Chester Park Care Home Care Home Service

Transcription

1 Chester Park Care Home Care Home Service 40 Lambhill Street Kinning Park Glasgow G41 1AU Telephone: /9967 Type of inspection: Unannounced Inspection completed on: 27 April 2017 Service provided by: Oakminster Healthcare Ltd Service provider number: SP Care service number: CS

2 About the service Chester Park is a care home for older people and is registered for a maximum of 109 places. The service provider is Oakminster Healthcare Limited. Maximum places were reduced to 73 whilst building works are taking place. There were 65 residents in occupation during this inspection. Chester Park is a large three storey building, located in the Kinning Park area of Glasgow. The care home is divided into five separate units. The units are known as Kelvingrove, Clydeview, Afton Court, McFarlane and Upper Clyde. Each unit is spread out over two or three corridors with bedrooms, lounge, dining room and communal toilets and bathrooms. McFarlane unit is used for short stay for residents who have been discharged from hospital and are undergoing a period of rehabilitation prior to their discharge home or to another care setting. Major refurbishment was underway affecting Afton unit. The large communal "gym" in the central part of the building was being used as a temporary storage area. The remainder of the unit was closed. There was no access to the central courtyard whilst works were in progress. There is a car park to the side of the care home. Some of the bedrooms had en-suite toilet and washbasin and others had en-suite baths. Further refurbishment is planned to improve the environment and allow installation of wet floor showers which will be more accessible for residents. Oakminster Healthcare Limited's stated aims are to enhance the quality of life of its residents. The people who use the service are referred to as "residents" in this report as this is the term preferred and used by the service. What people told us We sent out 18 questionnaires to service users and relatives Seven residents were assisted to complete and return the questionnaire. These showed that three "strongly agreed" and four "agreed" they were happy with the quality of care they received. There were positive responses to most of the questions asked. However, two "disagreed" and one stated "more or less" that there are enough trained and skilled staff on duty. Also, three "disagreed" there were frequent social events, entertainment and activities organised. Two relatives completed and returned questionnaires both "agreed" they were happy with the quality of care provided. Both were positive to most of the questions asked. One was very positive about responses from management to issues raised and commented there are: "Lovely caring staff who cope under great pressure". page 2 of 20

3 "...witnessed kindnesses given by staff." However, one "disagreed" that their relatives property and clothing were clearly marked and properly cared for and both "disagreed" there were enough staff on duty. One also "disagreed" there were enough activities and supports to stay in touch with family, friends and the local community. During the inspection we spoke with five service users. The overall impression was they were satisfied with the service provided. Some had been using the service for many years and said they were settled and content with the care and support provided. We spoke with seven relatives who gave mixed views about the service. Those whose relatives were admitted through the short stay service following discharge from hospital were very satisfied and stated they were particularly impressed with the staff and friendliness of the service. One relative said things were getting better and new staff recently recruited were "promising". There was concern about the lack of activities but hope that this was going to improve. One relatives was dissatisfied with the service and stated they were fed up bringing issues to management as "nothing ever gets done". Their main concern was about lack of personal care, lack of staff supervision to help prevent falls and inappropriate activities that residents couldn't join in with. Self assessment Services are not being asked to complete a self assessment in this inspection year 2017/18. Discussion took place about the service's development plan and the manager had started to use this as a tool for tracking and monitoring service improvement. From this inspection we graded this service as: Quality of care and support Quality of environment Quality of staffing Quality of management and leadership 2 - Weak 2 - Weak 2 - Weak Quality of care and support Findings from the inspection The views of residents and relatives about care and support was hard to gauge. There had been no recent survey carried out by the service provider and only a small number of questionnaires returned to the Care Inspectorate. Most residents at Chester Park cannot express their views easily and rely on others to represent them. We could not see that sufficient efforts had been made to ascertain views and respond to them. From the relatives we spoke with some were contented but others were not. See recommendation 1. page 3 of 20

