Care service inspection report

Transcription

1 Care service inspection report Full inspection Loretto Personalised and Self - Directed Support Services (Glasgow) Housing Support Service Maryhill Road Glasgow Inspection completed on 29 October 2015

2 Service provided by: Loretto Care 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 5 Quality of staffing 5 Quality of management and leadership 5 Very Good Very Good Very Good What the service does well Loretto is excellent at including the people they support in all aspects of their daily lives and the running of the service. They have a motivated staff team who pride themselves on their ability to respond to the individual needs of the people they support and providing opportunities to lead active and varied lives. What the service could do better We identified some areas for development throughout the inspection and these are documented within the report. The manager should continue to support staff to access and understand best practice documents so that they can link this with the practical support that they provide. The service is currently moving to using the outcome star to ensure that they are working in an outcome focussed manner and that this is reflected in their support planning paperwork. page 3 of 30

4 What the service has done since the last inspection Inspection report The service has continued to show a commitment to participation and has recruited a new community engagement and activity coordinator. The service has undergone a restructuring of staff and has struggled with some staff shortages during the recruitment process which has now been completed. There are a number of new staff in the service and the service has increased the number of deputy service managers. The increase in deputy service managers will allow an increased presence and direct contact with support staff and people using the service. The service has been working on developing their support planning processes with the introduction of the 'Outcome Star'. Conclusion Loretto continues to provide a very good service where people are involved in the support they receive and the running of the service. The team have worked hard during an unsettled period to ensure that the changes being made in the service do not impact on the care and support that people receive. 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 Personalised and Self Directed Support Services (Glasgow) Learning Disability is a combined housing support and care at home service, managed by Loretto Care. It comprises two service locations in the Maryhill and Whiteinch areas of Glasgow. The service offers a range of support to adults with learning disabilities, acquired brain injury, mental health or alcohol dependency needs. The Maryhill service is a housing complex for 29 individuals with a shared secure entrance, office base and common room, there are staff on site 24 hours a day. There is a second staff base in Whiteinch which has a sleepover member of staff available. An outreach service is currently provided to two people living in the community. The aim of the service is.. "To provide the support that enables people to reach their full potential and achieve the goals they set." 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. page 5 of 30

6 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 5 - Very Good Quality of staffing - Grade 5 - Very Good Quality of management and leadership - Grade 5 - Very Good Inspection report 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 undertaken by one inspector 14 October am-6pm and 20 October 11am-8:15pm. We completed the inspection and gave feedback to the manager 29 October. During this inspection process, we gathered evidence from various sources, including the following: We looked at: - insurance and registration certificates - self-assessment - participation strategy - service brochure - questionnaires - newsletter - finance records - handover documents - minutes from managers' meetings - three care plan files - medication records and audits - minutes of staff meetings - minutes of service user meetings - training records - two staff files - service development plan - complaints log - health and safety audit and records - accident and incident records page 7 of 30

8 - risk assessments - policies including medication, adult protection, rights, risks and limits to freedom policy, supervision and quality assurance. We spoke to: - manager - 2 Deputy Service Managers - community engagement and activity coordinator - community engagement and activity Lead - nine people who use the service - five support assistants - community Nurse. Inspection report We held a forum for service users so that they could give us feedback on the service, we also observed the morning handover session and interactions between staff and people who use the service We sent care standards questionnaires to the manager to distribute to staff and people using the service. We received completed questionnaires from 14 members of staff and 20 people using the service. As part of the inspection, we took account of the completed annual return and self-assessment forms that we asked the provider to complete and submit to us. 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 page 8 of 30

9 Inspection Focus Areas (IFAs) Inspection report 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. The provider identified what they thought they did well and areas for development. The self-assessment contained a range of information which accurately reflected what we found on our visits. Further areas for development could include more specific information on what outcomes have been achieved for service users and the evidence to support this. Taking the views of people using the care service into account During the course of the inspection we spoke to nine of the 41 people using the service and we received 20 completed care standards questionnaires. The views and opinions expressed by people using the service were very positive and we have taken account of service users views when commenting on each of the quality themes and statements. We have included some service user comments in this section and throughout the report. "I'm happy, very happy". "It's smashing here, they're very good (staff). They help me with my shopping and that". page 10 of 30

