City of Edinburgh Council Shared Lives Adult Placement Service Bonnington Centre 200 Bonnington Road Edinburgh EH6 5NL Telephone:

Transcription

1 City of Edinburgh Council Shared Lives Adult Placement Service Bonnington Centre 200 Bonnington Road Edinburgh EH6 5NL Telephone: Inspected by: Lynne Cameron Type of inspection: Announced (Short Notice) Inspection completed on: 18 December 2013

2 Contents Page No Summary 3 1 About the service we inspected 5 2 How we inspected this service 6 3 The inspection 10 4 Other information 21 5 Summary of grades 22 6 Inspection and grading history 22 Service provided by: City of Edinburgh Council Service provider number: SP Care service number: CS Contact details for the inspector who inspected this service: Lynne Cameron Telephone enquiries@careinspectorate.com City of Edinburgh Council Shared Lives, page 2 of 23

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 Staffing 5 Very Good Quality of Management and Leadership 4 Good What the service does well The service continues to provide family based care by continuing to support existing carers and recruiting new carers to support adults to live in a family setting that provides a consistent, supportive and loving environment. This environment meets the needs of vulnerable adults enabling them to meet their potential. The service responds well to individual needs including emergency placements where appropriate, showing a flexible approach of the service. What the service could do better The service should continue to gain the views of those that use the service, those who provide the service and from other stakeholders. The current system for approving carers needs to be formalised and independent with relevant policies and procedures that are clear and transparent. The service should consider setting up a relevant Panel for the approval of prospective carers in line with other similar services. What the service has done since the last inspection The service has continued to establish itself as a service for the support and care to adults with learning disabilities. The service has worked at raising its profile with other services and teams and has had a recent successful recruitment campaign. The service progressed the areas identified in the previous inspection report such as format for reviews, personal plans and the carer's handbook. City of Edinburgh Council Shared Lives, page 3 of 23

4 Conclusion The service provides an invaluable resource to adults with learning disabilities that enable them to live in a family setting within communities in a consistent person centred way. The commitment of carers in fulfilling their role as carers in caring for adults with varying degrees of physical, psychological and emotional needs to promote all aspects of individuality is highly commendable. The staff team are highly committed to ensuring that those that are using this service are at the centre of everything they do. The ability of staff in delivering the service to a committed high standard means that service users and carers can be confident that staff are competent and knowledgeable in the work they do. Who did this inspection Lynne Cameron City of Edinburgh Council Shared Lives, page 4 of 23

5 1 About the service we inspected The City Of Edinburgh Shared Lives is run by Edinburgh City Council. The service was registered with the Care Inspectorate on 1st April 2011 to provide an Adult Placement Service to adults with learning disabilities. The service provides a resource that enables adults to live in their communities in a family setting. No more than two adults can be placed at any one time within the household of any adult placement carer. The service has gone through a transition where the service now provides short breaks and long-term accommodation specifically to adults with learning disability and no longer older people. This criteria is now in place for new requests for this service. At the time of inspection there was 29 long-term carers and 19 short break carers. Two long-term carers are currently being assessed with four short break carers and two long-term carers recently approved. Based on the findings of this inspection this service has been awarded the following grades: Quality of Care and Support - Grade 5 - Very Good Quality of Staffing - Grade 5 - Very Good Quality of Management and Leadership - Grade 4 - Good 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. City of Edinburgh Council Shared Lives, page 5 of 23

6 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 after a short notice announced inspection that took place on Tuesday 3rd December at a social winter event. We went back to the service on the 9th December, 10th December, 11th December, and 16th December. We concluded our inspection on the 18th December and provided feedback to the manager on Wednesday 18th December The inspection was carried out by locum care inspector Lynne Cameron. During this inspection we gathered evidence from various sources, including relevant policies, procedures, and other documents, including: Attendance at Winter Social night for carers and service users Carers information pack Information for service users Assessment of service users and personal plans Assessment of carers Service questionnaires Supervision records of carers Minutes of review of carers Publicity material Case records of service users Training material Minutes of staff meetings Staff training, supervision records Face to face interviews with eight carers Telephone Interviews with four carers Telephone call to one birth parents Face to face interview with four people who use the service Policies, procedures including employee handbook, Risk assessments Medication records Interview with manager Interview with team manager City of Edinburgh Council Shared Lives, page 6 of 23

