Avonlea Care Home Service Children and Young People West Banks Avenue Wick KW1 5LX Telephone:

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1 Avonlea Care Home Service Children and Young People West Banks Avenue Wick KW1 5LX Telephone: Type of inspection: Unannounced Inspection completed on: 21 July 2014

2 Contents Page No Summary 3 1 About the service we inspected 5 2 How we inspected this service 7 3 The inspection 11 4 Other information 22 5 Summary of grades 23 6 Inspection and grading history 23 Service provided by: Highland Council Service provider number: SP Care service number: CS If you wish to contact the Care Inspectorate about this inspection report, please call us on or us at enquiries@careinspectorate.com Avonlea, page 2 of 25

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 4 Good Quality of Environment 4 Good Quality of Staffing 5 Very Good Quality of Management and Leadership 4 Good What the service does well Avonlea has recently moved into new premises. The environment is of a very high standard. The overwhelming strength of this service is a staff group that are committed to maintaining and operating to a high standard. The staff group develops and maintains very good relationships with young people where they are able to build their self-esteem and confidence to enable them to feel a sense of belonging. The service has involved young people in the development of this new service, taking recognition of the young peoples' opinions ensuring that they were integral to the development of the overall service. What the service could do better There was a need to ensure that all young people had a personal plan which was reviewed by the service ever six months. We also found that essential aspects of a young person's behaviour had not been included in their risk assessment. There had also been slippage in permanent staff having validated restraint training. All of these aspects of development have to be rectified immediately on receipt of this report. What the service has done since the last inspection The service had recently made a move to a purpose-built new build. This has seen an environmental transformation where young people have a comfortable, wellresourced new premises. The public areas are of a very high standard and all young Avonlea, page 3 of 25

4 people have en suite bedrooms that have been furnished and decorated with their input. Conclusion Avonlea's new premises has a design and layout where young people can enjoy living in a safe and comfortable surroundings. The service should continue to develop as they have a well-motivated staff team that are committed to ensuring that young people achieve Avonlea, page 4 of 25

5 1 About the service we inspected The Care Inspectorate regulates care services in Scotland. Information about all care services is available on our website at This service was previously registered with the Care Commission and transferred its registration to the Care Inspectorate on 1 April Requirements and recommendations If we are concerned about some aspect of a service, or think it could 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, but where failure to do so will not directly result in enforcement. Recommendations are based on the National Care Standards, relevant codes of practice and recognised good practice. - 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 and Regulations or Orders made under the Act or a condition of registration. Where there are breaches of Regulations, Orders or Conditions, a requirement must be made. Requirements are legally enforceable at the discretion of the Care Inspectorate. Avonlea is registered to provide a care service for up to six children and young people. It is a purpose-built residential unit, developed to provide accommodation and care for children and young people who are looked after by the Highland Council Social Services. It is situated on the south side of Wick, close to local shops and amenities. Avonlea aims to provide a high quality service for young people where care provided is determined by the individual needs of the young person. The service aims to work in partnership with the young person, their families, carers and other professionals involved in their life. This is to ensure the best care package is in place throughout their time at Avonlea. Based on the findings of this inspection this service has been awarded the following grades: Quality of Care and Support - Grade 4 - Good Quality of Environment - Grade 4 - Good Quality of Staffing - Grade 5 - Very Good Quality of Management and Leadership - Grade 4 - Good Avonlea, page 5 of 25

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. Avonlea, page 6 of 25

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 This inspection was carried out on 21 July 2014 by one inspector. Feedback was given to the depute manager on the 21 of July The manager sent us information on their service in their annual return. They also sent us information on how they think they meet the National Care Standards (NCS) in the Quality Themes in their self assessment. In this inspection we gathered evidence from various sources, including the relevant sections of policies, procedures, records and other documents, including: * Certificate of registration * Personal plans * Medication records * Accident records - both service users and staff * Violent incident recording * Young people individual risk assessments * Restraint records * Staff records including training records * Sex and sexuality training, child protection training, first aid training * Continuing Professional Development (CPD) timetable * Supervision timetable * Complaints records * Insurance certificate * Repairs log and maintenance records * Minutes of staff and service users meetings * Monthly meetings * Admission and discharge questionnaires * Quality assurance systems, reports * Audits of service user involvement * Stakeholder questionnaires * Feedback on development plan * Notifications. Avonlea, page 7 of 25

