Care service inspection report

Transcription

1 Care service inspection report Full inspection Bield Housing Association - Flexicare (Glasgow) Support Service 1 Coxton Gardens 71 Coxton Place Garthamlock Glasgow Inspection completed on 28 April 2016

2 Service provided by: Bield Housing & 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 31

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 Quality of management and leadership 4 Very Good N/A Good What the service does well The feedback we received from people who use this service and their carers was generally positive. Overall, this is a service that is continuing to perform at a good level. What the service could do better The service needs to continue to review how it plans to fill the managers post on a permanent basis going forward. The daily notes could be more person centred, detailed and informative. The service should continue to make progress in establishing the legal status or people who use the service. What the service has done since the last inspection The service was continuing to make good progress in implementing 'Promoting Excellence training in dementia'. The service had further developed the range of activities and resources for service users to access. page 3 of 31

4 The service has developed a new 'Performance and Development Framework' which fits in with the Scottish Social Services Council (SSSC) Framework for Continuous Learning (FCL). The service was moving towards an outcome focused approach and was developing 'life story work' and a new 'one page profile' and a new care plan format. The service continues to perform well and we look forward to seeing this performance being consolidated and improved going forward. Conclusion This service has performed well in all the areas we inspected and we found that outcomes for people who use it were generally good. Managers and staff in this service are committed to providing the best possible standard of support to people with dementia. Both the people who use the service and their carers benefit greatly from the support provided by Bield Flexicare. page 4 of 31

5 1 About the service we inspected Inspection report Bield Flexicare service provides support to people with dementia and their carers living in North, East and West Glasgow. The service provides social and befriending support to people in their own homes and in the community. This maintains social links and stimulation for people who use the service and respite for their carers. There is a range of activities available to people such as outings, visiting favourite places, eating out, shopping, exercise sessions and support with overnight short breaks. One of the aims of the service is "to work closely with service users, their families and other main carers, developing a responsive needs led service". 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. page 5 of 31

6 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 - N/A Quality of management and leadership - Grade 4 - 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 31

7 2 How we inspected this service The level of inspection we carried out In this service we carried out a medium intensity inspection. We carry out these inspections where we have assessed the service may need a more intense inspection. What we did during the inspection We wrote this report following an unannounced inspection. This was carried out by one Inspector. The inspection took place on Thursday 28 April 2016 between 9.40am and 3.10pm. We gave feedback to the resource manager and senior on Thursday 28 April As part of the inspection, we took account of the completed annual return and self assessment that we asked the provider to complete and submit to us. We sent fifty-one care standards questionnaires to the manager to distribute to service users and relatives. Four service users sent us completed questionnaires. Relatives and carers returned nine completed questionnaires before the inspection. We also asked the manager to give out seventeen questionnaires to staff and we received four completed questionnaires. During this inspection process, we gathered evidence from various sources. We spoke with: - The resource manager - The senior. We looked at: - Complaints policy and procedure - Care plans - Accidents and incidents records - Management audits - Risk assessments - Training records - Supervision and appraisal records page 7 of 31

8 - Registration certificate - Certificate of insurance. 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 8 of 31

9 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 Care Inspectorate received a fully completed self assessment document from the provider. We were satisfied with the way the service provider had completed this and with the relevant information they had given us for each of headings that we grade them under. The provider identified what they thought they did well, some areas for development and any changes it had planned. The service provider told us how the people who used the care service had taken part in the self assessment process. Taking the views of people using the care service into account We sent out fifty-one Care Service questionnaires to service users and four were returned. All the respondents strongly agreed or agreed when they were asked, 'Overall, I am happy with the quality of care and support this service gives me'. One respondents said they did not know about the services complaint procedure, and one did not know they could also make a complaint to the Care Inspectorate. We received the following comments in the Care Service Questionnaires we issued to service users: "I enjoy the service especially when the dog comes to visit." "Who has ever sat down with me to go through a page 9 of 31

