Bute House Care Home Service Adults Barrhill Terrace Cumnock KA18 1PT

Bute House Care Home Service Adults Barrhill Terrace Cumnock KA18 1PT Inspected by: Sandra Hobley Type of inspection: Unannounced Inspection completed on: 17 July 2012

Contents Page No Summary 3 1 About the service we inspected 5 2 How we inspected this service 7 3 The inspection 12 4 Other information 24 5 Summary of grades 25 6 Inspection and grading history 25 Service provided by: Community Care Homes Limited Service provider number: SP2003002426 Care service number: CS2011281675 Contact details for the inspector who inspected this service: Sandra Hobley Telephone 01294 323920 Email enquiries@careinspectorate.com Bute House, page 2 of 26

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 Environment 3 Adequate Quality of Staffing N/A Quality of Management and Leadership 3 Adequate What the service does well The service encouraged feedback from service users and carers about the service that they received. Service users and carers were complimentary about the care provided. What the service could do better Following this inspection the Care Inspectorate has highlighted areas for improvement including: To plan and deliver support that takes account of the interests, needs and beliefs of people to enable them to fulfil their aspirations and achieve their potential. To ensure that people who use this service are offered a range of appropriate, purposeful, recreational and stimulating activities on a regular basis. To ensure that care plans consistently reflect the assessed needs of residents and evidence how the plan is followed on a daily basis. To improve the standard of record keeping. What the service has done since the last inspection The provider had put in place an action plan to address required improvements and was continuing to liaise with us about the progress of this. The provider had reviewed and improved the entire management structure and supervision of this home. Bute House, page 3 of 26

Staff conduct issues had been addressed. A task centred approach to care was gradually being replaced by more person centred approach based on individual choice. Conclusion At this inspection we have found adequate performance. There has been significant change within this service since the last inspection in response to anonymous concerns raised about the standards of care and management within the home. The provider has undertaken a review of the organisational culture to ensure that this is based on the values set in legislation and national care standards such as respect, dignity and choice. The management and supervision structure within the home has been improved. The provider needs time to ensure that planned actions are fully implemented within this service. Who did this inspection Sandra Hobley Bute House, page 4 of 26

1 About the service we inspected "The Care Inspectorate regulates care services in Scotland. Prior to 1 April 2011, this function was carried out by the Care Commission. Information in relation to all care services is available on our website at www.careinspectorate.com The Care Inspectorate will award grades for services based on findings of inspections. Grades for this service may change after this inspection if we have to take enforcement action to make the service improve, or if we uphold or partially uphold a complaint that we investigate. The history of grades which services have been awarded is available on our website. You can find the most up-todate grades for this service by visiting our website, by calling us on 0845 600 9527 or visiting one of our offices. 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. - 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 and 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 Inspectorate." Bute House is registered to provide care to a maximum of 47 older people which may include 4 respite care places. At the time of inspection 29 people were resident within this service. Bute House is a purpose built care home located within the town of Cumnock, East Ayrshire. The accommodation offers a choice of single and shared bedrooms over two levels. The upper floor can be accessed via a passenger lift. Service users also have access to three lounges, dining area, conservatory and small quiet room. Smoking is permitted within one lounge. Service users are also able to access a small enclosed garden area. The stated aim of the service is: "To offer all our residents a 'home from home', an environment where they feel comfortable and cared for and where their individual needs are understood and Bute House, page 5 of 26

catered for by our staff". The service was registered with the Care Inspectorate on 16 May 2011. 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 Environment - Grade 3 - Adequate Quality of Staffing - N/A 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 www.careinspectorate.com or by calling us on 0845 600 9527 or visiting one of our offices. Bute House, page 6 of 26

