Bield at Home - Linlithgow/Biggar Support Service Care at Home Westport Resource 1 St Ninians Road Linlithgow EH49 7BY

Transcription

1 Bield at Home - Linlithgow/Biggar Support Service Care at Home Westport Resource 1 St Ninians Road Linlithgow EH49 7BY Inspected by: Jane Brown Type of inspection: Announced (Short Notice) Inspection completed on: 21 March 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 23 5 Summary of grades 24 6 Inspection and grading history 24 Service provided by: Bield Housing & Care Service provider number: SP Care service number: CS Contact details for the inspector who inspected this service: Jane Brown Telephone enquiries@careinspectorate.com Bield at Home - Linlithgow/Biggar, 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 3 Adequate Quality of Staffing 3 Adequate Quality of Management and Leadership 3 Adequate What the service does well Bield at Home is a small and bespoke care and support service for older people living at home. The type of support being provided ranges from assistance with shopping to more intimate personal care. Staff work hard to provide an individualised response to service users. We observed staff interacting with service users in a calm and respectful manner, taking time to work through the tasks to be completed. What the service could do better Bield at Home is a relatively new service which is in a pilot phase. We became aware that an evaluation is to be undertaken of this pilot project. We will check this at our next inspection, with a view to assessing how the feedback received has influenced the shape of the service going forward. The service should review the systems it uses to canvas the views of service users and their representatives and ensure these are relevant to the Bield at Home service. We noted that some improvement was needed in the detail of recordings in support plans and in medication administration records (MARS). The provider must ensure all staff are appropriately trained and supported to undertake and fulfil their roles and responsibilities competently and confidently. Bield at Home - Linlithgow/Biggar, page 3 of 25

4 The provider must ensure there are appropriate audits and quality control systems in place to measure the quality of the service being provided and to inform improvements. What the service has done since the last inspection This is the first inspection since the service was registered in November During this inspection we visited service users in Linlithgow only, as at that time none of the service users living in Biggar were in receipt of personal care and the number of care and support hours being provided in Linlithgow was greater than that in Biggar. Conclusion Bield at Home, Linlithgow/Biggar is a small pilot project which was registered with the Care Inspectorate in October This was the first inspection of the service since it was registered. We have made some requirements and recommendations for improvement as a result of this inspection. The service provider (Bield Housing Association) plans to carry out an evaluation of the project during Our findings during this first inspection would suggest that the provider needs to re-visit the function and purpose of Bield at Home so as to provide greater clarity about the scope and limits to the service. The provider must then ensure that all staff are suitably trained, monitored and supported to deliver the aims and objectives of the service now and as it develops. The provider must also ensure that there are effective audit processes in place to ensure that quality assurance is being monitored on an on-going basis and actions taken to effect improvement where needed. Who did this inspection Jane Brown Bield at Home - Linlithgow/Biggar, 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 registered with the Care Inspectorate on 29 October Requirements and recommendations If we are concerned about some aspect of a service, or think it could do more to improve its service, 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 the Regulations, Order or conditions, a requirement must be made. Requirements are legally enforceable at the discretion of the Care Inspectorate. Bield at Home - Linlithgow and Biggar is a small care at home service operating from sheltered housing office bases in both Linlithgow and Biggar which are owned and operated by Bield Housing Association. This service is part of a pilot project that also includes a service operating in Dunfermline, which is separately registered and inspected by the Care Inspectorate. The majority of current service users are tenants within Bield sheltered housing developments in these geographical areas. Service users can purchase the service using self directed support payments following an assessment of need by the local authority. They can also purchase the service privately. At present, the service is provided during day time hours only. The aims and objectives of the service are stated as: "To work with tenants, their families and other main carers to develop a responsive, needs led service which enhances current service provision To give tenants choice about the services that they purchase To support people to live independently in their own home/tenancy To provide a person centred, flexible service To help maintain tenants within their current tenancies." Bield at Home - Linlithgow/Biggar, page 5 of 25