8 We talked with the following: * The temporary manager * Residential social worker * Three staff members * Two young people (the other young person was on holiday). We also observed: * How the staff work * The premises. 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 Avonlea, page 8 of 25

9 The annual return Every year all care services must complete an 'annual return' form to make sure the information we hold is up to date. We also use annual returns to decide how we will inspect the service. Annual Return Received: Yes - Electronic Comments on Self Assessment Every year all care services must complete a 'self assessment' form telling us how their service is performing. We check to make sure this assessment is accurate. The service submitted a self assessment form as requested by the Care Inspectorate. This contained information on what the registered manager and staff thought that they did well and how they thought some things should be improved. Taking the views of people using the care service into account We interviewed two young people who were using the service. The other young person was currently on holiday and we were unable to interview them. Both young people were satisfied with the service they received. Both gave examples where they were given opportunities to be involved in their day-to-day running of the service. In the previous unit they had requested the expansion of WiFi which was initiated. All young people had been involved in the development of the new premises and they opinions were represented throughout the build with the choice of carpets and the internal decoration of their individual rooms. Both young people indicated that they felt safe and free from bullying. They also indicated that they knew how to use the complaints system. Young people made the following positive comments: * "I'm more settled and am trying my best". * "Staff are very good at supporting you". * "We are encouraged to keep in touch with our families. We can do this by telephone and Skype". * "The food is very good and staff are good cooks". * "Staff are very good at listening". * "Staff are very encouraging and have supported me to achieve". Avonlea, page 9 of 25

10 * "My school attendance has improved since I have been here". * "I would rate the environment as a 6 [excellent]". * "Staff are excellent". * "I can't think of anything that can improve". * "I've a handbook that gave me information about how to make a complaint". We also issued six Care Standards Questionnaires (CSQs) and all were returned. The questionnaires highlighted high satisfaction levels indicating that all young people agreed with the statement 'Overall, I am happy with the quality of care'. One questionnaire indicated that two young people did not feel protected from bullying. The inspector spoke to all young people to be reassured that they were indeed free from abuse and bullying Taking carers' views into account It was not possible to interview carers during this inspection. We did note that seven parents had recently been sent out a questionnaire from the service and one was returned. One comment stated: "they seem to be doing a good job with my son". Avonlea, page 10 of 25

11 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: 4 - 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 At this inspection, we found that the performance of the service was very good for this Quality Statement. The service supported participation and feedback for improving the service. We looked at a range of documents such as young peoples' personal plans, review minutes, young peoples' meetings and staff meetings. We also spoke with staff and young people, and observed the interaction that staff had with young people to assess this Quality Statement. All young people stated that they were actively involved in the creation and reviewing of personal plans. Young people also had daily case notes where they were encouraged to directly comment and sign their notes. There was also weekly case recordings which were sent out to parents and social workers to promote a partnership approach to caring for young people. These opportunities ensured active participation in the care needs of the young people. There was extensive evidence of involvement in the day-to-day service. We examined participation records which evidence that there had been numerous young peoples' meeting in the last year. These meetings were chaired by the local Who Cares? Scotland worker, who had developed very good relationship with the young people of this service over the last few years. Young people stated that they were encouraged and supported to express their opinions. We found many examples where young people commented directly on potential changes and had also been integral in offering their opinions about the design and colour pallet for the new premises. The staff recorded suggestions and there were a number of methods which showed staff responded and gave feedback to young people. These included a participation log and also numerous notice boards which contained information on the service. Young Avonlea, page 11 of 25