2 How we inspected this service The level of inspection we carried out In this service we carried out a high intensity inspection. We carry out these inspections where we have assessed the service may need a more intense inspection. What we did during the inspection We wrote this report following an unannounced inspection that took place on the following dates: 16 July 2012 from 11.00am - 6.30am 17July 2012 from 9.30am - 5.30pm The inspection was carried out by Care Inspectorate Inspectors Sandra Hobley, and Michael Thomson. The focus of this inspection was to look at the progress made following anonymous concerns raised about the standards of care and protection issues. We also looked at the progress made by the service to meet the requirements and recommendations from our last inspection on 21 February 2012. In this inspection we gathered evidence from various sources, including the relevant sections of policies, procedures, records and other documents, including: Care files Care reviews Staff communication records Residents meeting minutes Information about advocacy Staff meeting records Staff rotas Staff training records Accident /incident records Certificate of Registration Staffing Schedule Dependency assessments Insurance details Maintenance records Medication records Communication with carers We spoke to the following people: Service users (5) Operations Manager Bute House, page 7 of 26

Nursing and Care Staff (6) Managing Director Cook Painter Relatives and visitors (5) We also observed how staff worked and looked at some areas of the environment. 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 www.firelawscotland.org Bute House, page 8 of 26

What the service has done to meet any requirements we made at our last inspection The requirement The provider must ensure that people who use care services are offered a range of appropriate, purposeful, recreational and stimulating activities on a regular basis. This is in order to comply with: SSI 2011/210 Regulation 4(1)(a) - a requirement to make proper provision for the health, welfare and safety of service users. Timescale: Within 3 months of receipt of this report What the service did to meet the requirement See Quality Theme 1, Quality Statement 1.3 The requirement is: Not Met The requirement The provider must be able to demonstrate that, when they plan and deliver support, they take into account the interests, needs and beliefs of people to enable them to fulfil their aspirations and potential. This is in order to comply with: SSI 2011/210 Regulation 4(1)(a) - a requirement to make proper provision for the health, welfare and safety of service users. Timescale: Within 3 months of receipt of this report What the service did to meet the requirement See Quality Theme 1, Quality Statement 1.3 The requirement is: Not Met The requirement The provider must improve the standard of record keeping. This is in order to comply with: SSI 2011/210 Regulation 5(1) - a requirement to prepare a written plan which sets out how the service user's health, welfare and safety needs are to be met. Timescale: Within 24 hours of receipt of this report What the service did to meet the requirement See Quality Theme 1, Quality Statement 1.3 The requirement is: Not Met Bute House, page 9 of 26

The requirement The provider must: a) ensure that care plans consistently reflect the assessed needs of residents and evidence how the plan is followed on a daily basis. b) improve the robustness of the care plan audit tool. This is in order to comply with: SSI 2011/210 Regulation 4(1)(a) - a requirement to make proper provision for the health, welfare and safety of service users. Timescale: Within 4 weeks of receipt of this report. What the service did to meet the requirement See Quality Theme 1, Quality Statement 1.3 The requirement is: Not Met What the service has done to meet any recommendations we made at our last inspection One recommendation was made at the last inspection on 21 February 2012. Progress in meeting this recommendation is reported on under the relevant quality theme and statement. 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 did not request a self assessment document from the provider on this occasion. Taking the views of people using the care service into account We spoke to five residents during our inspection who told us that overall they were happy with the quality of care that they received at this home. Comments included: "There is still not an awful lot to do. Occasionally I've been on bus outings. Staff are all very nice. The food is good and includes a variety of fruits on a daily basis. There are plenty staff on duty". Bute House, page 10 of 26

"There are plenty of staff when you need them and they are all very nice. Staff come right away when I activate the alarm call". "I'd like to be at home but it's alright here. I have never been in the garden. I don't even know if they have one or where it is". "Staff always treat me with respect and dignity". Taking carers' views into account We refer to relatives, friends and advocates as carers. They do not include care staff. We spoke to five relatives who told us that overall they were happy with the quality of care that their relative received. Comments included: "There is a big improvement in the environment. It is now much brighter and lighter for people living here. I have no concerns. My relative is well looked after". "We are happy with the care my relative receives. We have never really had any concerns about the care here. Our only criticism is that the provider was slow to communicate with us about events within the home which encouraged rumour and anxiety. However, we have now received a letter and a meeting is arranged which should help communication. There is the name of a keyworker on the back of our relatives bedroom door, but we don't know who this is. Activities do take place, my relative occasionally goes on a bus outings. There hasn't been consistency in the management arrangements of the home for some time. We notice the changes in staff. The environment is much improved. We have found no issue with staff attitudes". Bute House, page 11 of 26