4 Our observations of interactions between residents and staff indicated most staff knew residents well and were aware of their preferences for care and support. However, the personal plan records did not detail this well. We sampled seven personal plans and found some sections were missing or incomplete. This meant care seemed to take place without an agreed written format being referred to and used fully. See Requirement 1. Care outcomes were variable. We saw a small number of residents with unkempt appearance, clothes that didn't fit and little to do or engage with. There were other residents who were content with their care and settled. A small number of residents with dementia or cognitive impairment exhibit stress or distress for reasons which are often hard to determine. We observed two residents in McFarlane unit calling out for periods of minutes. On two occasions observed staff interaction was not sympathetic and records showed one of the residents had been "using the buzzer frequently". The night staff in Kelvin and Clyde unit were observed carrying out cleaning duties leaving the lounge with seven residents, two of whom could be disruptive to others, unsupervised. Although the individual personal plans had some reference to how to support and manage residents with stress/ distress the practices were not always focused in the best way. Further improvements must be made to improve the experience of care for residents with stress and distress. See Requirement 2. We checked how residents nutrition was being monitored and found the weight recording systems had been inaccurate for some residents for some months. This was in the process of being recalculated so it was hard to tell if residents weights were stable or not. From observation service users appeared well fed and the meals looked appetising. Menus displayed sometimes did not match with the food choices that arrived and meals that were pureed were not labelled so that care staff knew what they were. This meant staff could not explain clearly to residents what their meals were. These aspects need to improve. See recommendation 2. We noted some fluid charts for service users recorded low intake of fluid for several days. It was not clear what the fluid target was as this was not recorded. This needed more focus to ensure hydration needs are met. We could not be sure service users hydration needs were being met as records were unclear. See recommendation 3. Information was displayed about activities within the care home. However, these were often only suitable for the most able residents. An activity record was kept in resident's personal plans and this recorded participation. However, we noted many residents had not had an activity that they could take part in. This was often because there was limited staff resources to assist more highly dependent residents. See recommendation 4. We checked medication records and found overall these were kept well. However, there were instances where there was no quantity of medication supplied recorded, some administration codes were not used correctly on the medication administration records and a small number of missing signatures were seen. These details are important to ensure medication is tracked and accounted for. The medication audits had picked up on some of these issues. See theme 4 management and leadership. Residents finances were managed to varying levels by care home staff depending on residents individual circumstances. We found records were in place that could be tracked and checked. The agreement for personal expenses was not in place for all residents. We noted systems had not been used to best effect for one resident we sampled who had not had money spent "in his best interest" when it could have been. See recommendation 5. page 4 of 20

5 Requirements Number of requirements: 2 1. The service provider must ensure that personal plans fully set out how to meet the individual health, welfare and safety needs of each resident. 2011/210) Regulation 5(1) Personal plans. Timescale for meeting this requirement: by 31 August This is a repeat requirement. 2. The service provider must ensure that staff respond promptly, consistently and appropriately to residents who experience stress/distress. 2011/210) Regulation 4(1) Welfare of users. Timescale for meeting this requirement: by 31 July This is a repeat requirement. Recommendations Number of recommendations: 5 1. The service provider should ensure that the views of residents and families are clearly recorded to ensure these can be listened and responded to. National Care Standards for Care Homes for Older People: Standard 11 - Expressing Your Views 2. The service provider should ensure nutritional risk assessments are carried out accurately, menus displayed match with the food choices sent and it is clear to staff what a pureed meal is so this can be communicated to the service user. National Care Standards for care homes for older people, Standard 13 - Eating Well. 3. The service provider should improve the method of monitoring hydration of residents by ensuring fluid charts have a fluid target set and there is clear guidance to staff if this is not reached. National Care Standards for care homes for older people, Standard 13 - Eating Well. 4. The service provider should ensure meaningful activities are promoted for all residents and staff are supported with training and resources to provide this. page 5 of 20

