were fully aware of their responsibilities and what they should do if they were to have any concerns. The provider had an adult protection policy and procedure which set out guidance for staff about what they should do. Staff said they were aware of the providers whistleblowing policy (see areas for improvement). Team meetings were held regularly and topics such as transport, service user reviews, communication, policy and procedure updates, keyworking, engagement with service users, informing senior staff about activity changes, sickness reporting and updates were seen to be discussed. Staff spoken with also identified supervision which they received on a regular basis describing it as a very useful format for them to discuss any issues and for seeking guidance, but also said that there were lots of opportunities for informal supervision. Newer staff spoken with described their induction to the service, they said it was comprehensive and covered all aspects of their roles. Staff were seen to be very motivated, and knowledgeable about people's individual needs and how these were to be met. All staff spoken with said that they really enjoyed their jobs. Families said this when asked about staff: Inspection report - "Had a letter about fund day recently and staff speak to me when picking X page 24 of 32

25 up" - "Staff all doing a good job" - "X has specific staff, he has been involved in choosing his team. Previously he didn't cope with new staff, now he has chosen new staff members to work with him" - "Staff are good at looking at triggers for his anxiety and can avoid behaviour getting worse, staff will talk to me and we can work out what has caused anxiety" - "We know staff very well" - "One thing I appreciate is they have continuity of staff" - "Quality of staff depends on commitment of services, this service has really positive commitment" - "Regularly in touch with service, call in twice per week and speak to staff" - "They have a keyworker I speak to her regularly" - "I had opportunity to observe X with staff at music therapy Leonard Cheshire have now built this in to her week, have noticed difference in X's confidence". Areas for improvement In order to ensure that staff have access to the necessary training to equip them to meet the needs of the people they support, the provider should continue with the review of their IT systems in order to improve the recording and booking of training courses for staff. The provider to continue to ensure that all staff have access to relevant training to support them to develop the skills to communicate effectively with the people they support. The provider and manager should consider encouraging staff to access human page 25 of 32

26 rights training via careaboutrights.com. In order to enhance staff awareness of their responsibilities about keeping customers safe from abuse, the manager should raise awareness of the Winterbourne View report and the recommendations it contains. Grade 5 - Very Good Number of requirements - 0 Number of recommendations - 0 Statement 4 We ensure that everyone working in the service has an ethos of respect towards service users and each other. Service Strengths The manager provided very good evidence that everyone working in the service has an ethos of respect towards the people who they support and to each other. Staff spoken with said that they felt they were fully involved in making decisions and developing support in partnership with the people they support and their families. We observed during the inspection that the people using the service were being supported in a way that was friendly and respectful. Staff interactions were seen to be respectful and they asked people for their input in decisions and explaining what they were doing whilst they were providing support. There were enough staff available to support people with their activities. Staff were experienced and knew the people well and this contributed to the quality of the interactions. There were support processes and checks in place for staff like regular supervision, appraisals and team meetings in place. These processes were vital for assessing things like attitudes and values and addressing concerns. People page 26 of 32

27 being supported and their families were given their opportunity to provide their views on staff as part of reviews. Families were involved in choosing staff which they said had a positive impact on the experience of the people using the service. Families told us: Inspection report - "X has specific staff, he has been involved in choosing his team. Previously he didn't cope with new staff, now he has chosen new staff members to work with him" - "Staff are good at looking at triggers for his anxiety and can avoid behaviour getting worse, staff will talk to me and we can work out what has caused anxiety". Staff and management had worked very hard to develop and improve communication strategies in the service with the use of signs, symbols, photography, and MAKATON. We felt that these were very positive examples of how the staff in the service were respectful of the people they support and families views, and was clear evidence of how they actively sought to include them in the decision making process. All of the staff spoken with said that they felt they were part of a good and effective team and that they felt valued and respected by the management and colleagues. Relatives spoken with said that the staff were respectful to them and their loved ones. There was very strong evidence that staff observed, and staff spoken with were very motivated and committed to meeting the needs of the people they support. They were seen to be warm, caring and respectful not only to the people using the service but in their interactions with each other. This ethos of respect had a direct impact on how the support was provided to the people who used the service. page 27 of 32

28 Areas for improvement The manager and staff need to be aware of the gathering of people using the service and staff in the morning, and the size of the premises and how these can contribute to episodes of challenging behaviour or upset. This time needs to be managed sensitively as there was observed to be lots of noise, activity and interactions which some people using the service may find difficult to engage with and may find distressing. Support plans were very person centred and contained lots of important information about the people being supported, however, in some instances they were seen to contain some inappropriate recording such as 'I will be allowed to'. This was discussed at feedback and the team leader advised that this would be addressed. Grade 5 - Very Good Number of requirements - 0 Number of recommendations - 0 Inspection report page 28 of 32

29 Quality Theme 4: Quality of Management and Leadership Quality theme not assessed 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 There are no outstanding recommendations. 6 Complaints No complaints have been upheld, or partially upheld, since the last inspection. page 29 of 32

30 7 Enforcements We have taken no enforcement action against this care service since the last inspection. Inspection report 8 Additional Information There is no additional information. 9 Inspection and grading history Date Type Gradings 30 Apr 2015 Unannounced Care and support 4 - Good Environment 4 - Good Staffing 4 - Good Management and Leadership 4 - Good 30 Apr 2014 Unannounced Care and support 4 - Good Environment 4 - Good Staffing 4 - Good Management and Leadership 4 - Good 30 May 2013 Unannounced Care and support 3 - Adequate Environment 3 - Adequate Staffing 3 - Adequate Management and Leadership 3 - Adequate 20 May 2010 Announced Care and support 5 - Very Good Environment Not Assessed Staffing Not Assessed Management and Leadership 5 - Very Good 20 Aug 2009 Announced Care and support 5 - Very Good Environment 5 - Very Good Staffing 5 - Very Good page 30 of 32

31 Management and Leadership 5 - Very Good 16 Jul 2008 Care and support 4 - Good Environment 4 - Good Staffing 4 - Good Management and Leadership 4 - Good page 31 of 32

32 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 32 of 32