11 "It's good, I like it, I always get to go out to country and western nights". "Sometimes I'm happy here, sometimes I get a bit fed up". "The staff are pleasant" "I like the help with changing my bed and cooking". "I'm doing lots myself, I get some help with things". "I like staying here in Loretto because they are too good to me". "Anytime I need them, I just go over the road to see them". Inspection report "The support has been very good since I've got the depression they've been very good coming up night and morning to have a chat just to talk to me". Taking carers' views into account We did not meet any relatives during the course of the inspection. 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: 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 Loretto display an excellent level of practice when it comes to ensuring that service users participate in assessing and improving the quality of the care and support provided. We came to this conclusion after talking to staff, service users and considering the following documents: - service user and carers surveys - participation and involvement strategy - support plan files - minutes from service user forums - service newsletter. We saw that as well as an organisational participation strategy, there was a local strategy in place which aimed to provide a coordinated overview of all aspects of participation within the service. We spoke with the community engagement and activity team lead who explained to us that the participation strategy is currently under review and the new strategy will include a 'toolkit' for others to facilitate meetings so it is not reliant on one specific individual to facilitate them and a consistent standard is delivered. Work has also been started on developing a 'constituted' group which will be run by service users page 12 of 30

13 who have been supported to elect a chairperson, secretary and treasurer. The group will develop its own identity, aims and objectives and have started planning how they will fundraise to support the activities of the group. Service users we spoke to were very excited about the new roles they had in setting up this group and saw it as something they would be totally in charge of and would give them some responsibility for deciding what the group does and how it is run. We saw that there is a comprehensive action plan in place to address a variety of areas of participation and involvement to take forward within the organisation, we were pleased to see that this included reviewing methods to ensure those with more complex needs or those who have been historically more difficult to engage are given the same opportunities to get involved. We saw that the service also had a family and carers involvement strategy which states that the service sets out to routinely involve service users, their family, friends and carers in the planning and delivery of services and wherever possible they will ensure that there are opportunities for carers who wish to do so, can get involved in decisions affecting the planning and delivery of the service. We saw that people are involved in their support planning and reviews and there was feedback from service users documented in the review paperwork as well as space for service users to rate the service using the four quality themes that the service is inspected on. Service users have regular meetings with their keyworkers to put together monthly summaries and check that they are both happy with the support plans in place and update them when things have changed. They also have regular reviews which gives other people involved a chance to give their views and a formal update of the support plans in place. People told us that they know about their reviews and they can invite anyone they want to. This showed us that seeking the views and opinions of service users about their support and the service in general is an ongoing process for the service. page 13 of 30

14 We saw that regular service user forums were used to discuss a number of areas such as outings, social activities, changes in the environment and service developments as well as providing information on issues such as the changes in welfare benefits, self-directed support and relevant legislation and best practice documents such as Keys to Life (National Learning Disability Strategy) and the recommendations from the Winterbourne View report. We saw that in the common area at the Maryhill service, there was a presentation displayed which identified some of the areas that service users felt applied to them taken from the Keys to Life document. One of the staff told us how service users will look at this display and it has prompted discussions with staff and other service users around its contents. This is positive as it is available for those who maybe have not attended the forums as well as acting as a discussion point and prompt to engage in discussions about the standards of support that people using services should expect. We saw that there was a notice board in the common room featuring pictures of various activities and outings service users had taken part in. There was also feedback in the form of "you said, we did" to let service users know what had been done as a result of issues and suggestions they had raised. These issues came from a variety of sources not just the forums but from other methods of feedback including informal comments made to staff. We saw the latest edition of the service newsletter which contained information about various activities people had taken part in, individual and service achievements, staff news and recruitment, how to get involved in the service. There was also information about the work of the community engagement and activities coordinator and a section on the Care Inspectorate, who the inspector is and how to contact them. At the back of the newsletter is a tear off section where people can submit feedback about the service. People are encouraged to give feedback to both the service and to complete the Care inspectorate questionnaires. The form also asks people 'how many stars would you give staff at the service?' this uses the 6 point scale used by the Care Inspectorate with 6 being excellent and 1 unsatisfactory. This is yet another method of enabling people to give feedback to the service. page 14 of 30

