Care service inspection report

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1 Care service inspection report Full inspection Rosyth Support Service - Leonard Cheshire Support Service 195 Queensferry Road Rosyth Dunfermline Inspection completed on 26 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 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 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 used the service and their families are involved in developing the support provided to meet their individual needs. 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, and to ensure that they have access to all the training they need and any necessary refreshers within appropriate timescales. What the service has done since the last inspection 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. page 3 of 31

4 Conclusion Inspection report The service provided high quality care and support. Staff were committed to supporting people to participate in meaningful activities in their local community. page 4 of 31

5 1 About the service we inspected Inspection report Rosyth Support Service is a service provided by Leonard Cheshire Disability. The service is registered to provide a support service to a maximum of 12 people a day who have learning disabilities and physical and sensory impairments. The service currently operates Monday to Saturday. The service is centrally located within Rosyth and is close to local amenities and bus routes. There is a secure and secluded garden area to the rear of the building which is accessible to people with physical disabilities. 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. 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 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 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 The service was inspected during an unannounced visit on the 25 May 2016 and a further announced short notice visit on 26 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 31

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 31

9 Feedback was provided to the team leader, service manager and acting care supervisor on 26 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 31

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 PECS picture exchange as a form of communication. Taking carers' views into account Prior to the inspection we received two completed Care Standards Questionnaires (CSQs) from relatives, these strongly agreed that they were overall happy with the care and support provided. Four relatives were spoken with, three by telephone and one face to face. They told us that they were happy with the support provided to their loved ones, and that they felt involved and included. page 10 of 31

11 Comments included: - "Communication - Has a keyworker, parents have handover from staff am and evening - staff complete daily diary - Communication is intuitive staff speak in person and use diary. Was concerned when X was leaving school if communication would be as good, have not been disappointed". - "Transition was difficult as didn't know process last transition was starting school. What helped me pick this service was personal recommendation from parents of X's peers parents, helped seeing others, and reduced my anxieties". - "I felt service really got a grip of X as a person very reassuring that they know people as individuals, very respectful". - "Any problems we will all work out what we can do, plenty ideas and suggestions from staff". - "X understands simple verbal language - understand body language staff very observant. He can use signs verbal cues more important give choices which are meaningful - simple choices". - "We are involved in putting together support plan - reviews, review today - social worker invited and respite service; new social worker didn't turn up. We focus on what we want to achieve. For example, X has new contact lenses having problems with them staff have worked with me to learn how best to support X". - "Overall - when approaching transition felt so fearful if I knew then what I know now I wouldn't be so fearful. I feel very privileged that we have what we have. Feels like a family, sense of camaraderie, staff friendly and professional. Will keep in touch and mention everything about his day, couldn't ask for better. They capture in communication book small, seemingly trivial things which mean a lot and say a lot about who X is". - "X Spends time between service building and being out and about. Loves listening to music, swimming, disco and bowling". page 11 of 31

12 - "If there is anything I am not happy with will get on phone straight away. Reviews six monthly if anything they want to bring up any changes discussed". - "Feedback from staff am and evening and X has a diary, I write in it and staff write in it". - "Staff definitely know X well always treat her with respect". - "Communication is very good we have regular review meetings if anything at all, I will contact centre and meet staff. We meet a few times per year. We are involved in decision making as a family, we help her make decisions". - "X has advocate who attends review with keyworker, respite staff therapists, social worker". - "Couldn't be any happier with service, like a family. If any worries or if X unwell very supportive as a team". - "X has talker machine to communicate once you get to know them well you can understand her verbal communication. She also has Ipad and we are working with staff and have added photos of family, this helps when there are new staff". - "Service works well, feel comfortable and don't need to worry about X when she is at day support". - "Service very, very good, X attends Mon - Fri - she loves it". - "Meet with staff and if anything crops up staff contact me or I call them. Staff write in the diary". - "I have never had to complain staff know X well and all her wee tricks". - "X needs a special diet and is high risk of choking. Staff will always contact me if anything crops up, I can trust staff". page 12 of 31

13 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 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 people using the service where appropriate had their health needs assessed and met. Health professionals spoken with as part of the inspection said: - "Most people are quite stable. One service user we met regularly and there was an action plan, roles and responsibilities and Leonard Cheshire stepped up to the mark and monitored". - "Staff good at keeping in touch even will contact with something to run by me". page 13 of 31