10 list of 'can do' and 'cant do'. I have learnt the opportunities of them in the process of care. my main carer is very good most helpful and I think we get on well together. The carer is very supportive in meeting my needs. I feel I also get on well with the occasional helpers who fill in when my main carer is not available." Inspection report Taking carers' views into account We sent out fifty-one Care Service questionnaires to relatives and nine were returned. All the respondents strongly agreed or agreed when they were asked, 'Overall, I am happy with the quality of care and support this service gives me'. Two respondents said they did not know about the services complaint procedure, and one did not know they could also make a complaint to the Care Inspectorate. One respondent disagreed when asked ' the service checks with me regularly they are meeting my needs' and two disagreed when asked 'the service asks for my opinions on how it can improve'. We received the following comments in the Care Service Questionnaires we issued to relatives: "The service is meeting the needs of my relative at present. The fact the service is flexible on a demand led basis is really useful. Consistency of staff member is important to my relative given their condition. Staff and their management seem to be aware of my relatives specific needs and are keen to meet these as best they can". "The service has been exemplary. Bield is always willing to help and accommodate changing needs. I would recommend Bield to anyone else". page 10 of 31

11 "The service my relative receives and the people providing it are very acceptable. My relative feels respected and engaged". "The staff at Bield are very good. The carer who takes my relative out is outstanding nothing is too much for the carer". "I would say that bright bubbly and quick isn't always the approach required, best received or most constructive. A softer, gentler approach may be more revealing. Some staff achieve this instinctively. Staff do seem happy to be there. Overall, I am pleased that my relative is cared for by Bield and their staff. Individual requirements are addressed". Inspection report page 11 of 31

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 Inspection report Statement 3 We ensure that service users' health and wellbeing needs are met. Service Strengths We found that performance by this service continued to be very good in the areas covered by this statement. We concluded this after we looked at support plans and related recordings and spoke with staff, the resource manager, and service users and relatives views from completed questionnaires. We found the care and support to be provided was discussed with the person using the service and their carer at their initial assessment according to their needs and preferences. We found that there was a good range of activities on offer for service users to help reduce social isolation, such as visits to the pub for lunch, the theatre to see a show, visits to local parks and various exercise classes. People were generally supported consistently by the same workers who got to know them well and the things they liked to do. The service had a very good resource library for people who use the service to borrow a range of resources such as those for reminiscence, assistive technology, games and fact sheets on topics such as dementia, advocacy and safeguarding people with dementia. We found that the service had good links with healthcare professionals, regularly liaised with GP and district nurse, and often referred people to health professionals such as the Community Psychiatric Nurse or Occupational Therapist. Where it was identified as part of the support plan, staff supported people to attend hospital, GP and chiropodist appointments. page 12 of 31

13 Appropriate risk assessments were in place and there was an appropriate system in place for reporting accidents and incidents. From the records we saw we found that the majority of staff had recently attended training in Adult Support and Protection. We found that care plans were being reviewed at least once in every six months to comply with legal requirements. We were pleased to see that the care plans were generally being written in a person centred was and it was good to see the service has started 'life story' work. We also found that the service has developed a one page profile. We look forward to seeing how the information from life story works improves the outcomes for service users. We were pleased to see that Bield were currently developing new care plans and plans were in place for staff to attend ' Talking Points' outcome focussed training. We looked at the 'Striving to Achieve Results' STAR system where it said "Every individual will have a support plan that is based on assessed needs, is life story based, is outcome focussed and agreed with them". We share Bields aspiration and we look forward to seeing how this is progressing at the next inspection. Overall the feedback from the majority of people who use the service and their relatives was very positive with the majority indicating that they were satisfied with the service they received. Areas for improvement The provider should continue to monitor the very good quality of care. The provider should ensure it is rigorous in identifying any areas for improvement and implementing action plans to address these. page 13 of 31

14 We reported on at previous inspections and made a recommendation in relation to the information in care plans and in relation to Power of Attorney (POA). We were advised at this inspection that the provider was in the process of developing a letter to request confirmation of POA, however, this has not yet been rolled out. This element of the recommendation has not been met and will be restated. At this inspection we found that the quality of information varied with some very good person centred information e.g. "I would like you to shout when entering the house and I will shout back to you" and some not so good e.g."i would like staff to ask me if I would like support to have a bath". We acknowledge that the provider has recognised this and is moving a new care plan and this is commented on service strengths. However, we also thought the quality of information could be more 'outcome focussed' in the 'mystery shopper' visit and on care system. Examples of how to achieve this were discussed with the Manager and Senior during the inspection. We will continue to monitor the progress the service is making at the next inspection. This recommendation has not yet been met and will restated. (see Recommendation 1) Inspection report We signposted the service to the Joint Improvement Team publication 'Talking Points Personal Outcomes Approach Practical Guide' for information and guidance. We signposted the service to the British Association Occupational Therapy (BAOT) publication, 'Living well in care homes' for information and guidance. We signposted the service to the 'The Improvement Hub' website ( ) the new improvement resource for health and social care with a suite of programmes and a dedicated team all in place to support health and social care services to improve for information and guidance. page 14 of 31