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 The grade achieved for this quality statement at the last inspection on 21 February 2012 was 3 - Adequate. Elements of the evidence provided were re-visited and this statement remains 3 - Adequate. We concluded this after we talked to residents, carers, the operations manager and staff. We also took into account personal plans, minutes of meetings and other supporting documentation. The care service used different methods to encourage residents and relatives to express their views about the quality of individual care arrangements and more general aspects of the service provided. This included: * A keyworker/named nurse system. * Residents/relatives meetings. * Reviews. * Letters to families about developments * Newsletters * Comments/suggestions * Complaints procedure. Since our last inspection there had been a complete review of the organisational structure and culture. This included a new General Manager, Operations Manager and new Managing Director. The organisation had re defined its values and philosophy to ensure that people using the service are central to the service provided. The values statement for the organisation now states: 'the services we provide must follow the clients lead, we must be innovative, open and meaningful in our efforts to truly hear the clients voice. We must make sure that the power to change, lead and develop our services lies with those who use them, not those who provide them'. Bute House, page 12 of 26

This statement was now being shared with residents, carers, staff and stakeholders. Training had been developed for all staff to ensure that they fully understood the company's philosophy and values and applied this in their day to day practice. The service had written to all carers requesting feedback on the values statement. The service had written to all carers asking how they wanted to be kept up to date about non urgent matters i.e. by letter, email or text. In addition all carers had been invited to an open afternoon to personally meet the new management team. Nominations were also being sought from carers to participate in a small steering group to guide the work of the service or to volunteer their time within the service. We found that the service responded to feedback received from residents and carers. Areas for improvement The home planned to appoint a champion to ensure that people's voices were heard and lifestyles were fulfilled. Some relatives told us that the service needed to continue to improve communication as they were not always kept up to date about health or other issues relating to their relatives care. However, as previously stated we note that the service had sent a letter out to people about communicating with them. (See recommendation 1 for this quality statement). Some relatives and residents told us that they did not know who their keyworker was or what this role entailed. (See recommendation 2 for this quality statement). Grade awarded for this statement: 3 - Adequate Number of requirements: 0 Number of recommendations: 2 Recommendations 1. The role of keyworker within this service should be developed and promoted. Residents and carers should be informed of the name of their keyworker and what this role entails. National Care Standards Care Homes for Older People, Standard 7: Moving in National Care Standards Short Breaks and Respite Care Standards for Adults, Standard 7: Starting to use the service 2. The service should continue to improve communication with families, keeping them up to date and fully informed about issues relating to their relatives care. National Care Standards Care Homes for Older People, Standard 5: Management and staffing arrangements Bute House, page 13 of 26