6 National Care Standards for care homes for older people, Standard 12.4 Lifestyle - Social & Standard 17.4 Daily Life. 5. The service provider should ensure personal expenses agreements are in place and up to date for all residents who have monies managed by care home staff. The policy on managing residents finances should be fully implemented to help ensure monies are managed appropriately and spent in a resident's best interest to promote a better quality of life and respect their previous wishes and choices. National Care Standards for care homes for older people, Standard 8.4 Making Choices Grade: 3 - adequate Quality of environment Findings from the inspection The environment was mostly clean and tidy throughout the five units of the care home. Regular checks were carried out on water temperatures, window restrictors and other health and safety issues. However, issues were noted with the decoration and maintenance of Kelvin and Clyde units. Both of these units were in need of refurbishment. Clyde was in the poorer state with many areas in need of repair. Corridors were low in light and lacked points of interest. Bathrooms lacked homely touches and there was damage to the bathroom and corridor walls. Lounge carpets were stained and worn. This has been the subject of a requirement over the last year. See Requirement 1. The nurse call system is intrusive and the tone potentially disturbing to residents in Kelvin and Clyde units. Research has shown intrusive noise can increase levels of agitation and distress for residents with dementia. Upper Clyde unit is also disturbed by the alarm tones for McFarlane unit. Ways of reducing intrusive noise disturbance were being looked into by management. The audibility of the nurse call system was not reliable in all parts of Kelvin and Clyde units. This must be addressed. See Requirement 1. Progress with the refurbishment of Afton unit has been slow and this has resulted in the lift being difficult to access at times when workmen are present. During the inspection no work was being carried out and timescales for completion had been delayed. The dirty utility (sluice rooms) were not used appropriately and presented risks of cross contamination. These matters of health and safety must be improved urgently. See Requirement 2. We noted a lack of use of falls prevention alarms in Kelvin unit. This was concerning as one resident had fallen and no action had been taken to re-assess and consider equipment needs. The systems used to monitor and prevent falls needed review to ensure best practice was taking place. See Requirement 3. Some improvements to signage had been put in place in upper Clyde and a point of interest created. Further work was needed to ensure the environment was appropriate for older people with dementia. See recommendation 1. page 6 of 20

7 Access to outdoor space was limited by the refurbishment works in progress and therefore residents relied on staff to take them outside. "Fresh air time" was being time-tabled to try to support residents to get outdoors. We noted a resident had a padlock on a bedside table. This is not homely and a lockable drawer should be available. Another resident was waiting for a bedroom key. This should be addressed. See recommendation 2. Two relatives commented on clothing getting lost in the laundry. The laundry had many items of clothing which were not labelled and lost property. Two pairs of glasses were seen in a dirty utility and one in the laundry. These items were not labelled. Care of resident's property should be improved. See recommendation 3. Requirements Number of requirements: 3 1. The service provider must ensure the environment is improved as a priority in the Afton Court unit and thereafter in Kelvin and Clyde units. This must include: - redecoration, - provision of an accessible bath, - improvements to lighting - improvements to fabrics and furnishings - review of the nurse call system. 2011/210) Regulation 10 Fitness of premises. Timescale for meeting this requirement: for completion of work in Afton Court unit by 30 June For completion of all other works by 1 September This is a repeat requirement. 2. The service provider must improve health and safety in relation to the use of dirty utilities (sluice rooms). As follows: Dirty utility rooms must be kept locked when not in use by staff. All care staff must have a clear protocol to follow for cleaning commode pots and urinals. The urinal washer machine must be flushed and maintained appropriately or taken out of use permanently. hand wash sinks must be installed into dirty utility rooms. Bins must be operational and have pedals and lids. Toiletries and other hazardous items such as razors must be removed from communal bathrooms and stored securely. 2011/210) Regulation 10 Fitness of premises. Timescale by 3oth June page 7 of 20