7 Interview with staff team Attendance at team meeting Telephone conversation with Scottish Development Worker, Shared Lives Plus. 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 City of Edinburgh Council Shared Lives, page 7 of 23

8 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. A completed Self Assessment was submitted by the service and provided relevant information for each of the Quality Statements. The service identified the strengths and areas for improvement. The Self Assessment included the areas that had been taken forward from the last inspection. Taking the views of people using the care service into account We met with five adults at the Winter social event. Some had been with carers for a long time and others had only just moved in with their carer. From observation and discussion it was clear that there were warm positive relationships and service users appeared happy and safe with their carers. The carers were very attentive. Some quotes: "I call them Mum and Dad". "I love it". Taking carers' views into account We met with eight carers and had telephone conversation with a further four carers. The carers all confirmed that they all received a lot of very good support from the service and they had a number of opportunities to have ongoing training and development. It was clear from observation and discussion that the carer had established a bond with the adult, and that they were part of the family. Some quotes: City of Edinburgh Council Shared Lives, page 8 of 23

9 "If you put views forward they look at it". "The matching is very in-depth which is good". "Lots of improvements in the last year". "Always at the end of the phone". "SW excellent - gives us good support". We received four questionnaires that indicated they were happy with the service. We had a telephone conversation with one birth parent, who was very happy with the information provided about how the matching process and placement went. "Staff were very knowledgeable and skilled". City of Edinburgh Council Shared Lives, page 9 of 23

10 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 met this statement well. There were various opportunities for both adult carers and the people they were caring for to participate in assessing and improving the quality of the care and support provided by the service. We found a comprehensive Service User Guide describing, in service user friendly formats, the kind of information service users and family members would want to know about the service. We found that the service had developed the review format for both carers and service users. For carer's reviews, there are specific questions that relate to the functioning of the staff and management team and what suggestions they have about how the service could be improved. Carers confirmed they are asked for their views and thought there had been a lot of improvement over the last year. One improvement being the level of fees, where carers thought they are now getting paid for the level of care and support they are providing. For carers wishing to remain on the previous payment scheme this was fulfilled. Staff had supported the carers in the consultation process of the proposed changes. We found that reviews of services users were being undertaken six monthly and different communication tools were used in gaining the views of the service user. We found evidence of Talking Mats being used effectively as a way of gaining the views of service users. We found service users provided feedback in their reviews. From a service user staying long-term, "I am happy living with... this is my home and I am close to... family. Comments made by a family member of an adult having short break care, stated "...is City of Edinburgh Council Shared Lives, page 10 of 23

11 the perfect setting for... varied activities and wants to stay again". We found examples where young people had remained with their former foster carers, following an adult carer assessment. These young people are now adults in their 30's and 40's. This has meant they have been provided with consistency and a good sense of identity. The adults spoken with said they were happy and viewed their carers as parents, emphasising the commitment from carers that strengthened the attachment and belonging to a family. We found the service very responsive to changing situations providing additional short breaks to ensure carers were well supported. This meant that service users whose health needs were changing, for example, were well supported to remain with their carers and continued to experience continuity of care. Information leaflets provide good information about Shared Lives, this has been produced by SharedLivesPlus. This leaflet includes short 'life stories' and gives a good sense of what the service is about. We found that carers were provided with good supervision with opportunities to provide feedback on a regular basis which impacted on them as carers and for continuing to provide successful placements that contributed to the health and wellbeing of service users. Areas for improvement The service should continue to involve carers and service users in assessing the service, (see Quality Theme 4 Statement 4). Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0 Statement 3 We ensure that service users' health and wellbeing needs are met. Service strengths We found that there was very good support to ensure the health and wellbeing needs of service users was well met. We found that the updated personal plan format was thorough, comprehensive and person centred, covering a range of areas. Important details were recorded including specific health details. We found Personal Plan agreements, support plans and risk assessments in place. The risk assessment includes any measures needed to minimise risk. The paperwork contained symbols and all had outcomes and objectives set out. We found very good details of service users' needs in the personal plans, with outcomes stated, for City of Edinburgh Council Shared Lives, page 11 of 23