15 It was good to see that the service now relied on the community engagement and activities team to support service users with participation activities such as the forums and completing feedback questionnaires. This means that people are supported by someone who is independent from the staff team that supports them on a daily basis. It also means that there is someone available for individuals who require more support to engage in participation and involvement activities. Staff were very positive about the work undertaken by the community engagement and activities coordinator and told us how the one to one attention they were able to give to individuals had led to people who have not historically engaged, now becoming involved in activities and their community. Staff and service users have recently started attending meetings with the National Involvement Network to see if this is something that they would like to become more involved with. One service user in particular has shown interest in this and some of the training activities offered by the network. Overall we saw that there were a range of different ways in which people using the service could participate in their service and give feedback about the quality of care and support they received. This included: service user and carer surveys, feedback forms for activities held in the service, one to one time with keyworkers, review meetings and service user forums. We saw that people were listened to, feedback was responded to and methods of getting people involved were regularly reviewed. People told us that they felt listened to, knew who to talk to if they were unhappy with anything and that they could talk to the manager anytime. Areas for improvement The action plan for the community engagement and activity team that we saw was very comprehensive and identified various areas where the service will continue to review and develop the ways that it can support individuals to get involved in the service, organisation and their individual care and support. We look forward to seeing how this service continues and develops the excellent work that it has been doing. page 15 of 30

16 Grade 6 - Excellent Number of requirements - 0 Number of recommendations - 0 page 16 of 30

17 Statement 5 We respond to service users' care and support needs using person centered values. Service Strengths We found that the service was performing at a very good level in responding to service users care and support needs using person centred values. This year we are using an Inspection Focus Area (IFA) to identify excellence and to promote and support improvement in care homes and combined housing support and care at home services. We have asked providers to complete a self assessment as well as answering a number of specific questions during the inspection which explore health outcomes for people with a learning disability. The IFA also provides a focus on Human Rights, Safety, Supporting communication and the wider recommendations from the Keys to Life and Winterbourne View findings. Information gathered from our inspection activity in will provide valuable intelligence at all levels, including a national overview. These are our findings: The staff we spoke to had a clear understanding of person centred planning and felt that it was one of the things that the service did particularly well. All the service users we spoke to felt that they were involved in the planning of their support and that no decisions were made without them being consulted first. We saw that people were being supported by the staff and the community engagement and activity coordinator to identify different activities that they would like to try so that people were engaged in a meaningful way and individual outcomes could be identified relevant to each person. We saw that people had been supported to access and try different activities and links had been made with local businesses to support ventures such as designing and creating a community garden for the service. We heard from staff how this has been particularly successful as they have seen individuals who page 17 of 30

18 usually do not engage, take interest and join in the work being undertaken. Staff feel that this has been a benefit of having a dedicated worker to spend one to one time focussing on activities and engagement with individuals and having time to make the links with community projects. We saw that information is available to support people to know their rights and expectations they can have of the support provided to them. This has been backed up by the focus on the recommendations from 'Keys to Life' during the service users forums and the display in the common room. We saw that there were generally good systems in place for the administration and storage of medication and service users had individual medication lockers in their flats. These were important to ensure that people were supported to receive their medication safely. We pleased to hear that work is being undertaken with individual service users to identify how they can be supported to become more independent in managing their medication. Staff have identified a number of different technologies which can support a range of issues people have such as electronic timer prompts for those who need minimal support in remembering to take medication at specific times. This is helping people to have more independence and control with their medication We observed during the handover session that staff were aware of individuals who were unwell and were able to ensure that the service was responsive to their needs, for example if they unexpectedly needed support to attend a hospital or doctors appointment. We spoke to the Community Nurse linked to the service, who was positive about the staff and the standard of support provided. They told us that they meet regularly with the Deputy Service Managers and that staff have good links with the dentist, nurses and GP's and are good at contacting them and feeding back any issues that arise. The Nurse has been working with the service to provide training sessions for both staff and service users around issues such as healthy eating and health promotion. The nurse felt that staff have good relationships with service users and communicate well with them. The service user files that we sampled showed good knowledge of the person's history, what's important to them and how to work with and communicate with them as individuals. There was clear information about how to support people page 18 of 30

19 and evidence of person centred planning. We saw that risk assessments and support plans had been reviewed regularly and regular monthly summaries were completed. The service has recently struggled with issues presented by an individual living in the service. It is acknowledged that this individual has caused significant disruption to the daily running of the service and this has impacted on other people using the service. The staff have worked hard to address these issues and support other service users to minimise the impact on them and made appropriate referrals under Adult Support and Protection legislation where required. Areas for improvement We saw that there were some basic health passports in place to provide essential information that could be quickly taken with the service users when they needed to attend hospital for any reason. We felt that these could be developed further to provide more information on areas such as communication and support needs. This would help ensure that the key information about the person and support required is passed onto other professionals where required. The service is in the process of changing to the 'Outcome Star' as a way to take forward a system of outcome focussed support planning. The introduction of the outcome star is seen as beneficial in terms of accurately recording, monitoring and reviewing identified outcomes for people. We look forward to seeing how the service has progressed with this at the next inspection. Grade 5 - Very Good Number of requirements - 0 Number of recommendations - 0 Inspection report page 19 of 30