8 3. The service provider must ensure that reassessment of a resident's needs take place after a fall. The systems to assess, record a falls prevention plan and ensure actions are taken following a fall must all be reviewed to ensure appropriate actions are taken to promote safety. 2011/210) Regulation 4 (1)(a) Welfare of users. Timescale by 30th June Recommendations Number of recommendations: 3 1. The service provider should improve the environment to take into consideration the needs of older people with dementia. National Care Standards for Care Homes for Older People, Standard Your. 2. The service provider should ensure service user's have access to a locked drawer and a choice of having a bedroom key if required. National Care Standards for Care Homes for Older People, Standard 16.1 & Private Life. 3. The service provider should ensure service user's belongings are labelled and cared for appropriately. National Care Standards for Care Homes for Older People, Standard 16.8 & Private Life. Grade: 2 - weak Quality of staffing Findings from the inspection McFarlane unit (short stay - intermediate care) had an increase in staff at night from two to three staff and this was proving beneficial. A new staffing agreement was coming into effect and this would result in a nurse being on duty in this unit on nights as well as days. A number of new staff had recently been employed and this was described as "promising" by relatives and would reduce the use of agency staff. The staffing for the four units of the main care home was observed to be under pressure and at times was not meeting residents needs. Staff could not communicate easily with one another and finding staff could take time. Improving the way staff can locate one another in order to help residents would be beneficial. page 8 of 20

9 New named nurse, named carer and keyworker allocations had just been carried out. We heard how roles were sometimes blurred and duties had not always been carried out as intended. Lack of leadership on all units was an issue and at times this was impacting on the quality of care. See recommendation 1. We sent out 32 questionnaires for staff. Only one was completed and returned to the Care Inspectorate. This indicated the staff member was not aware of important policies such as health and safety, recording incidents and complaints. The staff member commented there was a lack of training and support to staff. During the inspection we spoke with 20 staff and there were mixed views expressed but overall they were satisfied with the training and support provided. Most felt under pressure and that more staff were needed particularly in Kelvin unit. Six staff were not registered with the Scottish Social Services Council (SSSC). The timescale for this to be completed had lapsed and so the provider must ensure action is taken appropriately. See Requirement 1. New induction workbooks had just been put into place but some staff had started a few months ago without this framework being used to support them and check progress. See Requirement 2. Many staff had conditions on their registration with the Scottish Social Services Council (SSSC) and must obtain additional qualifications in order to renew their registrations. The staff group was very mixed with some more experienced than others. A staff training plan should be developed to ensure best practice is promoted. See recommendation 2. Night staff were sometimes working on their own and some were new to the care home and needed greater support and supervision. An incident occurred on night duty and staff did not respond well to a fire alarm incident. Some of these staff had not had fire training. This is due to be addressed urgently by the Fire Service and service provider. Staff deployment on nights needed urgent review to ensure there were sufficient staff who are experienced and competent in order to be able to meet the safety and care needs of residents. See Requirement 3. A new minimum staffing schedule was in progress of discussion. Requirements Number of requirements: 3 1. The service provider must take steps to ensure that only staff who are registered with the Scottish Social Services Council (SSSC) or another recognised regulatory body, or who are newly recruited and are capable of achieving such registration within 6 months of commencing in post, may carry out work in the care service in a post for which such registration is required. The Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011, SSI 2011/210 regulation 9(2)(c) which refers to the provisions of regulations 6(2)(a) and 7(2)(d) whereby any person, who in order to perform the duties for which the person is employed in the care service, is required by any enactment to be registered with any person or body and is not so registered; also regulation 15-, and regulation 19 Offences, in particular regulation 19(1) which makes if an offence to contravene or fail to comply with regulation 9(1)[ together with and the Regulation of Care (Fitness of Employees in relation to Care Services) SSI 2009/118 (Scotland) (No 2) Regulations 2009 as amended by SSI 2009/439 and 2010/443. page 9 of 20