14 - "Have provided training - overall PEG care. I will run study day or visit service, there is also trainer within Leonard Cheshire". - "Staff are very aware of persons needs. I have observed staff practice with one service user, staff knowledgeable, willing to look at other activities person might be involved in, very proactive". - "Staff implement SALT strategies". - "Staff - if they have any concerns they will raise them with me". - "I have a long history of working with the service. The manager doing quite a good job, people have goals, what they want to achieve". - "They have guidelines for people and ask me to provide training for staff. They are more flexible about getting training done. Service will refer to me, not always proactive usually in response to something happening". - "Better service than it previously was". Inspection report 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, 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 page 14 of 31

15 hard to improve their communication skills and there was some very good examples of staff using these observed during the inspection. Families told us: Inspection report - "X understands simple verbal language - understand body language staff very observant. He can use signs verbal cues more important give choices which are meaningful - simple choices". - "X has talker machine to communicate once you get to know them well you can understand her verbal communication. She also has Ipad and we are working with staff and have added photos of family, this helps when there are new staff". People using the service were supported to access activities which helped them to remain healthy such as, exercises, dancing, walking, swimming, bowling, and music therapy. Staffing ratios were on a one to one basis which meant that people received flexible support to get out and about. The provider and service had a complaints policy and procedure which gave people further opportunities to give their views on the quality of care and support provided. No complaints had been received at the time of the inspection. People were seen to have access to regular care reviews which were format for them to discuss what worked well and what didn't, and to also contribute to setting and measuring progress towards meeting outcomes for people. There was very good evidence observed during the inspection through examination of documentation, and discussion with relatives and health professionals that staff were aware of each individual's health needs. They worked well with other health professionals to ensure that these were assessed regularly and addressed (see areas for improvement). When asked about what they thought about the quality of care and support provided, relatives said: page 15 of 31

16 - "Communication - Has a keyworker, parents have handover from staff am and evening - staff complete daily diary - Communication is intuitive staff speak in person and use diary. Was concerned when X was leaving school if communication would be as good, have not been disappointed". - "Transition was difficult as didn't know process last transition was starting school. What helped me pick this service was personal recommendation from parents of X's peers parents, helped seeing others, and reduced my anxieties". - "Any problems we will all work out what we can do, plenty ideas and suggestions from staff". Inspection report - "We are involved in putting together support plan - reviews, review today - social worker invited and respite service; new social worker didn't turn up. We focus on what we want to achieve. For example, X has new contact lenses having problems with them staff have worked with me to learn how best to support X". - "X spends time between service building and being out and about. Loves listening to music, swimming, disco and bowling". - "If there is anything I am not happy with will get on phone straight away. Reviews six monthly if anything they want to bring up any changes discussed". - "Feedback from staff morning and evening and X has a diary, I write in it and staff write in it". - "Communication is very good we have regular review meetings if anything at all, I will contact centre and meet staff. We meet a few times per year. We are involved in decision making as a family, we help her make decisions". - "X has advocate who attends review with keyworker, respite staff therapists, social worker". - "Couldn't be any happier with service, like a family. If any worries or if X unwell very supportive as a team". page 16 of 31

17 - "Service works well, feel comfortable and don't need to worry about X when she is at day support". - "Service very, very good, X attends Mon - Fri - she loves it". Areas for improvement We found that support plans and care files contained a lot of detailed information, particularly in relation to people's 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. We also found that in some instances that the hazards identified were recorded as control measures an example being the safe storage of medication being recorded as a hazard. In order to ensure that the people who use the service are involved as much as they can be in decision making and having their support needs met. The provider to continue with plans to ensure all staff have up to date training in effective communication. The support plans were seen to contain important details of where a person had a legal guardian and who should be contacted in relation to being involved in decision making in relation to people's health and wellbeing needs. A discussion was held during feedback on refreshing staff knowledge and understanding of working with adults with incapacity and where to access best practice guidance via the Mental Welfare Commissions website or the Care Inspectorates Hub. Grade 5 - Very Good Number of requirements - 0 Number of recommendations - 0 Statement 5 Inspection report page 17 of 31

18 We respond to service users' care and support needs using person centered values. 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 (see quality theme 1, statement 1). 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 observed and spoken with clearly knew the individuals they supported very page 18 of 31

