E2 Support Service Care at Home Westerlea 11 Ellesly Road Edinburgh EH12 6HY Telephone:

Transcription

1 E2 Support Service Care at Home Westerlea 11 Ellesly Road Edinburgh EH12 6HY Telephone: Inspected by: Stephen Ball Karen Fraser, Inspection Manager Type of inspection: Unannounced Inspection completed on: 8 January 2014

2 Contents Page No Summary 3 1 About the service we inspected 5 2 How we inspected this service 7 3 The inspection 12 4 Other information 23 5 Summary of grades 24 6 Inspection and grading history 24 Service provided by: Capability Scotland Service provider number: SP Care service number: CS Contact details for the inspector who inspected this service: Stephen Ball Telephone enquiries@careinspectorate.com E2, page 2 of 26

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 Very Good Quality of Environment 5 Very Good Quality of Staffing 5 Very Good Quality of Management and Leadership 5 Very Good What the service does well The E2 Centre provides a stimulating day service, offering a variety of group activities for people with complex support needs. The service works very well with regards to the care and support planning to meet the individual needs of customers who access the service. Clear support protocols are in place, along with detailed risk assessments. What the service could do better At our last inspection we made a requirement that the service must undertake a review of customers risk assessments on a six monthly basis to meet current legislation. At this inspection, we identified that although progress has been made, there is still room for improvement. We have highlighted this further within this inspection report. What the service has done since the last inspection The service has continued to provide a valuable service to its customers and their carers. E2, page 3 of 26

4 Conclusion Inspection report continued The E2 day centre provides a very good service to its customers and carers and customers we spoke with (and from their comments from the completed inspection questionnaires) told us they were happy with the care and support they received. Although a very good service, there are areas we have identified and discussed with the service provider about further improvement and development. Who did this inspection Stephen Ball Karen Fraser, Inspection Manager E2, page 4 of 26

5 1 About the service we inspected The Care Inspectorate regulates care services in Scotland. Prior to 1 April 2011, this function was carried out by the Care Commission. 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 Requirements and recommendations If we are concerned about some aspect of a service, or think it needs to do more to improve, we may make a recommendation or requirement. - A recommendation is a statement that sets out actions the care service provider should take to improve or develop the quality of the service based on best practice or the National Care Standards. - A requirement is a statement which sets out what is required of a care service to comply with the Public Services Reform (Scotland) Act 2010 ("the Act") and secondary legislation made under the Act, or a condition of registration. Where there are breaches of Regulations, Orders or conditions, a requirement may be made. Requirements are legally enforceable at the discretion of the Care Inspectorate. ABOUT THE SERVICE WE INSPECTED E2 is a day centre run by Capability Scotland to provide day care for adults over the age of 16 who have complex care needs. It has been registered with the Care Inspectorate since 1 April The centre can accommodate up to 18 service users a day. On the day of inspection there were 18 service users in attendance. The service operates from 8:30am until 4 pm Monday - Thursday and from 8:30am until 3:30pm on a Friday. There are opportunities to participate in a range of activities e.g. arts and crafts, music, cooking, social and leisure pursuits and personal development. People who access E2 mainly come from Edinburgh however they also support people from surrounding areas - Fife, Midlothian and East Lothian. 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 - Grade 5 - Very Good Quality of Staffing - Grade 5 - Very Good Quality of Management and Leadership - Grade 5 - Very Good E2, page 5 of 26

6 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. E2, page 6 of 26

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 announced inspection. The inspection was led by inspector Stephen Ball and assisted by inspection manager Karen Fraser. The inspection took place on the 9th of December between 09:30 and 16:15. We provided feedback to the registered manager on the 8th January As part of this inspection, we took account of the completed annual return and selfassessment forms that we asked the provider to complete and submit to us. We sent 20 care standards questionnaires to the manager to distribute to service users, relatives and carers. Eight service users and or relatives sent us their completed questionnaires prior to our inspection. We also asked the manager to give out questionnaires to staff and we received three completed questionnaires. During this inspection process, we gathered evidence from various sources, including the following: We spoke with: * The registered manager of the service. * The team leader. * Three support staff on a 1-1 basis. * Four service users on a 1-1 basis for a brief time. * (We also observed the group activities for a period of time and the working relationships between service users and support staff. We attended: * A care and support plan review meeting, attended by the customer, their carer, their social worker, the keyworker and the registered manager of the service. We looked at: * The service customer involvement policy * Minutes of service user meetings. E2, page 7 of 26