15 Grade 5 - Very Good Number of requirements - 0 Recommendations Number of recommendations The provider should ensure that the service accurately records how care is to be carried out and records reflect the level of communication between staff and the service. The provider should ensure that information on power of attorney is in place. (National Care Standards care at home Standard 3:Your personal plan, Standard 11:Expressing your views, Standard 4:Management and staffing). page 15 of 31

16 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 provides. Service Strengths The service used a range of ways to ensure that service users were fully informed. This included a welcome pack which contained information on the services complaints procedure. We thought the information in the welcome pack was detailed and comprehensive and gave service users all the information they needed to make an informed decision. This included contact details, information on Power of Attorney ( POA ), Striving to Achieve Results ( STAR ) leaflet, dementia standards and a mission statement. We also found that the service had comprehensive detailed and informative 'Service User Agreement' (SUA) which was issued to service users and this was signed and dated. Each service user was issued with a letter detailing the charges for using the service. The information we saw detailed service users rights and responsibilities. We found that each service user had a named key worker in place who was responsible for the needs of individual service users. We found that service user had access to independent advocacy. page 16 of 31

17 Areas for improvement We would like to see information on how service users can access the latest Care Inspectorate report. Grade 5 - Very Good Number of requirements - 0 Number of recommendations - 0 Inspection report page 17 of 31

18 Quality Theme 3: Quality of Staffing Quality theme not assessed page 18 of 31

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 We found that the services performance was good in this statement. It was good to see that regular staff meetings were taking place. We found that staff had 'Dementia Training' as part of the Scottish Government 'Promoting Excellence' initiative. See comments under Areas for Improvement. We saw up to date training records were in place for staff and we saw good examples of appropriate training such adult support and protection, dementia, medication, first aid, Parkinson's, stroke awareness epilepsy and palliative care. The service had a detailed training plan for The service has developed a 'Performance and Development Framework' (PDF). This was to be introduced on a department and team by team basis over a twelve month period. The provider said in the literature that we saw 'this fits within the parameters of the SSSC's Continuous Learning Framework'. We look forward to seeing how this develops at future inspections. Inspection report Records indicated that all staff had an SVQ level II equivalent or above; We found there was a stable staff team with no turnover of staff in this service since the last inspection. Service users indicated that it was generally the same staff who visited them. page 19 of 31

20 Staff indicated that they received very good training relevant to their job and could request specific training in areas that interested them to help them support individuals. We found that the service had compiled a resource library of good practice information for staff to refer to keep them up to date with current best practice. Staff indicated that they had a good team, were well supported and enjoyed their work. They felt that managers were approachable and they could contact them at any time if they had any questions or concerns. We issued seventeen Staff Care Inspectorate Questionnaires (CSQ) before the inspection and four were returned. No concerns or issues were raised in the CSQ. We received the following comments from the CSQ's: 'I have been given a lot of support and have felt very valued as an employee'. 'Training is offered and undertaken regularly. I am satisfied that my needs and objectives are supported by my line manager and that the support offered to service users is of a high standard offering person centred care package'. Areas for improvement It was good to see that regular staff meetings were taking place. However, not all staff attended these meetings. We found that this could be less than 50%. We were advised that it was part of staffs terms and conditions to attend meetings and they could be subject to disciplinary procedures for not attending. We would like to see practice issues being introduced for discussion at staff meetings. We would like to see as many staff as possible attending staff meetings. This was discussed with the manager during the inspection. page 20 of 31