10 Timescale by 30 June The service provider must review and provide a comprehensive induction for new staff to ensure essential subjects are covered within the first weeks of commencing employment. For example, moving and assisting, adult support and protection and fire procedures. 2011/210) Regulations 9(2)(b) Fitness of employees & 15(b)(i). Timescale for meeting this requirement: by 30 June The service provider must review and increase the numbers and skill mix of staff on day duty in Kelvin unit and on night duty for the whole home in order to meet the safety and care needs of residents. 2011/210) Regulation 15(a). Timescale for meeting this requirement: by 30 June Recommendations Number of recommendations: 2 1. The service provider should ensure staff are clear in their roles and nurses are focused on the care of residents assessed as having nursing needs. Improved leadership was needed in all units and clarity over named nurse, named carer and keyworker roles. National Care Standards for Care Homes for Older People, Standard 5 - management and staffing arrangements. 2. The service provider should ensure at least 50% of nursing and care staff have a minimum of SVQ 2 qualification. A training plan should be put in place to address this and the needs of staff who have conditions in place with their SSSC registrations. National Care Standards for Care Homes for Older People, Standard management and staffing arrangements. Grade: 2 - weak Quality of management and leadership Findings from the inspection The new manager was in post since December 2016 and had developed a three month development plan to focus on areas such as staff recruitment and retention, induction and training, quality assurance, meaningful activities for residents and participation. page 10 of 20

11 There was some evidence that some residents, relatives and staff had been involved in improving the service since the last inspection which had resulted in positive feedback from those involved. The service had also received some complaints since the last inspection however the outcomes of the investigations and action taken as a result had not been communicated to the complainant within the appropriate timescales. See recommendation 1. We saw evidence of quality assurance through various audits with some action plans developed. However, findings were not always reflected in the document submitted on a weekly basis to the Operations manager and improved outcomes for residents were not always evident as a result. We saw the quality assurance system had not included McFarlane unit (intermediate care) and management told us this was being addressed. See recommendation 2. We saw in Kelvin unit a resident was having medication disguised in food (covert). The agreement for this action had not been reviewed in the last 6 months and the method of disguise was not clear. This was not picked up by the medication audit and improvements need to be made in order to monitor covert medication more closely. See recommendation 3. External management had an overview of statistics sent by the service on a weekly basis however some of the information had not been completed or appeared not to have been up dated. We were told that this system was currently under review. The Quality and Compliance manager had been managing another care home service and therefore had not been involved in validation of audits at Chester Park. We were told that this would now be take place. Important areas of tracking such as staff registrations with Scottish Social Services Council (SSSC) had not taken place until mid April 2017 despite this issue being raised in other services provided by the same service provider a few months earlier. This showed a lack of internal action to communicate clearly across the service provider's five care homes. There was a "piecemeal" approach to refurbishment of the care home. This was resulting in delays and unacceptable standards within areas of the home. Overall, there are concerns about continued admissions of residents given need for refurbishment works in Clyde and Kelvin units. Further discussion will take place with the service provider to establish a clearer long term plan for the care home. Requirements Number of requirements: 0 Recommendations Number of recommendations: 3 1. The service provider should ensure that complaints are always responded to within the timescales set. National Care Standards for Care Homes for Older People: Standard Expressing Your Views. page 11 of 20

12 2. The service provider should ensure the quality assurance systems are developed further to ensure better outcomes for residents. This should also include McFarlane unit (Intermediate care). National Care Standards for Care Homes for Older People: Standard 5 - Management and Arrangements. 3. The service provider should review the medication audit systems to ensure reviews take place of any service user who had medication disguised in food or drink (covert). This review should take place at least every 6 months, name the medication and the method of disguise as agreed with the pharmacist. This should be clear to the staff member administering the medication to ensure consistency and safety of practice. National Care Standards for Care Homes for Older People: Standard Keeping Well - Medication. Grade: 2 - weak What the service has done to meet any requirements we made at or since the last inspection Previous requirements Requirement 1 The service provider must ensure that personal plans fully set out how to meet the individual health, welfare and safety needs of each resident. 2011/210) Regulation 5(1) Personal plans. Timescale for meeting this requirement: by 31 August This requirement was made on 28 June Action taken on previous requirement We sampled five personal plans of residents living in the main care home and two from short stay residents. See Care and Support theme in main body of report. Not met Requirement 2 The service provider must ensure that staff respond promptly, consistently and appropriately to residents who experience stress/distress. page 12 of 20