20 Quality Theme 3: Quality of Staffing Grade awarded for this theme: 5 - Very Good Statement 1 We ensure that service users and carers participate in assessing and improving the quality of staffing in the service. Service Strengths We found evidence that the service was excellent at ensuring service users and carers participate in assessing and improving the quality of staff in the service. The strengths noted under quality theme 1, statement 1 also apply to this statement. We saw evidence of service users being involved in the recruitment of staff for the service. Service users were able to ask questions to potential staff members and feedback to the recruitment panel their views of the person. Service users were also supported to meet and greet candidates, welcoming them to the service and getting them refreshments prior to their interviews. This gave service users an opportunity to get involved in meeting candidates, interacting with them and then presenting feedback to staff at the end of the session. One service user told us how they had been involved in training staff about Learning Disabilities. They had been supported to write their personal story to share in Learning Disability week to raise awareness and change people's view on learning and physical disabilities. They told us how this had increased their self-esteem and confidence and that staff were working with them to ensure more opportunities for similar activities are identified. page 20 of 30

21 Areas for improvement Further work could be done to formalise the system used for gaining feedback from service users for use in the supervision and appraisal process. At the moment this is done verbally with service users and not always recorded as being discussed with staff. The service should continue to support people using the service to get involved in assessing and improving the quality of staff in the service. Grade 6 - Excellent Number of requirements - 0 Number of recommendations - 0 page 21 of 30

22 Statement 4 We ensure that everyone working in the service has an ethos of respect towards service users and each other. Service Strengths We found the performance of the service to be very good at ensuring that everyone working in the service has an ethos of respect towards service users and each other. We saw that the service had a 'good work practice policy' to encourage good practice within the organisation. It gave expectations for staff stating that it is the staffs responsibility to ensure that their work is performed to a competent standard and that they know the relevant policies, procedures, National Care Standards and SSSC (Scottish Social Services Council) codes of conduct. Also that it is their responsibility to keep up to date on professional issues and question colleagues actions if they are in any way concerned by them. We felt that this was a good way of reminding staff of their responsibilities as professionals and setting formal standards for them to maintain. This also linked to the responsibilities to service users policy which gave a clear description of responsibilities of staff and keyworkers in relation to working with service users, support planning, reviewing and documenting. This showed us that the organisation gave staff very clear guidance on expectations and standards for the service they were providing. Regular team meetings gave staff the opportunity to participate in group supervision and discuss areas such as: service users support, policies and procedures, best practice guidance and service developments. Protected time is available from the deputy service managers as part of the supervision process. This protected time aims to provide extra support to staff if required and these times are made explicit to staff. We saw that staff were asked to complete regular reflective accounts to enhance their learning as well as monitoring and improving practice. We felt that this system enables managers to more effectively support staff and tailor an individual approach to their learning and development. page 22 of 30

23 Staff had received training in 'Empowering Language' to help them work with service users to identify their individual outcomes. This is important as it supports service users to be in control of making decisions about their support as well as showing us that the service is committed to ensuring that staff communicate respectfully and in an empowering manner with people they support. Areas for improvement The manager acknowledged that formal supervision has not been as frequent as it should be given the recent staffing changes and other competing priorities in the service. Staff we spoke to that had not had supervision regularly over the past year told us that it had not made a difference as they still got regular protected time and that senior staff and managers were always available for them to speak to and would address any issues as they arouse. We discussed with the manager the need for formal, recorded supervision sessions to be as per the organisation's policy which also ensures that a range of areas are discussed rather than just addressing issues as and when they arise. Whilst we saw that the service has started to support staff to understand the recommendations from the Keys to Life and Winterbourne View reports, we felt that further work is required for staff to fully understand how this is related to the support that they provide. The manager informed us that the organisations training department is currently looking at developing training in this area which will be rolled out to all staff. The service is also working on a document to support the understanding of both staff and service users in these areas in a more practical sense, as well as evidence how the service meets the relevant recommendations. Grade 5 - Very Good Number of requirements - 0 Number of recommendations - 0 page 23 of 30