Statement 3 We ensure that service users' health and wellbeing needs are met. Service strengths The grade achieved for this quality statement at the last inspection on 21 February 2012 was 3 - Adequate. Elements of the evidence provided were re-visited and this statement remains 3 - Adequate. We concluded this after we talked to residents, carers, the operations manager and staff. We also took into account personal plans, minutes of meetings and other supporting documentation. We found a good range of equipment throughout the home to support people's needs. Residents were supported to maintain links with their own G.P. and other healthcare professionals. We sampled personal plans and found them to contain a range of assessment tools relating to health and wellbeing needs of residents including nutrition, continence and pressure care. Personal plans showed that residents accessed a range of healthcare professionals as required. The detail of personal plans showed some improvement. Life history (walk down memory lane) information was now held within the care file beside the care plan. The role of 'champions' to promote areas of practice including continence and nutrition was continuing to be developed within the home. The home currently had external support from a clinical improvement manager arranged through an external agency. Work was being undertaken with trained staff to reinforce professional responsibility and risk assessment Accidents and incidents were documented in the home. Records showed that appropriate action was taken to prevent further occurrence. We observed staff to support a resident with behavioural needs in a patient and consistent manner, as reflected in their care plan. Staff managed the situation very well coordinating visitors and others away from the situation. Staff confirmed awareness of the whistleblowing and told us that this had been policy of the month. Areas for improvement The provider acknowledged the need to review and develop policies and procedures for this service. The priority had been given to policies which safeguard service users such as Protection of Vulnerable People, whistleblowing, recruitment and management of service users finances, supervision etc. Draft policies were being circulated for consultation and a steering group including residents, carers and staff established to review new and revised policies. Bute House, page 14 of 26

We made the following 4 requirements and 1 recommendation at our last inspection. Work has started to address the improvements required. However, this had been overtaken by concerns raised following our last inspection. The priority for the provider had been to safeguard residents by ensuring that the care plans, daily notes and assessments all linked to produce an effective system to support residents. The operations manager planned to introduce alternative care planning documentation in the longer term. As such, the requirements and recommendation have been continued and will be examined in more detail at the next inspection. Requirement 1. The provider must ensure that people who use care services are offered a range of appropriate, purposeful, recreational and stimulating activities on a regular basis. Findings: We found that some progress had been made in meeting the above requirement. The activity coordinator consulted with residents about activities and events in the home. The activity coordinator was continuing to develop links with the local community. The home was trying to develop the role of volunteers within the home and had written to all carers to see if anyone wanted to volunteer time to support activities or spend time with residents who had no family visitors. However during our visits to the home we observed little activity taking place and still some evidence of a task orientated approach to care. We were informed that the activity coordinator was on leave. The service should continue to build on progress. This requirement is continued and will be examined further at the next inspection. (See requirement 1 for this quality statement) Requirement 2. The provider must be able to demonstrate that, when they plan and deliver support, they take into account the interests, needs and beliefs of people to enable them to fulfil their aspirations and potential. Findings: Some progress had been made as highlighted in the strengths above but this still needed to continue. This requirement is not yet met. (See requirement 2 for this quality statement) Requirement 3. The provider must improve the standard of record keeping. Findings: Some progress had been made as highlighted in the strengths above but this still needed to continue. This requirement is not yet met. (See requirement 3 for this quality statement) Requirement 4. The provider must: a) ensure that care plans consistently reflect the assessed needs of residents and evidence how the plan is followed on a daily basis. b) improve the robustness of the care plan audit tool. Findings: Bute House, page 15 of 26

Some progress had been made as highlighted in the strengths above but this still needed to continue. This requirement is not yet met. (See requirement 4 for this quality statement) We looked at the care plan for a resident with behaviour needs and found that there were no behaviour charts in place which could assist in identifying triggers for particular behaviours. We discussed this with the operations manager who agreed to address this as an area for improvement. Recommendation 1. The manager should monitor staff to ensure ongoing and meaningful engagement with residents throughout the day. Findings: Some progress had been made as highlighted in the strengths above but this still needed to continue. This recommendation is not yet met. (See recommendation 1 for this quality statement). Grade awarded for this statement: 3 - Adequate Number of requirements: 4 Number of recommendations: 1 Requirements 1. The provider must ensure that people who use care services are offered a range of appropriate, purposeful, recreational and stimulating activities on a regular basis. This is in order to comply with: SSI 2011/210 Regulation 4(1)(a) - a requirement to make proper provision for the health, welfare and safety of service users. Timescale: Within 3 months of receipt of this report 2. The provider must be able to demonstrate that, when they plan and deliver support, they take into account the interests, needs and beliefs of people to enable them to fulfil their aspirations and potential. This is in order to comply with: SSI 2011/210 Regulation 4(1)(a) - a requirement to make proper provision for the health, welfare and safety of service users. Timescale: Within 3 months of receipt of this report 3. The provider must improve the standard of record keeping. This is in order to comply with: SSI 2011/210 Regulation 5(1) - a requirement to prepare a written plan which sets out how the service user's health, welfare and safety needs are to be met. Timescale: Within 24 hours of receipt of this report 4. The provider must: c) ensure that care plans consistently reflect the assessed needs of residents and evidence how the plan is followed on a daily basis. d) improve the robustness of the care plan audit tool. Bute House, page 16 of 26