6 The support available includes assistance with domestic tasks, personal care, administration of medication, shopping, travel to appointments or day care services, social contact and hospital discharge. Based on the findings of this inspection this service has been awarded the following grades: Quality of Care and Support - Grade 3 - Adequate Quality of Staffing - Grade 3 - Adequate Quality of Management and Leadership - Grade 3 - Adequate 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. Bield at Home - Linlithgow/Biggar, 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 A short announced inspection was carried out by Jane Brown (Inspector, Care Inspectorate) on 20 and 21 March 2014 between the hours of 9.30am and 18:30 and 8:45am and 16:30 respectively. Feedback was given to the Project Team Leader during our visit on 21 March. We gathered evidence from a range of sources, including: - Bield's participation strategy - the service's information leaflets - Bield policies: medication/supervision/adult support and protection/complaints - Bield at home operational policy - service user support plans - on call guidelines - the service's self assessment - the service's annual return - completed Care Standards Questionnaires - service user agreements - staff supervision records - records of staff meetings - Bield's induction checklist. We also met with a number of service users living in Linlithgow and made telephone contact with a relative. We met with one relative during our visit to a service user. We spoke with the Project Team Leader, the Service Manager and staff. Bield at Home - Linlithgow/Biggar, page 7 of 25

8 We focused on the Linlithgow provision during this inspection. At this time, there were seven people using the Bield at Home service in Linlithgow and 43 hours of care and support were being provided each week. Four service users were living in the Bield sheltered housing development at Westport and three in the local community within the town. Of the seven service users, four were in receipt of personal care, with the remaining three receiving domestic support only. There were four staff working in the Linlithgow project, two of whom had temporary contracts and two who had zero hour contracts. Three of the service users were purchasing the Bield at Home service via a self directed support payment. The manager for Bield at Home in Linlithgow also has responsibility for all 27 sheltered housing tenants living at Westport. The Biggar project was delivering domestic support up to 18 hours per week to 10 service users at the time of this inspection. 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 Bield at Home - Linlithgow/Biggar, 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. We received a self assessment completed by the Service Manager. This seemed to reflect the aspirations and aims and objectives of the service more than the current operational position. Taking the views of people using the care service into account We issued eight Care Standards Questionnaires, some of which were completed by both the service user and their family representative, some by the service user themselves and some by a family member. There were no concerns raised within these responses about the quality of the service being received. Service users told us if they had any concerns about the service they would have no hesitation in approaching the manager, whom they described as approachable and helpful. All of the service users we spoke with were happy with the service they were receiving. One service user told us they liked their carer and they were a very good worker. Another service user told us "The carers know how I like things done. If there was a problem I would speak to the manager. I would rate these people". And another said "I like the carers - they are really caring." Bield at Home - Linlithgow/Biggar, page 9 of 25

10 Taking carers' views into account One relative we spoke with told us their relative can have up to three carers, though it is mainly the same one who visits. They told us "they are all very good and "all understanding". They also told us that their relative seemed to get on well with the carers. They had experienced one missed visit a few weeks previously. However, they had been satisfied with the manager's response. They also told us that the carers always arrived on time and stayed for the allocated time. Overall, the relative told us they were satisfied with the service and trusted Bield at Home to look after their relative. Another relative told us they had no concerns about the quality of the service. Bield at Home - Linlithgow/Biggar, 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: 3 - Adequate 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 saw that the service was operating to an adequate level in this area. We measured this by looking at the systems in place for accessing the views of service users and their families about the quality of the service. We saw that the provider had produced a colourful leaflet about the Bield at Home Service as well as an A4 size information booklet. This provided prospective service users and their families with information about the service as well as details about how to make a complaint. The booklet also suggests that any feedback on the service should be given to the Bield at Home manager, whose contact details are listed on the front page. We noted that the provider had put in place a service user agreement form which covered areas such as a description of the services available, staffing and staff conduct and monitoring and review. Areas for improvement As this is a pilot project, an evaluation exercise is to be carried out by the provider. We will look at this during our next inspection, including the methodology used and how the provider has utilised the feedback to shape the future of the service provision. We became aware that the project manager had begun some work on drafting a newsletter for Bield at Home, though this had not yet been officially published. Bield at Home - Linlithgow/Biggar, page 11 of 25

12 Whilst we noted that the provider had produced an information booklet for the service which detailed how to make a complaint, some service users we spoke with were unclear how they would go about this. We would suggest that the Newsletter could be used to publicise this information. We will monitor this at the next inspection. In their self assessment, the provider had told us that there was a participation strategy in place for the service. However, we saw that this pre-dated the introduction of the pilot and was not tailored to Bield at Home. We were also advised that participation was being recorded through a continuous improvement record. However, we noted that this was not being carried out specifically for Bield at Home. There was no evidence of meetings taking place with service users or their families. It was therefore unclear how the service was accessing their views or developing the service in response to their feedback. See recommendation 1. We noted that whilst reviews of care and support were taking place, the records of these were not particularly detailed. We also saw that changes in the presenting needs of a service user where not noted in their support plan. We have made a requirement in Quality Statement 1.3 about support plans which also applies here. Grade awarded for this statement: 3 - Adequate Number of requirements: 0 Number of recommendations: 1 Recommendations 1. The provider should develop the participation strategy so it is tailored for the Bield at Home service. This should include how the provider plans to engage with service users and their families/representatives and evidence continuous improvement. National Care Standards. Care at Home. Standard 11 and Housing Support Services - Standard 8 - expressing your views. Bield at Home - Linlithgow/Biggar, page 12 of 25