13 2011/210) Regulation 4(1) Welfare of users. Timescale for meeting this requirement: by 31 July This requirement was made on 28 June Action taken on previous requirement See Care and Support theme in main body of report. Not met Requirement 3 The service provider must ensure the environment is improved as a priority in the Afton Court unit and thereafter in Kelvin and Clyde units. This must include: - redecoration, - provision of an accessible bath, - improvements to lighting - improvements to fabrics and furnishings - review of the nurse call system. 2011/210) Regulation 10 Fitness of premises. Timescale for meeting this requirement: for completion of work in Afton Court unit by 30 November For completion of all other works by 1 April This requirement was made on 28 June Action taken on previous requirement See theme in main body of report. Not met Requirement 4 The service provider must review and provide a comprehensive induction for new staff to ensure essential subjects are covered within the first weeks of commencing employment. For example, moving and assisting, adult support and protection and understanding restraint. 2011/210) Regulations 9(2)(b) Fitness of employees & 15(b)(i). Timescale for meeting this requirement: by 31 August This requirement was made on 28 June page 13 of 20

14 Action taken on previous requirement See theme in main body of report. Not met What the service has done to meet any recommendations we made at or since the last inspection Previous recommendations Recommendation 1 The service provider should ensure that the views of residents and families are clearly recorded to ensure these can be listened and responded to. National Care Standards for Care Homes for Older People: Standard 11 - Expressing Your Views. This recommendation was made on 28 June Action taken on previous recommendation Reviews of personal plans were being carried out every 6 months and this included space to record comments. These were sometimes recorded well. Some reviews were still due to be carried out. There was little evidence of other methods being used to record views such as surveys or focus groups. This recommendation is not met. Recommendation 2 The service provider should ensure it is clear who residents' family members are and record clearly their full name, address and contact details. National Care Standards for Care Homes for Older People: Standard Supporting Arrangements. This recommendation was made on 28 June Action taken on previous recommendation The documentation in use for short stay residents had been reviewed and this was recorded more clearly. This recommendation is met. Recommendation 3 The service provider should consider how best to evidence within the records that personal hygiene, oral care, pressure relief and end of life care needs have been met. National Care Standards for Care Homes for Older People: Standard 5 - Management and Arrangements. This recommendation was made on 28 June page 14 of 20

15 Action taken on previous recommendation Progress was being made in record keeping. Folders were now in use to show personal hygiene, oral care and turning or repositioning charts. End of life care plans and anticipatory care planning had not yet been completed yet. This will be checked at the next inspection. Recommendation 4 The service provider should ensure that odours from drains in the MacFarlane unit are eradicated. National Care Standards for Care Homes for Older People: Standard Your. This recommendation was made on 28 June Action taken on previous recommendation Odours were reduced at the entrance to MacFarlane unit. This recommendation is met. Recommendation 5 The service provider should ensure that infection control procedures are followed by - a) ensuring a handwash sink is installed in sluice rooms. b) that regular checks are made to ensure soap is always available for handwashing. c) that yellow bag/pad waste is secured appropriately in waste bins and kept off the floor. d) that razors and toiletries are kept securely. National Care Standards for Care Homes for Older People: Standard Your. This recommendation was made on 28 June Action taken on previous recommendation Soap was available for hand washing. However, no other progress was seen. This recommendation is not met. See theme - Requirement 2. Recommendation 6 The service provider should ensure the nurse call system is audible by staff and responded to within a reasonable timescale. The noise should not be intrusive to residents. National Care Standards for Care Homes for Older People: Standard 4.3: Your and Standard 9.4: Feeling Safe and Secure. This recommendation was made on 28 June Action taken on previous recommendation We noted the buzzer noise to be intrusive in parts of Clyde and Kelvin units and staff told us it was not audible in all areas in these units. This recommendation is not met. See theme - Requirement 1. page 15 of 20