12 example, "To feel that I am being looked after well - this is very important to me to feel safe and secure". We found the service users were treated as individuals with respect and dignity with their health and wellbeing needs being well met. We found carers had copies of personal plans which informed the carers what was needed to meet the needs of the service user. We found the service to be flexible in meeting the needs of an adult in an emergency situation, and the placement agreement reflected the nature of the placement. We found that staff had been trained in the use of 'talking mats' which supported communication with service users. Various symbols were used depicting different aspects of the person's life, and evidence of opportunities for using advocates when needed. Carers receiving such full information were clear of the needs of the user of the service and if they could meet their needs. We found completed medication records, signed by the supervising worker, ensuring that medication was being administrated appropriately. We found good multi agency working and appropriate referrals were made to various services, for example an Occupation Therapy assessment of a carers home when offering a short break. This assessment contributed to minimising risk of falls. We found robust assessments of carer's including all relevant checks. When considering any match the carers prepared a profile, and there was evidence of very good profiles, written with the service users in mind, such as 'a day in the life of...' presented in picture form, colourful and person centred. We found examples of timescales being met and actions followed through between reviews. The detail of service users' personal plans and carers' profiles provide good information in considering a potential match which is compatible. We found matching lists that contain good information to inform matching discussions. These are updated and discussed monthly. The matching process is gradual and is reviewed regularly to assess if the placement should go ahead. The same process is in place for long-term and short breaks. Carers told us they received a lot of in-depth information prior to a match and was impressed of the quality of the assessment of the service user. Placement agreements are in place for all service users. These are comprehensive and reflect individual needs. Some carers had been caring for the same adults for up to 30 years, and were aware of the changing needs of the person being cared for. They had extensive knowledge about health and wellbeing needs. Carers told us that they are provided with good support and opportunities for ongoing training and development, for example adult support and protection. City of Edinburgh Council Shared Lives, page 12 of 23

13 The carers' handbook has been updated and contains all relevant information; it is comprehensive including codes of practice, food, hygiene, making compliments and complaints. The writing is person centred. All carers have the handbook and have been asked about how it can be improved or if there are gaps. The handbook makes it clear of what the expectations are to ensure the service users' health and wellbeing needs are met. Reviews of carers were very detailed and the minutes reflected outcomes for the carer in respect of achievements and challenges, how this linked to caring for the service user, and how the service could be improved. We found a good policy on reporting a significant occurrence and found examples of where these had been responded to appropriately and actions taken, for example a referral to Occupational Therapy about additional equipment. These records were signed and dated by the manager. We found examples of carers identifying and responding to the changing health needs of service users, ensuring that the health and wellbeing needs were well met. Areas for improvement To ensure the safety and ongoing wellbeing of service users who may have to be placed outwith their home environment, the service should proactively recruit carers who can provide emergency placements as an additional resource. The service should also consider asking current carers about their views and availability as emergency carers. (See Recommendation One) Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 1 Recommendations 1. The service should proactively recruit carers who can provide emergency placements as an additional resource that could impact on the safety of an adult. The service should also consider asking current carers about their views and availability as emergency carers. National Care Standard 5 Statement 2 and National Care Standard 9 Statement 2. City of Edinburgh Council Shared Lives, page 13 of 23

14 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 The strengths highlighted in Quality Theme 1, are also relevant to this statement. We found there were good opportunities for service users and carers to participate in assessing and improving the quality of staffing in the service. Carers told us they had plenty opportunities to provide comments about staffing at various events, this included, their formal reviews, their supervision and support sessions and at support groups. We found carers have regular carers' support meetings approximately 5-6 times a year. These meetings are well attended and notes of the meeting demonstrate meaningful discussions, for example changes in payments, development of a participation statement, handbook. This gave carers the opportunity to put their views forward and we found items discussed at these meetings were actioned and followed through. We found that after each support group, staff wrote to carers thanking them for attendance and informing them of future event dates. We found staff kept carers and service users engaged in developing the service. In addition there have been other social events that include service users in the summer and winter. At the Winter social night we were told by carers that they were well supported and that staff listened to their views and ideas. We found that carers advocated for the person being cared for and was able to support and assist the service user in putting their views forward. We found that service users also were provided with independent advocacy services that supported them in putting their views forward on specific matters. We observed at this event staff communicating well to service users and that service users within their reviews and from ongoing contacts, seen in case records, the views of the service user about support from staff was well documented. We found that relatives of service users were asked about the support from the short breaks service. Feedback from relatives contributed to the wellbeing of the service user. City of Edinburgh Council Shared Lives, page 14 of 23