13 Statement 3 We ensure that service users' health and wellbeing needs are met. Service strengths Inspection report continued We saw that the service was operating to an adequate level in this area. We measured this by sampling service user support plans and observing staff practice with service users in their own homes. We saw that support plans contained photographic identification of service users as well as details of who should be contacted in an emergency. They also contained a care needs summary. Support plans were well set out and included the current situation, the expected outcome for the support being provided and any actions needed. We saw that six monthly review meetings were taking place involving all appropriate parties. We sampled activity logs and timesheets which were located in service user's homes. We saw that staff were consistently recording the times of their visits - when they arrived and when they left. We also sampled contact notes and saw that staff were making an entry for all visits. There was no evidence of any missed visits. This was confirmed by those service users we met with. We observed staff with service users and noted that these interactions were positive, warm and caring. Staff told us that before they start working with a new service user, they are shown the support plan and the manager attends with them on the initial visit. We saw that staff respected the privacy of service users. For example, they always knocked at a service user's door and waited to be invited before entering. We saw that the service had developed an on call protocol to ensure that service users could make contact with staff outwith normal hours. Bield at Home - Linlithgow/Biggar, page 13 of 25

14 Areas for improvement We noted that recordings in support plans were not consistent for all service users. This is an area that must be worked on to ensure that all information is up-to-date, consistent across all service users and reflects current levels of need. Our findings from this inspection are as follows: One service user's support plan stated that a family member held power of attorney, but it was unclear if this was welfare, financial, or both. Another service user told us that family members held welfare and financial power of attorney, but this had not been recorded in the support plan. In order that staff ensure third parties with legal powers are appropriately involved in care planning and decision making, the support plans should detail the limits and extent of their legal involvement. It was evident that records of review meetings could be more detailed regarding what was discussed and the actions to be taken forward. Part of the support plan included a home risk assessment. We noted examples of this form which were unsigned and undated. For one service user we saw that risk assessment information and instructions for staff had been completed in These were to have been reviewed in 2013, but there was no record of a review having taken place. We noted that support plans would benefit from being much more detailed about any medical issues. For example, we noted that the support plans for two service users did not detail they were living with a degree of cognitive impairment and the impact this may have on their ability to remember things. There did not appear to be a diagnosis within the support plan, though there was evidence to suggest that the service users may be living with dementia. The dementia care standards promote the early diagnosis of dementia. We would therefore suggest that the service should be ensuring this is discussed with all service users and their representatives to whom this may apply, with appropriate actions taken. We also became aware that one service user had previously suffered a stroke and a fall resulting in a fracture. None of this information has been recorded in the support plan and there were no related risk assessments in place. We saw that some sections of support plans were being written in the first person and some in the third person. It would be helpful if this was consistent. When visiting one service user we noted that they did not have a service user agreement in place. For another service user, an initial assessment was in place but there was no support plan following on from this. The initial assessment had been completed some months previously. In another example, there were three different copies of a support plan all with different dates. Bield at Home - Linlithgow/Biggar, page 14 of 25

15 We saw one service user's contact records had nothing recorded over a period of 5 consecutive days. Support plans did not detail the support provided by other parties, such as family members. See requirement 1. We sampled medication administration records (MARS). We noted some gaps in recording and some records which contained a question mark instead of a staff signature, but no reason had been stated for these omissions on the reverse of the MAR in line with good practice. One service user had been recorded as having been given their medication on a particular date within the contact notes, but on the same date the MAR sheet record was a question mark. We saw one MAR sheet on which medication prescribed had been handwritten but with no information about dosage instructions. We also observed that one service user had not taken all their pain relief medication at the time it had been administered and was about to be given a further dosage. See requirement 2. We have also made a requirement about medication training in Quality Statement 3.3. Grade awarded for this statement: 3 - Adequate Number of requirements: 2 Number of recommendations: 0 Requirements Inspection report continued 1. The provider must review support plans to ensure they are an accurate reflection of current need. This must include, but is not limited to ensuring: - there is a detailed support plan in place for all service users - full details of those parties with legal responsibilities and the extent and limits of these responsibilities are recorded - there are detailed records of six monthly review meetings with action plans - support plans include details of all appropriate medical information which may influence how care and support is to be delivered - referrals are made to other agencies for diagnosis/support as required - service user agreements are completed in all cases - risk assessments are fully completed and in place for any risks linked to care and support needs as well as within the environment in which care and support is being delivered. For consistency, recordings in support plans should be made in either the first or third person, and there should be a written record detailing the support given during each visit. Bield at Home - Linlithgow/Biggar, page 15 of 25