This is in order to comply with: SSI 2011/210 Regulation 4(1)(a) - a requirement to make proper provision for the health, welfare and safety of service users. Timescale: Within 4 weeks of receipt of this report. Recommendations 1. The manager should monitor staff to ensure ongoing and meaningful engagement with residents throughout the day. National Care Standards Care Homes for Older People, Standard 17: Daily life Bute House, page 17 of 26

Quality Theme 2: Quality of Environment 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 environment within the service. Service strengths The grade achieved for this statement was 3 - Adequate. We decided this after we talked to service users, relatives, the operations manager and staff. We also took into account the personal plans, minutes of meetings and other supporting documentation. Also see comments under Quality Statement 1.1 Areas for improvement See areas for development identified under Quality Statement 1.1 in relation to service user participation. Grade awarded for this statement: 3 - Adequate 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 grade achieved for this quality statement at the last inspection on 21 February 2012 was 3 - Adequate. Elements of the evidence provided were re-visited and this statement remains 3 - Adequate. We concluded this after we talked to residents, carers, the operations manager and staff. We also took into account personal plans, minutes of meetings and other supporting documentation. A current certificate of insurance was displayed within the home. There was a secure door entry system and visitors to the home were required to sign in/out. Risk assessments were undertaken and records of accidents and incidents were maintained. We found a good system of audit in place for accidents and incidents. Bute House, page 18 of 26

The home employed a maintenance person and records showed that repairs were identified and promptly actioned. During our inspection a decorator was undertaking a programme of work within the home. Areas of the environment had been refurbished including painting, redecoration, soft furnishings and new equipment and resources purchased. Residents, carers and staff all commented positively about these improvements. Records showed that staff received training in food hygiene, moving and handling, infection control and fire safety. Staff described a process of recruitment within this service in accordance with safe practice. Areas for improvement All staff had been required to complete a questionnaire to find out their understanding of their role in protecting vulnerable people. The results of this had been analysed and showed that staff did not fully understand the definition of 'harm'. This related particularly to more subtle types of harm within a care setting. Staff did understand their duty to report concerns and who they should report these to, although they needed further clarification about what to do if issues were not addressed. The training manager had developed values and beliefs training in response to the results of this which would also incorporate 'respect' as a core value. Training was now to be implemented for all staff. The whistleblowing policy had been updated. It was planned to introduce a pocket size information card with philosophy, values and beliefs, along with guidelines for whistleblowing and adult support and protection At a previous inspection we made a requirement about ensuring that doors leading onto stairwells were appropriately risk assessed. At the last inspection we found that a risk assessment was in place although we were not clear how the provider had come to the conclusion that it was not necessary to take further action on their findings. The provider agreed to review the risk assessment, which was done on 14 May 2012. This review of the risk assessment identified intent to secure all doors. There is no indication of when this work will be undertaken. (See recommendation 1 for this quality statement). We looked at maintenance records which showed that routine maintenance was taking place within the home. However, records showed some gaps in routine maintenance checks. (See recommendation 2 for this quality statement). Grade awarded for this statement: 3 - Adequate Number of requirements: 0 Number of recommendations: 2 Bute House, page 19 of 26

Recommendations 1. The manager should determine a date for completion of work to secure doors leading onto stairwells as identified in the provider's risk assessment dated 14 May 2012. National Care Standards Care Homes for Older People, Standard 4: Your environment 2. The manager should review maintenance records to ensure all maintenance checks are clearly documented. National Care Standards Care Homes for Older People, Standard 4: Your environment Bute House, page 20 of 26