12 people stated that they felt listened to and that they had ample opportunities to put their ideas forward. Both young people stated that they were involved in menu planning. They stated that they had choices at meal times. Staff were very good a giving young people choice and also taking these choices forward. The service had developed a new welcome pack which included a handbook about the service. These handbooks contained information on how to make a complaint. Both young people had used the complaint system in the last year. We examined the complaints records and were satisfied that all young people were aware of how to make a complaint and that the manager responded to these appropriately and constructively. The service had a feedback survey which was issued to all stakeholders. This provided young people and their parents with opportunities to comment directly on the service by filling in annual questionnaires. Their comments and suggestions are contained in the overall service development plan which is produced annually. Young people confirmed they had regular access to advocacy services through Who Cares? Scotland. We noted that the worker regularly visited the service. Young people indicated that they had a good relationship with them and would access them for additional support if they needed. Areas for improvement The service should develop their handbook to include the contact details of the Care Inspectorate to ensure young people are aware that they can contact this agency if they have a complaint (see Recommendation 1). Service user meetings were not occurring monthly as indicated in their self assessment. The service should try to ensure that these occur as regularly as possible as they are integral to their commitment to active participation. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 1 Recommendations 1. The service to develop its handbook to ensure that it contains the contact details of the Care Inspectorate. Young people must be informed that they have the right to raise a complaint with this agency if they wish. Avonlea, page 12 of 25

13 National Care Standards, Children and Young People - Standard 8: Exercising Your Rights. Statement 3 We ensure that service users' health and wellbeing needs are met. Service strengths The service was delivering high quality care resulting in very good outcomes for young people using the service. We looked at records and spoke with young people and staff. Young peoples' personal plans took account of important details in their lives. This included information based on the principles of Getting Right For Every Child (GIRFEC), the Scottish Government's child-centred approach to support. The personal plans contained information about health issues. The young people had detailed planners which had information pertaining to allergies, medication and dietary needs. All young people were registered with a GP, dentist, and optician. Staff supported young people to make appointments and ensured that they attended. Both young people stated that staff took very good care of them and indicated that staff looked after them when they were unwell. We examined young peoples' medication in the service. The service managed young peoples' medication effectively. They had systems for ordering medication, storing it safely and disposing of it safely. Arrangements for monitoring the issue of medications were in keeping with the best practice document 'The Handling of Medicines in Social Care RPSGB 2007'. This ensured the young peoples' medication was managed safely. Staff were committed to ensuring young people were well protected and supported. Many staff had attended additional training in health related issues such as medication training; child protection; working towards good outcomes; and autism. Staff had a very good resource centre with additional reference material and access to online material. Young peoples' health education was well supported in the service with inputs by staff on good mental health, personal hygiene and substance abuse. The service also had external links from health professionals, such as the Child and Adolescent Mental Health service (CAMHs) and access to other health professionals. Staff were found to be confident at meeting the health needs of the young people in the service. We found food was appreciated by young people. They indicated that these were nutritious and that they were involved in menu planning. There was well-balanced menus that always contained cooked vegetables and salad. Young people also spoke with pride about cooking in the service and one young person stated that they "had made the best ever Chicken Tikka". Avonlea, page 13 of 25

14 All young people were involved in a variety of activities which kept them healthy. We found lots of examples where young people had access to playing outside, going to the tennis, ruby or football. Young people said that staff were heavily involved in supporting physical activity and we saw staff enjoying playing basketball and swingball with young people. Staff were very good at identifying young peoples' interests and were continuously helping young people to attain new skills and interests. Many young people were involved in community clubs like the army cadets. Staff had high levels of awareness of the challenges facing young people starting a new school and also moving into the service. We saw many examples where staff shadowed young people to school to provide them with additional support. This enabled young people to become familiar with the environment, the staff and the routines, and enabled the transition to be well-managed. Areas for improvement There was a need for one young peoples' risk assessments to be expanded to include behaviour issues. This risk assessment should have clarity for staff to ensure that they are aware of strategies to minimise the risk to young people (see Recommendation 1). We found that the personal plans of two young people had not been updated within the timescales outlined in regulations. All young peoples' personal plans should be reviewed every six months (see Requirement 1). During the sampling of young peoples' files. We found that not all young people had Looked After Children reviews in keeping with: SSI 2009/210 Regulation 45(2). Subject to paragraphs (3) and (4) the local authority must, by complying with the requirements in paragraph (5), carry out the following reviews of the child's case: (a) A first review within six weeks of the placement; (b) A second review within three months from the date of the first review; and (c) Thereafter subsequent reviews within six months from the date of the previous review. All young people should have regular reviews every six months by the local authority. Grade awarded for this statement: 4 - Good Number of requirements: 1 Number of recommendations: 1 Avonlea, page 14 of 25