15 Service users put their views forward about the service at the time of a proposed match with carers so that service users can be informed about using the service. Views are sought at their reviews about ongoing aspects of the staff and service. We found that service users' comments about the service included "I am pleased with the service... yes I am very happy". Areas for improvement As identified in the Self Assessment the service should further develop questionnaires to reflect the performance of the team. This will provide additional information to the service in identifying any ongoing training and developmental needs of staff as well as general service improvement. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 1 Recommendations 1. The service should further develop questionnaires to reflect the performance of the team. National Care Standard 5 Statement 1, 2,9. Statement 3 We have a professional, trained and motivated workforce which operates to National Care Standards, legislation and best practice. Service strengths The strengths highlighted in Quality Theme 1, are also relevant to this statement. We found that the service had a very knowledgeable, skilled and committed staff group who work to the National Standards, legislation and best practice. All the work undertaken is person centred. At the Winter social event we observed how well the staff knew and interacted with service users and their carers. Carers told us that the staff they worked with were experienced, knowledgeable and always there to offer advice and support. We found a clear supervision policy than includes frequency and expectations. We found that staff were receiving regular supervision and where there had been any line management absence, supervision was still provided by another senior social worker. Evidence from supervision records demonstrate a two process and addressed appropriate areas for discussion. Supervision records are signed and dated. We found that the service was supported by a range of policies and procedures, one City of Edinburgh Council Shared Lives, page 15 of 23

16 of which is the Departmental Performance Review and Development (PRD) policy. This is on the Council's Intranet site, one of the Health and Social Care commitments and objective is: 'People are supported to live at home or in other community settings to maintain and improve their independence'. Linking this to PRD, staff have started the process of undertaking the (PRD) and we found evidence that staff have contributed well to this, linking it to the above objective and that they found the process very useful. We found that staff received a variety of appropriate training and development to provide ongoing support to them as workers to deliver a skilled service appropriate to the needs of the service users. Staff were enthusiastic about training and development and this was undertaken in various ways. We found training logs in place for staff and that staff had attended a range of training that includes: Talking Mats, Welfare Reform, and Personalisation in practice. For newly qualified staff additional support was provided to develop the workers Post Registration Training and Learning(PRTL). The ability of staff in delivering the service to a committed high standard means that service users and carers can be confident that staff are competent and knowledgable in the work in supporting and delivering a service to both service users and carers. Staff attend Shared Lives Scotland committee meetings, and receive regular updates about relevant information such as contracts and panel reviews that contributes to the sharing of ideas for developing the service. A good link has been established with the Scotland Development worker of Shared Lives. We found the staff team had regular team meetings and that with peer support offered a positive way of sharing ideas. The team have developed a plan (October 2013 that has key objectives laid out for the next 12 months. (These have been included in areas for improvement). The team also reviewed the achievements they have made in the previous 12 months. We found the service also used the expertise and knowledge of training materials provided by SharedLivesPlus for training and development of carers and that the team was linked in to taking forward the National Learning Disability Strategy. We found carers being provided with a range of training opportunities, for example tele-care, and adult support and protection. These are reflected in the carers' review documentation. City of Edinburgh Council Shared Lives, page 16 of 23

17 Areas for improvement The service should continue to support staff and carers in training and development opportunities to continue to keep up to date with National changes and legislation. As identified in the Self Assessment the service should look at ways of delivering training for carers who cannot attend training easily. This would include E-learning. (See Recommendation One) Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 1 Recommendations 1. The service should look at ways of delivering training for carers who cannot attend training easily. This would include E-learning. National Care Standard 5 Statement 10. City of Edinburgh Council Shared Lives, page 17 of 23