8 * Minutes of staff meetings. * A sample care and support plans. * A sample care and support plan reviews. * A sample of incident and accident reports. * Any complaints the service had received. * Relevant quality assurance information. * Service improvement and development action plans. * Newsletters. * Collated the responses from questionnaires issued to service users, carers and relatives. 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 E2, page 8 of 26

9 What the service has done to meet any requirements we made at our last inspection The requirement The service provider must ensure that support plans are reviewed at least every six months. This is to comply with the Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011(SSI 2011/210) Requirement 5 (2)(b)(ii) - A provider of a care service must review the personal plan at least once in every six month period whilst the service user is in receipt of the service. Timescale: Within 28 days on receipt of this report. What the service did to meet the requirement Evidence seen from the sample of support plans we looked at, reviews with service users were being held on a six monthly basis. The requirement is: Met - Within Timescales The requirement The service provider must ensure risk assessments are undertaken for all residents and reviewed on a 6-monthly basis or less as and when required. This is to comply with the Scottish Statutory Instruments (SSI) 2011 No 210, Welfare of users, (4.1a) make proper provision for the health, welfare and safety of service users National Care Standards, Housing Support, Standard 2 - Management and staffing Timescale: Within 28 days on receipt of this report. What the service did to meet the requirement Whilst we saw evidence that the service had developed in the area of completing risk assessments for service users and reviewing them on a six monthly basis, we did identify some gaps. Risk assessments were not being reviewed for everyone in a consistent manner. We are therefore repeating this requirement. Please see Statement 1.3 for details. The requirement is: Not Met E2, page 9 of 26

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 Inspection report continued Comments on Self Assessment Every year all care services must complete a 'self assessment' form telling us how their service is performing. We check to make sure this assessment is accurate. We received a fully completed self assessment document from the service 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 the headings that we grade them under. The service provider identified what they thought they did well, some areas for development and any changes they planned. Taking the views of people using the care service into account We sent out 20 care standard questionnaires to people using the service, relatives and carers. Eight were returned to us. Feedback from service users Positive comments made included: "E2 is an excellent facility providing me with a tailored service." "Overall my care needs are met however due to staff changes, some of my care is not at the standard I have come to expect at E2." Taking carers' views into account Positive comments made included: "X (service user) has attended the E2 service since leaving school. She is very happy and looks forward to going there Mon to Fri., joining the various groups and activities they plan for. We have regular reviews in which other agencies like the respite service and others from the Action Group are invited to. I make contact via the communications books or by telephone. The E2 service is the hub of X's doing and she looks forward to going and I know she is well looked after." E2, page 10 of 26

11 Views of staff We received three completed questionnaires from staff. The majority of the responses were very positive. E2, page 11 of 26

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 We found the service to work very well to involve customers and their carers in assessing and improving the quality of the service provided. Capability Scotland (the service provider) has a customer involvement policy which details the variety of opportunities which are available to customers to have a voice about the service they receive and how it can be shaped by their involvement. The opportunities included: * Setting their personal goals they would like to achieve through their support plan with the support from the service. * Person centred support planning. * Involvement in the recruitment of staff (commented on further in statement 3.1 of this inspection report). * Information on how to take part in the review of the support plan and provide feedback. * A suggestion scheme is available to people * Annual satisfaction survey. The service provider also operates a procedure called `Have your say`. This in essence is a platform customers and carers can use to give feedback on any aspect of the service they receive, whether positive or as an area of development. Capability Scotland also has a customer involvement co-ordinator, whose primary role is to continuously explore ways to obtain feedback from customers and their families to support the process of continuously improve and develop the service they receive. E2, page 12 of 26

13 We looked at the `Have your say` comments from people. The large majority were very positive about their experiences of using the service. Each customer and carer / parent is asked to complete a service satisfaction survey at the stage of reviewing the individuals support plan. The questionnaire asks the following questions: 1. Are you happy with the service provided? 2. Do you feel involved in everything which you feel is important to you? 3. Do you feel your keyworker as the level of training required to meet your needs? 4. Do you feel safe and secure? 5. A review of three outcomes set previously and three outcomes moving forward? 6. Additional comments. These questionnaires play part of the quality assurance systems operated by the service provider, to assess the performance of the service and how it meets the support needs of their customers. We read a copy of the most recent annual customer satisfaction survey and again the findings were very positive. The service also had information available to people on how they can make a complaint to either the service or the Care Inspectorate. This was in the format of the complaints procedure and information displayed on notice boards within the service. The service has not received any formal complaints since our last inspection. A newsletter was also in place and displayed on the notice board within the service. It contained useful information to customers and their carers about service information, and forthcoming events. Areas for improvement The service should continue to develop in this area. Grade awarded for this statement: 6 - Excellent Number of requirements: 0 Number of recommendations: 0 E2, page 13 of 26