21 A significant number of staff had completed 'Dementia Training' as part of the Scottish Government 'Promoting Excellence' initiative. It was not clear how this had improved outcomes for people who use the service. We look forward to seeing if the new care plan format and the 'Performance and Development Framework' ( PDF ) address this going forward. We said at the last inspection that the service had completed a pilot and were rolling out 'People Performance Framework' to manage staff development and were planning to implement the Scottish Social Services Council (SSSC),'The Framework for Continuous Learning in Social Services' ( FCL ). We were advised at this inspection that the 'People Performance Framework' was no longer being used and the service was moving to new 'Performance and Development Framework' ( PDF ). This was to be introduced on a department and team by team basis over a twelve month period. The provider said in the literature that we saw 'this fits within the parameters of the SSSC's Continuous Learning Framework'. We were presented with the 'Performance and Development Framework Guidelines 2016/2017' Inspection report We did not see any guidance on how 'reflective practice' would be recorded. We were not presented with any completed PDF to evaluate at this inspection, therefore, we were unable to evaluate if the documents contained 'reflective practice' and would support staff to maintain their registration with SSSC. We will evaluate how the PDF is being implemented at the next inspection and we look forward to seeing how this new system is developed going forward. We signposted the service to the Scottish Social Services Council (SSSC) website for 'Step into leadership' Leadership learning pathways for Scotland's social services for information and guidance. We signposted the service to the Institute for Research and Innovation in Social Services ( iriss ) publication 2015 'achieving effective supervision' for information and guidance. We signposted the service to 'Reflective Writing Guidance notes for students' page 21 of 31

22 April for information and guidance. We also suggested that it is important that the provider informs staff that it is an element of the Scottish Social Services Council (SSSC ) Codes of Practice 6:- "As a social service worker, you must be accountable for the quality of your work and take responsibility for maintaining and improving your knowledge and skills", that staff take equal responsibility for their own learning and development. Grade 4 - Good Number of requirements - 0 Number of recommendations - 0 Inspection report page 22 of 31

23 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 We found that the performance of this service was good in this statement. We found that there were good systems for monitoring quality in this service. These included: The manager, deputy manager and senior carried out regular checks on staff working in people's homes which were recorded in Observation Records and included the views of people using the service, carers and the staff themselves. The service used the 'CARESYS' IT system to monitor all aspects of the service to ensure that everything was up to date and complete. Management had access to the daily notes written by staff and monitored the information in them. We continued to find that entries were variable with some well written and contained appropriate detail and some were not as informative or detailed. We found at this inspection that a new quality assurance system' Striving to Achieve Results(STAR) had been developed and the service was due its first audit under the new system in May 2016.The new system focusses on 'outcomes' and we look forward to seeing how this improves outcomes for service users going forward. The service had attained the Customer Service Excellence Award for quality which was assessed annually. The service had an internal audit system in place and a system to record accident and incidents. The service had a complaints procedure in place. It was good to the service continued to operate a system of 'mystery shopper' visits to check on staff. We suggested this could be developed further by checking staff have arrived and left on the allotted time, they are following the page 23 of 31

24 support plan,the service reminds service user on how to raise a complaint and to introduce a schedule to ensure all staff are visited periodically. We again offered advice on how the information recorded at such visits could be better and this was discussed with the senior and manager during the inspection. e.g. We saw that staff "chatted "with service users, however, there was no information on what they talked about and there were no direct quotes from service users to indicate their views or how they were feeling. We are hopeful that the quality of information recorded will improve as the service moves to a more outcome focussed approach. We were advised that the service has received had no in-house complaints since the last inspection. Areas for improvement The provider should continue to monitor the good quality assurance systems. The provider should ensure it is rigorous in identifying any areas for improvement and implementing action plans to address these. We said at the last inspection that the service has been without a permanent manager since November The service is currently managed on a temporary peripatetic basis. We have asked the provider to write to the Care Inspectorate detailing the plans they have on how they propose to manage the service on a permanent basis going forward. We received the following response from the provider: 'We are in the process of recruiting a full-time manager on a temporary basis for six months. The position is only temporary as Bield are currently reviewing all of it's services within Glasgow due to the Tender Framework'. We were pleased to see that a new manager was now in place. However, we were advised that this was on a temporary contract basis until October This creates a degree of uncertainty and continuity for the future management of the service. We will continue to monitor the position of manager going forward until a permanent manager is appointed. We have reworded the requirement. This requirement is not met and is restated. Inspection report page 24 of 31