18 Quality Theme 4: Quality of Management and Leadership Grade awarded for this theme: 4 - 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 The strengths highlighted in Quality Theme 1, Statement 1 and Quality Theme 3, Statement 1 are also relevant to this statement. We found the carers events provided opportunities to be involved in discussing the quality of management and leadership. An example of this was, the service manager of the service had attended a meeting at which the proposed fee structure was discussed. Any decisions made by the agency are communicated in writing to carers and also at the support groups. Feedback had also been provided to carers on the last inspection report and how the areas of improvement were taken forward jointly. The service has worked hard over the last year to raise their profile with other services in the organisation and in their recruitment of new carers. For example we found the service had developed a leaflet, and presentation material for sector and transitions team and articles in an in-house magazine, 'A life Shared'. We found a good Shared Lives Team Profile that promotes visibility of the team. We found the service had used a range of multimedia ways of recruiting new carers and highlighting the service to the public. This included plasma screens, press releases, a Shared Lives banner, article in the Big Issue, a recruitment event, stalls in various venues and involvement in the Christmas tree festival. Carers and service users were involved in the tree festival by making decorations putting messages on them to hang on their tree for the festival. This meant the service users were fully involved in publicising the service to a whole range of audiences. We found that the Health and Social Care Vision and Strategy framework support the service to develop their plans in that the statements within this strategy directly relate to delivery of the Shared Lives service, for example: "Effective personalised services and person centred pathways of care" City of Edinburgh Council Shared Lives, page 18 of 23

19 "Improving and increasing support for carers". We found that a good link is established with the co-ordinator of SharedLivesPlus who contributes to identifying good practice across the country that informs this service. Areas for improvement The service should continue to keep up to date with National developments and best practice, for example communication needs of service users. Given service users currently in the service are older people, the service should also ensure that staff are kept up to date with research and development, for example Dementia. (See Recommendation One) Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 1 Recommendations 1. The service should continue to keep up to date with National developments and best practice, for example communication needs of service users. The service should also ensure that staff are kept up to date with research and development, for example Dementia. National Care Standard 5 Statement 2. 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 The strengths highlighted in Quality Theme 1, and 3 are also relevant to this statement. City of Edinburgh have a quality assurance system that includes a case file audit programme that involves team managers. This will include the records of those receiving this service. The service has undergone restructuring and it has worked hard at re-establishing and refreshing itself. The service has reworked paperwork to reflect views of service users and carers which are reflected in completed review minutes. We found the service also invites the views of carers and service users via support groups and feedback forms demonstrating that the service user is encouraged and supported to make their views known about the service. City of Edinburgh Council Shared Lives, page 19 of 23

20 We found that Edinburgh City Council has established a Health and Social Care Partnership Strategic Framework, that sets out the Health and Social Care integration agenda. Plans are set out in this document that identifies Strategic Objectives, for example, Care and Support is personalised and person centred, which links to the areas already identified in Quality Theme 3, Statement 3. This reinforces expectations on service delivery and the importance of service users being at the centre, evidenced in personal plans about their rights and responsibilities as an individual. Following on from the last inspection we found that senior management provided positive feedback to staff about the service they were delivering. Areas for improvement Although the service asks for views of service user and carers they are not routinely collated. In addition the service should further develop their feedback mechanisms for service users. (See Recommendation One) We found the mechanisms for approving carers needs to be more structured. The current system for approving carers needs to be formalised and independent with relevant policies and procedures that are clear and transparent. The service should consider setting up a relevant Panel for the approval of prospective carers in line with other similar services. It is suggested that this Panel should include a pool of membership that includes carers and services users (or families). (See Recommendation Two) Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 2 Recommendations 1. The service should collate the findings from the views of service user and carers and should further develop their feedback mechanisms for service users. National Care Standard 5, Statement The service should consider setting up a relevant Panel for the approval of prospective carers in line with other similar services. National Care Standard 5, Statement 4. City of Edinburgh Council Shared Lives, page 20 of 23

21 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 N/A. 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). City of Edinburgh Council Shared Lives, page 21 of 23

22 5 Summary of grades Quality of Care and Support 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 Good Statement 1 Statement Very Good 4 - Good 6 Inspection and grading history Date Type Gradings 22 Jan 2013 Announced (Short Notice) Care and support Staffing Management and Leadership 5 - Very Good 5 - Very Good 5 - Very Good 14 Sep 2010 Announced Care and support 5 - Very Good Staffing Not Assessed Management and Leadership 5 - Very Good 2 Dec 2009 Announced Care and support 5 - Very Good Staffing 5 - Very Good Management and Leadership Not Assessed 5 Dec 2008 Announced Care and support 5 - Very Good Staffing 4 - 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. City of Edinburgh Council Shared Lives, page 22 of 23

23 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: City of Edinburgh Council Shared Lives, page 23 of 23