14 Statement 3 We ensure that service users' health and wellbeing needs are met. Service strengths Inspection report continued We sampled a number of key policies and procedures operated by the service. These included the adult support and protection guidance, use of restraint, infection control, the administration of medication, incident reporting and the management of challenging behaviour to name just a few. We found these documents gave clear guidance to staff in the operation and delivery of the care and support agreed with customers. We sampled at random a total of eight care and support files belonging to customers. The files contained the following information: * All about me - a one page summary of the care and support needs agreed with the individual customer. * A weekly schedule of their activities * The care and support plan - detailing the goals they would like to achieve with the support of the service. * Detailed support protocols - clear guidance on how staff are to meet the care and support needs of people. For example; mealtime assistance and personal care. * Information relating to any medication * Risk assessments - for example; moving and handling and challenging behaviour. * Keywork meetings or group meetings with customers. * Review meetings of the care and support plans. * Person centred planning (PCP's). * Restraint care plans - Use of belts and restraints in wheelchairs and cars. * Epilepsy support plans (where relevant to the individual). We sampled a variety of relevant care and support related documents from the list above. We found that every customer had a detailed support plan in place, detailing the goals the customer would like to achieve with the support from the service. The review of the care and support plans were being held consistently on a six monthly basis (to meet current legislation) and were very well recorded. One of the inspectors attended and observed a review meeting with a customer and their carer to assess how the individual was progressing with using the service and whether their care and support needs were being met. The customer and carer reported that they were happy with the support they were receiving to date. In addition, there was an `enablement folder` in place. This contained very comprehensive supportive guidance for staff in relation to assisting customers with their moving and handling, exercise and hand movements. This material had been put together with input from the occupational therapist and other health professionals. It E2, page 14 of 26

15 also contained photographs of the preferred positions for customers, bringing consistency to the approach the care and support was provided. We saw this to be one of the key strengths for this statement. At our last inspection of the service, we made the recommendation for the service provider to amend their medication administration records (MAR) to allow for easier completion by staff. Evidence seen at this inspection told us that the service has reviewed the format used and has brought improvements to the way administered medication is recorded. The service worked with customers to design a programme of activities to which customers could take part in. We observed some of these activities taking place, which included art and craft (ahead of the nativity play) and the use of the sensory equipment. Each of the facilitated activities have a feedback folder in place. This allows for staff to record what went well during the activity and what could be changed for future groups, following feedback from customers. We spoke with two customers during the course of our visit and attended some of the group activities taking place, to observe the support provided and the interaction between customers and staff, which was positive. Each of the customers has a communication diary which they carry on their person. This was seen to be a useful communication aid for the service, staff and the customer's carer / parents. We looked at the incident and accidents recorded by the service since our last inspection. 41 incidents or accidents had occurred, many of which were very minor and we would question the relevance of them being recorded in this way. Areas for improvement Inspection report continued We identified that some of the policies and procedures should be reviewed to ensure they met current legislation and best practice. Some policies and procedures were a little old, for example the risk assessment procedure was last reviewed in We are therefore making the recommendation that these policies and procedures should be reviewed. Please see recommendation 1. At our last inspection of the service, we made the recommendation for the service to review their written agreements with customers, to detail how the support agreed with the customer could be ended by the customer, carer or the service. We were provided with a draft copy of the written agreement which senior management had yet to approve and implement. Given that work is in progress for this area of development, we will follow this up at our next inspection of the service. Also at our last inspection of the service, we made the requirement that risk assessments must be reviewed on a six monthly basis, or more often as and when E2, page 15 of 26