15 Requirements 1. All young people should have a personal plan which is reviewed regularly every six months. This is in order to comply with: SSI 2011/210 Regulation 5 Personal Plans (2). Subject to paragraph (3) - a provider of a care service must: (a) Make the personal plan available to the service user and to any representative consulted under paragraph (1); and (b) Review the personal plan - (i) When requested to do so by the service user or any representative; (ii) When there is a significant change in a service user's health, welfare or safety needs; and (iii) At least once in every six month period whilst the service user is in receipt of the service. Timescale: immediately on receipt of this report. Recommendations 1. All young peoples' risk assessments should be developed to include aspects of their behaviour which may pose risk. National Care Standards, Care Homes for Children and Young People - Standard 4: Support Arrangements. Avonlea, page 15 of 25

16 Quality Theme 2: Quality of Environment 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 environment within the service. Service strengths The findings in this section are similar to those identified in Quality Theme 1, Quality Statement 1. Areas for improvement The service should continue to consult with young people regarding maintaining a well-maintained and homely living environment. 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 The service was adequate at ensuring that the environment was safe and young people were protected. The service provided a wide range of evidence to show that it kept young people safe and protected. The service had a comprehensive child protection policy and staff had a good awareness and understanding of procedures. The service had corporate child protection paperwork which would be used if they had identified any concerns. All young people indicated that they felt safe and stated they were free from bullying. All young people indicated that they felt safe and protected within the service. They all stated that they had good relationships with the staff group. We observed appropriate levels of staffing and supervision of young people in the service. The consequence was young people felt happy and valued in their respective homes. Avonlea, page 16 of 25

17 The depute manager was responsible for risk assessments in service. There was specific activity risk assessments which were carried out for a range of needs and situations. More generic risk assessments were carried out prior to activities or a holiday. We examined the premises and found that staff had established safe practices to ensure the environment was safe for young people. The service had an appropriate security policy and all visitors had their visits recorded. The service had a comprehensive range of recording systems for accident and incidents. We sampled these records and found that incidents were appropriately managed and young people were well supported. Most staff had validated training in Crisis, Aggression Limitation and Management (CALM). There had been very few incidents where the service had used restraint on young people. These were appropriately recorded by the service. The service previously managed their own training and this is now centrally managed by the local authority. The service had a competent person who ensured that all Legionella checks were carried out in accordance with the local guidance. This will ensure that the risk of young people catching Legionella is minimised. Both young people indicated that they liked the new resource and that they felt very at home in it. They particularly like their bedrooms and the outside space. Areas for improvement There was a need for the service to ensure that all permanent staff have validated CALM training to ensure that young people are kept safe and protected (see Requirement 1). Grade awarded for this statement: 4 - Good Number of requirements: 1 Number of recommendations: 0 Requirements 1. All permanent staff should have training on CALM to ensure that young people are safe and protected. This is in order to comply with: SSI 2011/210 Regulation 4(1)(a) - a provider must make the proper provision for the health, welfare and safety of service users. Timescale: three months on receipt of this report. Avonlea, page 17 of 25

18 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 findings in this section are similar to those identified in Quality Theme 1, Quality Statement 1. Areas for improvement The service should continue to consult with young people in accessing and improving the quality of staff. 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 All of the aspects of this Quality Statement were found to be met and the service was graded as very good. The service continued to have in place strategies which allowed staff to be trained and motivated. All staff interviewed were registered with the Scottish Social Services Council (SSSC). The majority of staff held an appropriate qualification to meet registration requirements. All new staff was supported by the local authority to achieve their Scottish Vocational Qualfication (SVQ) 3 and Higher National Certificate (HNC). Most staff interviewed indicated that they had completed the following courses: - Child protection Avonlea, page 18 of 25

19 - Food hygiene - First aid - Fire awareness - CALM. The access to these courses ensured that staff maintained their registration status The management team carried out regular audits of the training needs of staff and had developed action plans which identified future training. The service was proactive and planned training in advance. We found that staff had access to a wide range of best practice material and also research material which assisted staff keep their practice up-to-date. We found well established systems for supervision on a formal and informal basis. All of the staff had regular formal supervisions every month and every year and annual appraisals which were recorded on Personal Development Planning (PDP) paperwork. All staff indicated that they found supervision to be supportive. Staff indicated that they were well supported by both the internal management team but also from the external manager for the service. Staff stated that the manager was very approachable and that there was an open door policy in the service. We found that team meetings were a supportive mechanism for staff. We found that these were supplement with monthly team development days. These days include training inputs such as routine and rhythms and legal highs. These also provided staff to plan for the year ahead and also a regular opportunity to reflect on their practice and develop a consistent approach. Staff were found to be enthusiastic and committed to providing quality of outcomes for young people in this service. Areas for improvement There is a need for the service to address the slippage that has occurred with regard to staff accessing CALM training. This has been highlighted in Quality Theme 2, Quality Statement 2, Areas for Improvement. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0 Avonlea, page 19 of 25