19 well and worked hard to help them have their support needs met. This was also confirmed by relatives spoken with who said: - "Overall - when approaching transition felt so fearful if I knew then what I know now I wouldn't be so fearful. I feel very privileged that we have what we have. Feels like a family, sense of camaraderie, staff friendly and professional. Will keep in touch and mention everything about his day, couldn't ask for better. They capture in communication book small, seemingly trivial things which mean a lot and say a lot about who X is". - "Staff definitely know X well always treat her with respect". - "Communication is very good we have regular review meetings if anything at all, I will contact centre and meet staff. We meet a few times per year. We are involved in decision making as a family, we help her make decisions". - "Service works well, feel comfortable and don't need to worry about X when she is at day support". - "I have never had to complain staff know X well and all her wee tricks". Inspection report 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 outcomes recorded were seen to be generic and not reflect what the outcome would be for them individually. In addition some of the person centred recording was seen to be inconsistent with some recorded in the third person and some using the first. The manager and staff to continue to work with the people they support and families to identify person centred activities which support them to actively engage with their local communities. page 19 of 31

20 Grade 5 - Very Good Number of requirements - 0 Number of recommendations - 0 page 20 of 31

21 Quality Theme 2: Quality of Environment Quality theme not assessed page 21 of 31

22 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 22 of 31

23 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 were aware of the providers whistleblowing policy (see areas for improvement). Team meetings were held regularly and topics such as health and safety, person centred planning/reviews, compliments and complaints, progress since last meeting/focus for next, communication training, communication book, policy updates, service user agenda items, Saturday service, activity changes 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 page 23 of 31

24 - "Any problems we will all work out what we can do, plenty ideas and suggestions from staff". Inspection report - "We are involved in putting together support plan - reviews, review today - social worker invited and respite service; new social worker didn't turn up. We focus on what we want to achieve. For example, X has new contact lenses having problems with them staff have worked with me to learn how best to support X". - "Feedback from staff am and evening and X has a diary, I write in it and staff write in it". - "Couldn't be any happier with service, like a family. If any worries or if X unwell very supportive as a team". - "Meet with staff and if anything crops up staff contact me or I call them. Staff write in the diary". - "X needs a special diet and is high risk of choking. Staff will always contact me if anything crops up, I can trust staff". 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 rights training via careaboutrights.com. In order to enhance staff awareness of their responsibilities about keeping people safe from abuse, the manager should raise awareness of the Winterbourne View report and the recommendations it contains. page 24 of 31

25 In addition, the staff team would benefit from updating their understanding of risk of harm adult support and protection training from Fife Direct, working together training scenarios covering what is harm and the different types of harm. One member of the multidisciplinary team said: - "Will contact me with any adult protection concerns. For example - ongoing issues with food coming from home not being appropriate, staff raise these types of issues with me. Knowledge base re adult support and protection could be improved; there might be situations which they may not recognise as ASP. If they are concerned they do phone me. Always good to improve knowledge base". 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. Families said: - "Any problems we will all work out what we can do, plenty ideas and page 25 of 31

26 suggestions from staff". - "We are involved in putting together support plan - reviews, review today - social worker invited and respite service; new social worker didn't turn up. We focus on what we want to achieve. For example, X has new contact lenses having problems with them staff have worked with me to learn how best to support X". 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 being supported and their families were given their opportunity to provide their views on staff as part of reviews. Staff and management had worked with families, staff and members of the multidisciplinary team 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. This was confirmed by observing staff practice where one individual was seen to be supported by a staff member using PECS. The interaction observed was seen to be sensitive, respectful, supportive and professional. 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 page 26 of 31

27 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. Areas for improvement The manager and staff need to be aware of the gathering of people using the service and staff in the entrance of the building when they were leaving to go out to activities in the community and the impact this has on other people receiving support in other parts of the premises. This 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 distressing. This was discussed during feedback and we were informed the provider was actively looking for other premises which would hopefully help to alleviate this concern. Grade 5 - Very Good Number of requirements - 0 Number of recommendations - 0 page 27 of 31

28 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 28 of 31

29 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 23 Apr 2015 Unannounced Care and support 4 - Good Environment 4 - Good Staffing 4 - Good Management and Leadership 4 - Good 9 Jul 2014 Unannounced Care and support 4 - Good Environment 4 - Good Staffing 4 - Good Management and Leadership 4 - Good 15 Aug 2013 Unannounced Care and support 3 - Adequate Environment 4 - Good Staffing 4 - Good Management and Leadership 4 - Good 4 Aug 2010 Announced Care and support 6 - Excellent Environment Not Assessed Staffing Not Assessed Management and Leadership 5 - Very Good 4 Mar 2010 Announced Care and support 5 - Very Good Environment Not Assessed Staffing 5 - Very Good page 29 of 31

30 Management and Leadership Not Assessed 11 Dec 2008 Announced Care and support 5 - Very Good Environment 5 - Very Good Staffing 5 - Very Good Management and Leadership 5 - Very 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 c?nain eile ma nithear iarrtas. page 31 of 31

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