16 Recommendation 7 The service provider should review the induction process with a view to checking practice at intervals throughout the probationary period. Allocation of a mentor and improved evidence of use of induction materials would be good practice. National Care Standards for Care Homes for Older People: Standard Management and Arrangements. This recommendation was made on 28 June Action taken on previous recommendation New induction format had not yet been fully introduced to check practice at intervals throughout the probationary period. Mentors were now allocated. However, some new staff were not yet aware of this. This recommendation is not met. Recommendation 8 The service provider should ensure the quality assurance systems are developed further to ensure better outcomes for residents. National Care Standards for Care Homes for Older People: Standard 5 - Management and Arrangements. This recommendation was made on 28 June Action taken on previous recommendation There was a lack of action plans seen in response to audits undertaken. The audits often showed the same issues coming up each month and did not drive improvement. The service could consider using an overall service improvement plan to track progress in response to audits, inspections and so on. Supervisions, reviews, registrations and training were all in need of better tracking. This recommendation is not met. Complaints There have been no complaints upheld since the last inspection. Details of any older upheld complaints are published at Enforcement No enforcement action has been taken against this care service since the last inspection. page 16 of 20

17 Inspection and grading history Date Type Gradings 18 Nov 2016 Unannounced Care and support Not assessed Not assessed Not assessed Management and leadership Not assessed 26 May 2016 Unannounced Care and support 2 - Weak Management and leadership 2 - Weak 11 Feb 2016 Unannounced Care and support Not assessed Not assessed Not assessed Management and leadership Not assessed 27 Aug 2015 Unannounced Care and support Management and leadership 25 Feb 2015 Unannounced Care and support Management and leadership 28 Aug 2014 Unannounced Care and support 2 - Weak 2 - Weak Management and leadership 2 - Weak 8 Jan 2014 Unannounced Care and support Management and leadership 14 Jun 2013 Unannounced Care and support 2 - Weak page 17 of 20

18 Date Type Gradings Management and leadership 25 Jan 2013 Unannounced Care and support Management and leadership 7 Mar 2012 Unannounced Care and support Management and leadership 20 Apr 2011 Unannounced Care and support 5 - Very good Management and leadership 19 Dec 2010 Unannounced Care and support Not assessed Management and leadership Not assessed 26 Apr 2010 Announced Care and support 5 - Very good Not assessed Management and leadership 5 Nov 2009 Announced Care and support Management and leadership 27 May 2009 Unannounced Care and support Management and leadership Not assessed 17 Dec 2008 Unannounced Care and support page 18 of 20

19 Date Type Gradings Management and leadership Not assessed 23 Jun 2008 Announced Care and support Management and leadership page 19 of 20

20 To find out more This inspection report is published by the Care Inspectorate. You can download this report and others from our website. Care services in Scotland cannot operate unless they are registered with the Care Inspectorate. We inspect, award grades and help services to improve. We also investigate complaints about care services and can take action when things aren't good enough. Please get in touch with us if you would like more information or have any concerns about a care service. You can also read more about our work online at Contact us Care Inspectorate Compass House 11 Riverside Drive Dundee DD1 4NY enquiries@careinspectorate.com Find us on Facebook Other languages and formats This report is available in other languages and formats on request. Tha am foillseachadh seo ri fhaighinn ann an cruthannan is cànain eile ma nithear iarrtas. page 20 of 20