16 This is to comply with The Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011, SSI 210. Regulation 4 (1) (a) which is a requirement about the welfare of service users and Regulation 5 which is a requirement about personal plans. Timescale: within four weeks of the receipt of this report. Inspection report continued 2. The provider must ensure that all medication is administered and recorded in line with best practice. This must include but is not limited to ensuring that: - when medication is not administered or has been refused, the reasons for this are recorded on the reverse of the MAR chart - all medication being prescribed is accurately and appropriately recorded on the MAR sheet and includes dosage instructions - when medication is being administered, staff must ensure that it has been taken by the service user. This is to comply with The Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011, SSI 210. Regulation 4 (1) (a) which is a requirement about the welfare of service users. Timescale: within 24 hours of the receipt of this report. Bield at Home - Linlithgow/Biggar, page 16 of 25

17 Quality Theme 3: Quality of Staffing Grade awarded for this theme: 3 - Adequate Statement 1 We ensure that service users and carers participate in assessing and improving the quality of staffing in the service. Service strengths Comments made in Quality Statement 1.1 are also relevant to this Quality Statement. We have also applied the grade of 3 "adequate" awarded in Quality Statement 1.1 to this Statement. Areas for improvement The service should refer to the areas for improvement in Quality Statement 1.1 and ensure they implement any action plans required. Grade awarded for this statement: 3 - Adequate Number of requirements: 0 Number of recommendations: 0 Bield at Home - Linlithgow/Biggar, page 17 of 25

18 Statement 3 We have a professional, trained and motivated workforce which operates to National Care Standards, legislation and best practice. Service strengths We saw that the service was operating to an adequate level in this area. We measured this by looking at supervision records and minutes of staff meetings. We also spoke with the manager about training being provided to staff. We saw that supervision was now being provided to staff at intervals of 6-8 weeks. We also saw that staff meetings had been taking place this year. We were advised that the training made available to staff included first aid, moving & handling, food hygiene, equality and diversity and medication. The Project Manager told us they had completed the "Promoting Excellence" dementia training to the enhanced level and would be responsible for ensuring that all staff received training in this area. We will check how this has been taken forward at our next inspection. Areas for improvement Inspection report continued We noted that staff meetings had started to take place as recently as January There had been 2 meetings up to 28 April The earliest recording of staff supervision was February 2014, though one member of staff had been in post since May It was evident that the service had been operating for some months before staff supervision and staff meetings had been started. We will therefore monitor how frequently these have been taking place at our next inspection and that the provision of supervision is in line with the service's supervision policy. We saw some evidence of mandatory training having been carried out with two staff members. However, we did not see evidence of induction training that had been undertaken, though staff did tell us they had been provided with this. See recommendation 1. We became aware of an alleged incident which had taken place some months previously where a service user had indicated their care had been delivered inappropriately. There did not appear to be any written records of the investigation undertaken by the manager. The Care Inspectorate nor the local authority had been notified of this incident as required. See requirement 1. We have described some concerns we had about staff practice regarding the administration and recording of medication in Quality Statement 1.3. We have made a requirement here about refreshing staff training in this area. See requirement 2. Bield at Home - Linlithgow/Biggar, page 18 of 25