24 Quality Theme 4: Quality of Management and Leadership Grade awarded for this theme: 5 - Very Good Statement 1 We ensure that service users and carers participate in assessing and improving the quality of the management and leadership of the service. Service Strengths We found that that the service continued to perform to a very good standard in ensuring the service users and carers participate in assessing and improving the quality of management and leadership of the service. We decided this after speaking with service users, staff and managers and considering supporting documentation. The strengths noted under quality theme 1, statement 1 also apply to this statement. Areas for improvement The areas for development noted under quality theme 1, statement 1 also apply to this statement. We heard from the Community engagement and activities lead, that there are plans to develop ways for service users to become more involved in the management and leadership of the organisation including consulting them on the development of policies and ways of working. We look forward to seeing how this has progressed at the next inspection. Grade 5 - Very Good Number of requirements - 0 Number of recommendations - 0 page 24 of 30

25 Statement 3 To encourage good quality care, we promote leadership values throughout the workforce. Service Strengths We found that the performance of the service to be very good at encouraging good quality care by promoting leadership values throughout the workforce. We decided this after speaking to staff and service users and considering evidence relating to management, leadership and quality assurance. The participation methods mentioned in other sections of this report such as service user meetings and service questionnaires, evidence that service users are enabled to provide feedback and assess the quality of service provided. Systems described in quality theme 3, evidence how the service is committed to ensuring staff understand their roles and are encouraged to take responsibility for their own learning and development Staff and service users were very complimentary about the management and leadership of the service and we heard very positive comments about the support that is provided by the manager and deputy service managers. Staff and service users told us they feel comfortable to approach senior staff to voice any concerns they have and are confident that they will be addressed. The organisation has developed a new training programme for the Deputy Service Managers which provides them with the skills and knowledge to take on a more senior role which involves the supervision and development of staff. This training is for existing as well as new deputy service managers and the feedback from staff is very positive and they are confident it will help them fulfil their role. page 25 of 30

26 The organisation has also developed a leadership forum which is supporting staff to share ideas and best practice across the organisation. We saw that there was a Loretto Excellence and Quality manual for the service. The purpose of this file is to act as a reference tool for managers in achieving quality in their service and continual improvement for excellence. The quality policy is part of the manual which also includes various quality monitoring document templates. We saw examples of staff being supervised in the administration of medication. This was a new system where staff are to be shadowed every six months when administering medication. This is to identify where staff may need further support and to ensure they remain competent in the process. The examples of auditing that we saw showed us that the managers are committed to constantly assessing the quality of the service being provided and ensuring high standards are achieved and maintained. Areas for improvement The service is beginning to use the 'step into leadership' programme developed by the Scottish Social Services Council to promote effective leaderships throughout all levels of the staff team. Initially this is going to be taken forward with the Deputy Service managers. The manager acknowledges that some systems (such as supervision, practice observations and audits) have not been implemented as fully as they should have been over the past year as the service has struggled with a change in staff structure, a period of being short staffed, a number of new staff being recruited and some challenges with the people they support. It was discussed that the manager has responded well to the difficult circumstances and been supported by the staff team to enable a good level of support to be provided. They now need to ensure that all the relevant systems and processes are being utilised to promote the development and continued good practice in the service. page 26 of 30

27 Grade 5 - Very Good Number of requirements - 0 Number of recommendations - 0 page 27 of 30

28 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. 7 Enforcements We have taken no enforcement action against this care service since the last inspection. page 28 of 30

29 8 Additional Information There is no additional information. Inspection report 9 Inspection and grading history Date Type Gradings 8 Oct 2014 Unannounced Care and support 5 - Very Good Environment Not Assessed Staffing 5 - Very Good Management and Leadership 5 - Very Good 9 Oct 2013 Announced (Short Notice) Care and support Environment Staffing Management and Leadership 4 - Good Not Assessed 5 - Very Good 4 - Good 1 Nov 2012 Unannounced Care and support 5 - Very Good Environment Not Assessed Staffing 4 - Good Management and Leadership 5 - Very Good 20 Sep 2010 Announced Care and support 4 - Good Environment Not Assessed Staffing Not Assessed Management and Leadership 5 - Very Good 24 Sep 2009 Announced Care and support 5 - Very Good Environment Not Assessed Staffing 4 - Good Management and Leadership 4 - Good 1 Dec 2008 Announced Care and support 4 - Good Environment Not Assessed Staffing 4 - Good Management and Leadership 4 - Good 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