16 required. From our sample of the risk assessments we looked at, some had been completed but this wasn't the case for everyone. We spoke with the registered manager of the service who advised us that they were in the process of using a new form to complete the review of risk assessments. However evidence seen told us that some risk assessments and specific areas of care plans (for example epilepsy and restraint care plans) had not been reviewed on a six monthly basis. We are therefore repeating this requirement. Please see requirement 1. When we looked at the mealtime assistance guidance procedures for staff we found that 10 of the 19 had not been reviewed since The service works well with health professionals, including the speech and language therapist and we are therefore making the recommendation that the service undertakes a review of these mealtime assistance guidance for staff to meet the needs of customers. Please see recommendation 2. When we reviewed the frequency of when keyworker meetings were being held, we identified many gaps in the frequency of such meetings being held. The service's procedure stated that these meetings should be held on a three monthly basis, however evidence told us that this was not being held consistently for many customers. We discussed our findings with the registered manager of the service who advised that this was sometimes a challenge to hold meetings with customers due to their communication support needs. However we are aware that this isn't the case for all customers. The service provider should therefore look to increase the frequency of keyworker meetings and adopt a consistent approach, in line with their procedures. Please see recommendation 3. When we inspected the MAR sheets to assess as to whether the service had developed in this area following our previous recommendation, although the documents had been improved, we noticed different dates at the head of the documents compared to the dates when the medication was administered. We were of the view that old template documents were being used. The service therefore should be mindful to ensure all MAR sheets are completed accurately. We discussed this finding with the registered manager of the service. Following a customer's review we attended, we asked to see the support file for the individual. We quickly identified there to be a lack of information available as to the care and support needs of the customer other than information provided by other services accessed by the customer. There was a lack of a risk assessment in place and little detail around mealtime assistance needs. Contact information for the carer had been requested by the service around a week or so after the customer had started using the service. The service must undertake risk assessments and implement support plans for customers who access the service within a 28 day period. We are therefore making this a requirement and linking it to requirement 1. E2, page 16 of 26

17 Grade awarded for this statement: 4 - Good Number of requirements: 1 Number of recommendations: 3 Requirements 1. The service provider must ensure risk assessments and support plans are reviewed with customers on a 6-monthly basis or less as and when required. This is to comply with the Scottish Statutory Instruments (SSI) 2011 No 210, Welfare of users, (4.1a) make proper provision for the health, welfare and safety of service users. Timescale: Within a 28 day period on receipt of this inspection report. Recommendations Inspection report continued 1. The service provider should review their policies and procedures to ensure they are up to date to meet current legislation and best practice. National Care Standards, Support services, Standard 2 - Management & staffing arrangements. 2. The service provider should work with external health providers to review the mealtime assistance guidance for individuals to ensure their needs are fully met. National Care Standards, Support services, Standard 4 - Support arrangements. 3. The service provider should ensure that regular keywork support meetings are held with service users in line with the service's relevent policies and procedures. National Care Standards, Support services, Standard 4 - Support arrangements. E2, page 17 of 26

18 Quality Theme 2: Quality of Environment 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 environment within the service. Service strengths Statements 1.1, 3.1 and 4.1 have been taken into account for this statement. Areas for improvement Statements 1.1, 3.1 and 4.1 have been taken into account for this statement. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0 Statement 2 We make sure that the environment is safe and service users are protected. Service strengths We sampled the maintenance records and found that regular maintenance and safety checks had been carried out on the premises used by the service, including that of the hoists and other support equipment. Areas for improvement The service should continue to maintain the high standards of ensuring the environment is safe for service users and others. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0 E2, page 18 of 26

19 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 Statement 1.1 has been taken into account for this statement. We saw evidence that customers are actively involved in the recruitment of staff by sitting on the interview panel and asking the candidate questions as to their suitability to the support worker role. Support from staff and the use of icons and images played the role of supporting people who may have any communication support needs. The service provider advised us through the completion of their self-assessment prior to our inspection that they are working towards involving customers in staff training and development, for example the completion of their SVQ in health and social care. We will follow this up with interest at our next inspection. Areas for improvement Statement 1.1 has been taken into account for this statement. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0 Statement 3 We have a professional, trained and motivated workforce which operates to National Care Standards, legislation and best practice. Service strengths We met with a total of three staff on a 1-1 basis, in addition to meeting with the team leader and the registered manager. Those we spoke with told us they were happy in their work and felt supported by the colleagues and that of the management of the service. Staff also said they had confidence in the management of the service and that things would be addressed if they approached them with any concerns. E2, page 19 of 26