Quality Theme 3: Quality of Staffing - NOT ASSESSED Bute House, page 21 of 26

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 The grade achieved for this statement was 3 - Adequate. We decided this after we talked to service users, relatives, the operations manager and staff. We also took into account the personal plans, minutes of meetings and other supporting documentation. Also see comments under Quality Statement 1.1 Areas for improvement See areas for development identified under Quality Statement 1.1 in relation to service user participation. Grade awarded for this statement: 3 - Adequate 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 The grade achieved for this statement was 3 - Adequate. A new senior management team had been appointed and work was ongoing to clarify what internal management roles were required to support the new management structure and values of the organisation. This was to ensure that they had staff in roles with the right combination of skills and experience to develop a client lead service New information and management reporting systems had been introduced which enabled better analysis and response to key areas identified within the service such as service user clinical needs, health and safety risk and staffing. There was improved management of staff absence which provided better continuity Bute House, page 22 of 26

of care for residents. A Human Resources company was now employed to ensure that robust and safe recruitment procedures were in place that supported the organisational values and philosophy. The company's training manger was currently reviewing qualifications, skills and training needs of staff to ensure that an appropriate training programme was developed and implemented to meet the needs of staff and the aims and objectives of the service in line with statutory requirements. There was evidence that the provider was starting to put quality assurance systems and processes in place which involved service users, carers, staff and stakeholders. Areas for improvement We found examples of quality assurance tools such as care planning, medication and environment in use and no evidence outlining what actions were taken to address any issues identified e.g. If someone wanted a copy of their care plan there was no clear plan of action to address this. At all levels the service must use the information gathered through quality assurance to inform clear, measurable time limited action plans. (See recommendation 1 for this quality statement). The provider was developing a system of supervision for staff however it was not planned to implement this until late in 2013. We recommend that the provider consider bringing forward the implementation of this. (See recommendation 2 for this quality statement). Grade awarded for this statement: 3 - Adequate Number of requirements: 0 Number of recommendations: 2 Recommendations 1. At all levels the service must use the information gathered through quality assurance systems and processes to improve the quality of the service provided. National Care Standards Care Homes for Older People, Standard 5: Management and staffing arrangements 2. The provider should consider bringing forward the implementation of a structured staff supervision system. National Care Standards Care Homes for Older People, Standard 5: Management and staffing arrangements Bute House, page 23 of 26

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 SCSWIS re-grading the Quality Statement within the Management and Leadership Theme as unsatisfactory (1). This will result in the Quality Theme for Management and Leadership being re-graded as Unsatisfactory (1). Bute House, page 24 of 26

5 Summary of grades Quality of Care and Support - 3 - Adequate Statement 1 Statement 3 3 - Adequate 3 - Adequate Quality of Environment - 3 - Adequate Statement 1 Statement 2 3 - Adequate 3 - Adequate Quality of Staffing - Not Assessed Quality of Management and Leadership - 3 - Adequate Statement 1 Statement 4 3 - Adequate 3 - Adequate 6 Inspection and grading history Date Type Gradings 21 Feb 2012 Unannounced Care and support 3 - Adequate Environment 3 - Adequate Staffing Not Assessed Management and Leadership Not Assessed 15 Jul 2011 Unannounced Care and support 3 - Adequate Environment 3 - Adequate 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. Bute House, page 25 of 26

To find out more about our inspections and inspection reports Read our leaflet 'How we inspect'. You can download it from our website or ask us to send you a copy by telephoning us on 0845 600 9527. 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: www.careinspectorate.com or by telephoning 0845 600 9527. Translations and alternative formats This inspection report is available in other languages and formats on request. Telephone: 0845 600 9527 Email: enquiries@careinspectorate.com Web: www.careinspectorate.com Bute House, page 26 of 26