19 Grade awarded for this statement: 3 - Adequate Number of requirements: 2 Number of recommendations: 1 Requirements 1. The provider must ensure that all staff with supervisory and management responsibilities are appropriately trained and supported so they are able to respond in line with best practice to any allegations regarding staff conduct. This must include ensuring that there is a clear awareness of when to notify other agencies. This is to comply with The Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011, SSI 201. Regulations 15 (b) (i) which is a requirement about staffing and 4 (1) (a) which is a requirement about the welfare of service users. Timescale: within 6 weeks of the receipt of this report. Inspection report continued 2. The provider must ensure that all staff receive refresher training in the administration and recording of medication. This is to comply with The Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011, SSI 201. Regulations 15 (a) which is a requirement about staffing and 4 (1) (a) which is a requirement about the welfare of service users. Timescale: within 6 weeks of the receipt of this report. Recommendations 1. It is recommended that the provider puts systems in place to record and plan staff training as well as monitor the impact this is having on staff competence and outcomes for service users. National Care Standards. Housing Support - Standard 3 and Care at Home - Standard 4 - management and staffing. Bield at Home - Linlithgow/Biggar, page 19 of 25

20 Quality Theme 4: Quality of Management and Leadership Grade awarded for this theme: 3 - Adequate 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 Comments made in Quality Statement 1.1 are also relevant to this Quality Statement. We have also applied the grade of 3 "adequate" awarded in Quality Statement 1.1 to this Statement. Areas for improvement The service should refer to the areas for improvement identified in Quality Statement 1.1 and ensure they implement any action plans required. Grade awarded for this statement: 3 - Adequate Number of requirements: 0 Number of recommendations: 0 Bield at Home - Linlithgow/Biggar, page 20 of 25

21 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 We saw that the service was operating to an adequate level in this area. We measured this by looking at support plan information and how this was being reviewed and audited. We also spoke in some detail with the Project Team Leader regarding their knowledge of the service and how it might be evaluated and developed going forward. Areas for improvement Inspection report continued Bield at Home - Linlithgow and Biggar is part of a pilot project. We were advised by the Project Team Leader that an evaluation process will be carried out at some point during This is to involve collating feedback from service users and their families. We were advised that questionnaires were in the process of being drafted. However, these were not yet ready to be issued and there was no timescale set for the evaluation process to be concluded. It was also unclear how external stakeholders would be engaged in this process. We will look at how this has been progressed during our next inspection. We became aware that that there was no current system in place for carrying out audits of support plans. It was therefore difficult to be confident that the manager would have sufficient information to ensure they had an accurate and up-to-date overview of the needs of service users and how these might be developing. We saw that support plans held in the office tended to match the content of those being located in service user's homes. Whilst the manager was scanning contact notes about visits to service users into the "Care Sys" system, this seemed to be an administrative process only. We noted an example where it was evident that the service did not appear to be picking up on the fact that the service user's needs were changing and becoming more complex. In this particular case, there was no sense that reviews may be needed more frequently to monitor changes or re visit risk assessments. We noted another example where receipts for shopping carried out for a service user were loosely stored in a care plan file within the service user's home. There was no indication that these had been checked or audited at any time. We have described in Quality Statement 1.3 that medication administration records were not always being completed appropriately or accurately. Whilst there was evidence to suggest that this had been an on-going issue for some time, it had not been picked up and addressed by the manager. See recommendation 1. We looked at incident reports during our inspection. We saw that there had been one incident recorded. Due to the nature of this event, the Care Inspectorate should have been notified. Requirement 2 in Quality Statement 3.3 applies here. Bield at Home - Linlithgow/Biggar, page 21 of 25

22 Grade awarded for this statement: 3 - Adequate Number of requirements: 0 Number of recommendations: 1 Recommendations Inspection report continued 1. It is recommended that the service develops and implements audit processes which can be used on an on-going basis to monitor quality and how the service is responding to changes in service user need. This must include, but is not limited to, audits of service user support plans and medications records. National Care Standards. Care at Home - Standard 4 and Housing Support Services - Standard 3 - management and staffing. Bield at Home - Linlithgow/Biggar, page 22 of 25

23 4 Other information Complaints No complaints have been upheld, or partially upheld, since the last inspection. Enforcements We have taken no enforcement action against this care service since the last inspection. Additional Information An action plan was not required as this was the first inspection of this service since initial registration. 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). Bield at Home - Linlithgow/Biggar, page 23 of 25

24 5 Summary of grades Quality of Care and Support Adequate Statement 1 Statement Adequate 3 - Adequate Quality of Staffing Adequate Statement 1 Statement Adequate 3 - Adequate Quality of Management and Leadership Adequate Statement 1 Statement Adequate 3 - Adequate 6 Inspection and grading history All inspections and grades before 1 April 2011 are those reported by the former regulator of care services, the Care Commission. Bield at Home - Linlithgow/Biggar, 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: Bield at Home - Linlithgow/Biggar, page 25 of 25