20 We sampled a total of 10 staff files to assess how often staff met with their line manager for formal support and supervision in addition to their annual appraisal. The evidence told us that these areas of staff support were in line with their relevant staffing procedures. The service provider also operated an improvement request system, allowing staff to make suggestions to management and senior management about potential service improvements. We sampled a total of eight staff files, to explore the evidence of how often staff met with their line manager and how well they were supported in their roles, often which can be challenging due to the support needs of customers. Evidence told us that staff met with their line manager for their support and supervision meetings three times a year, in addition to their annual appraisal. This was in line with the service's relevant staff procedures. We read a sample of the staff meeting minutes and evidence told us that these meetings were being held on a regular basis and attended well by staff. Discussion topics included that of customer updates, operational issues and service development. We looked at the training records made available to us. Staff undertook a good level of training and regular refresher training in a number of areas. This included: moving and handling, mealtime assistance, administration of medication, epilepsy and food hygiene. A number of staff had completed a relevant qualification (for example SVQ 2 in social care) or were working towards its completion. Areas for improvement When we looked at the training records, we identified that adult support and protection was not included as a regular training item. We are therefore making the recommendation that the service includes this area of training for staff within their annual training programme. Please see recommendation 1. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 1 Recommendations 1. The service provider should look to include adult support and protection training into their annual training programme for staff. National Care Standards, Support services, Standard 2 - Management and staffing arrangements. E2, page 20 of 26

21 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 Statements 1.1 and 3.1 have been taken into account for this statement. Areas for improvement Statements 1.1 and 3.1 have been taken into account for this statement. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0 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 Capability Scotland has a comprehensive quality assurance policy in place, detailing the tools and methods used internally, and externally to assess and improve the quality of the service provided. The tools and methods used are included in our findings from statement 1.1 of this report, for example; `Have your say` questionnaires and annual satisfaction surveys. The service provider has a quality assurance and development team located within the head office of Capability Scotland. The department undertakes regular quality checks on the service provided at the E2 day centre. Any areas identified for improvement are addressed with the service manager and were added to a contained development actions register. Capability Scotland's accredited (through the British Standard Institution) quality and training management system covers the following areas: E2, page 21 of 26

22 * Ensure quality throughout the organisation. * Include all areas of care and support we provide to customers. * Take into account all legislative work, quality, safety and customers' rights and opinions at every stage and aspect of our work. * Recruit people with the skills and training required to provide the best possible service. * Train our existing staff to improve the skills and broaden the scope of what they can offer to customers and the organisation. The evidence in relation to the above areas has been commented on throughout this inspection report. In addition, the service has a number of systems in place to audit files and identify when processes are required, for example the review of support plans and risk assessments. We also saw clear information displayed on notice boards around the day centre about the service provider's quality assurance processes. Areas for improvement The service should continue to develop in this area. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0 Inspection report continued E2, page 22 of 26

23 4 Other information Complaints No complaints have been upheld, or partially upheld, since the last inspection. Enforcements We have taken no enforcement action against this care service since the last inspection. Additional Information Action Plan Failure to submit an appropriate action plan within the required timescale, including any agreed extension, where requirements and recommendations have been made, will result in the Care Inspectorate re-grading a Quality Statement within the Quality of Management and Leadership Theme (or for childminders, Quality of Staffing Theme) as unsatisfactory (1). This will result in the Quality Theme being re-graded as unsatisfactory (1). E2, page 23 of 26

24 5 Summary of grades Quality of Care and Support Very Good Statement 1 Statement Excellent 4 - Good Quality of Environment Very Good Statement 1 Statement Very Good 5 - Very Good Quality of Staffing Very Good Statement 1 Statement Very Good 5 - Very Good Quality of Management and Leadership Very Good Statement 1 Statement Very Good 5 - Very Good 6 Inspection and grading history Date Type Gradings 25 Feb 2013 Unannounced Care and support 4 - Good Environment 5 - Very Good Staffing 5 - Very Good Management and Leadership 5 - Very Good 24 Nov 2010 Announced Care and support 5 - Very Good Environment Not Assessed Staffing Not Assessed Management and Leadership Not Assessed 1 Oct 2009 Announced Care and support 5 - Very Good Environment 4 - Good Staffing 5 - Very Good Management and Leadership 5 - Very Good E2, page 24 of 26

25 21 Jan 2009 Announced Care and support 4 - Good Environment 4 - Good Staffing 5 - Very Good Management and Leadership 4 - Good All inspections and grades before 1 April 2011 are those reported by the former regulator of care services, the Care Commission. E2, page 25 of 26

26 To find out more about our inspections and inspection reports Read our leaflet 'How we inspect'. You can download it from our website or ask us to send you a copy by telephoning us on This inspection report is published by the Care Inspectorate. You can get more copies of this report and others by downloading it from our website: or by telephoning Translations and alternative formats This inspection report is available in other languages and formats on request. Telephone: enquiries@careinspectorate.com Web: E2, page 26 of 26