25 (see Requirement 1 ) We continued to find that the some of the information for people on how to make a 'Complaint' did not always include the name and address of the Care Inspectorate. We continue to find that several people said in completed CSQ's that they did not know about the services complaints procedure and did not know they could make a complaint to the Care Inspectorate. This should be addressed. We said at the last inspection that the quality of information recorded in 'caresys' did not always reflect and detail the engagement that the service had with service users. We continued to find that this was still the case. This was discussed during the inspection. (see Recommendation 1) We said at the last inspection that we did not find any evidence of how issues resulting from the internal audit system were being addressed. We also said at the last inspection that a support plan audit was in place, however, this could be further developed by including information on the quality of information contained in care plans. We have already commented under service strengths in this report that a new quality assurance system' Striving to Achieve Results( STAR ) had been developed and the service was due its first audit under the new system in May The new system focusses on 'outcomes' and we look forward to seeing how this improves outcomes for service users going forward. It is too early to assess the effectiveness of the new STAR quality assurance system. We will evaluate the STAR quality assurance system at the next inspection to assess whether the issues identified previously are addressed. It is clear the provider has taken steps to address this recommendation, however, we need to see if this is effective in practice. page 25 of 31

26 This recommendation is not met and is restated. (see Recommendation 2) We thought the service could improve the way in which activities were planned, managed and evaluated. We thought the service provided good activities for service users, however, these were not always demonstrated effectively. e.g. photos with no dates on them or narrative to give context or information on how service users enjoyed the activity, Activities were recorded in daily notes which was not the most effective way to access what activities had taken place. Therefore,we signposted the service to the British Association Occupational Therapy (BAOT) publication, 'Living well in care homes' for information and guidance. Grade 4 - Good Requirements Number of requirements The provider must continue to review the arrangements which have been made for the running of the service and how they propose to manage the service on a permanent basis going forward. This is order to comply with:- SSI 2011/210 Regulation 17.(c) Appointment of manager. Timescale for meeting this requirement: Within six months from receipt of this report. Recommendations Number of recommendations The provider should ensure that the quality of information recorded in 'caresys' accurately reflects the conversation and views of service users. page 26 of 31

27 (National Care Standards care at home Standard 11: Expressing your views, Standard 4: Management and staffing) 2. The provider should ensure that there is information on how issues arising from the internal audit system are addressed. (National Care Standards care at home Standard 4: Management and staffing) page 27 of 31

28 4 What the service has done to meet any requirements we made at our last inspection Previous requirements 1. The provider must notify the Care Inspectorate of the arrangements which have been made for the running of the service during that absence; and the name, address and qualifications of the person who will manage the care service during that absence. This is order to comply with:- SSI 2002/114 Regulation 22.(2)(c)(d) Notice of absence. Timescale for completion: On receipt of this report. This requirement was made on 23 April 2015 Please see comments under Quality Statement 4.4 Not Met 2. The provider must ensure that the complaints procedure includes the name and address of the Care Inspectorate and that all service users, their relatives and carers are made aware that they can raise a complaint directly with the Care Inspectorate. This is in order to comply with SSI 2011/210 Regulation 18.(1)(2)(3)(4)(5)(6)(a)(b)(7)(8) Complaints. Timescale for meeting this requirement: within six months of receipt of this report. This requirement was made on 23 April 2015 This requirement has been met and will be removed. Met - Within Timescales page 28 of 31

29 5 What the service has done to meet any recommendations we made at our last inspection Previous recommendations There are no outstanding recommendations. Inspection report 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 23 Apr 2015 Unannounced Care and support 5 - Very Good Environment Not Assessed Staffing 5 - Very Good Management and Leadership 4 - Good 20 May 2014 Unannounced Care and support 5 - Very Good page 29 of 31

30 Environment Staffing Management and Leadership Not Assessed 5 - Very Good 4 - Good 5 Aug 2013 Announced (Short Notice) Care and support Environment Staffing Management and Leadership 6 - Excellent Not Assessed 5 - Very Good 5 - Very Good 23 Aug 2012 Unannounced Care and support 6 - Excellent Environment Not Assessed Staffing 5 - Very Good Management and Leadership 5 - Very Good 15 Jun 2010 Announced Care and support 5 - Very Good Environment Not Assessed Staffing Not Assessed Management and Leadership 5 - Very Good 23 Jul 2009 Announced Care and support 5 - Very Good Environment Not Assessed Staffing 5 - Very Good Management and Leadership 4 - Good 8 Dec 2008 Announced Care and support 5 - Very Good Environment Not Assessed Staffing 3 - Adequate Management and Leadership 4 - Good page 30 of 31

31 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 cànain eile ma nithear iarrtas. page 31 of 31