20 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 findings in this section are similar to those identified in Quality Theme 1, Quality Statement 1. Areas for improvement The service should continue to consult with young people, where appropriate, regarding the quality of management. 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 At this inspection we found a good approach to quality assurance, with structured systems in place, to monitor and develop the quality of all aspects of the service. It provided a range of evidence to show that it involved young people, parents, and staff in evaluating all aspects of the service's operation. The service evidenced a good approach to quality assurance, with a number of structured systems in place to monitor and develop the quality of the service. It provided a range of evidence to show that it involved young people, parents and carers, staff, and stakeholders in evaluating aspects of the service's operation. The service offered all stakeholders the opportunity to fill in a feedback questionnaire as an effective quality assurance system. These contained very positive comments. The service was collating these to inform the action plan. The feedback recorded indicated that the service had very good relationships with parents, schools, health Avonlea, page 20 of 25

21 professionals and social work. The management team had a number of quality assurance audits. These included the file audit, medication first aid and training audits. These tools resulted in clear action plans which were monitored by the service. There was also monthly opportunity for staff to be involved in reflective practice at team development days. These days reviewed the overall development plan but also allowed regular opportunities for staff to give their opinion on how the service should improve. There had also been good compliance with previous inspections and the service had developed wide-ranging action plans which were fully actioned. The service was found to have a good performance in relation to this Quality Statement. Areas for improvement Although the service had a number audit tools which they used on a regular basis. We found that there were some issues pertaining to personal plan reviewing which would indicate that file auditing should be more rigorous. The service was signposted to the guidance on notification reporting as there had been a number of incidents that should have been notified to the Care Inspectorate (see Requirement 1). Grade awarded for this statement: 4 - Good Number of requirements: 1 Number of recommendations: 0 Requirements 1. The service must record and notify the Care Inspectorate of incidents referred to on the list contained in Regulations of The Regulation of Care (Requirements as to Care Services) (Scotland) Regulations This is in order to comply with: SSI 2011/210 Regulation 4(1)(a) - a provider must make the proper provision for the health, welfare and safety of service users. Timescale: within three months on receipt of this report. Avonlea, page 21 of 25

22 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). Avonlea, page 22 of 25

23 5 Summary of grades Quality of Care and Support Good Statement 1 Statement Very Good 4 - Good Quality of Environment Good Statement 1 Statement Very Good 4 - 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 16 Jul 2013 Unannounced Care and support 5 - Very Good Environment 5 - Very Good Staffing 5 - Very Good Management and Leadership 5 - Very Good 1 Mar 2013 Unannounced Care and support 6 - Excellent Environment 4 - Good Staffing 5 - Very Good Management and Leadership 6 - Excellent 16 Dec 2011 Unannounced Care and support 6 - Excellent Environment Not Assessed Staffing 6 - Excellent Management and Leadership Not Assessed Avonlea, page 23 of 25

24 6 Jan 2011 Unannounced Care and support 5 - Very Good Environment Not Assessed Staffing Not Assessed Management and Leadership Not Assessed 17 Sep 2010 Announced Care and support 5 - Very Good Environment Not Assessed Staffing Not Assessed Management and Leadership 5 - Very Good 27 Jan 2010 Unannounced Care and support 5 - Very Good Environment Not Assessed Staffing 4 - Good Management and Leadership Not Assessed 24 Jul 2009 Announced Care and support 5 - Very Good Environment 5 - Very Good Staffing 4 - Good Management and Leadership 5 - Very Good 3 Feb 2009 Unannounced Care and support 4 - Good Environment 4 - Good Staffing 4 - Good Management and Leadership Not Assessed 10 Jul 2008 Announced Care and support 4 - Good Environment 4 - 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. Avonlea, page 24 of 25

25 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: Avonlea, page 25 of 25