Nazareth House Care Home Service 13 Hillhead Bonnyrigg EH19 2JF Telephone: 0131 663 7191 Type of inspection: Unannounced Inspection completed on: 16 September 2016 Service provided by: Nazareth Care Charitable Trust Service provider number: SP2013012086 Care service number: CS2013317815
About the service This service registered with the Care Inspectorate on 20 January 2014. Nazareth House is a care home registered to provide a care service to 37 older people. The home does not provide nursing care. It is situated in a quiet area of Bonnyrigg in Midlothian and is set in substantial grounds. There are 36 bedrooms. One of these is a shared room. Nine bedrooms are on the ground floor and three of these have en suite facilities. The dining room, two lounge areas and a sensory room are also situated on this floor. On the first floor there are 27 bedrooms, 11 of which are en suite. There is also a quiet room on the first floor for people to us. There are two lifts to enable residents to move easily between floors. The service aims "to provide a high standard of care with the Scottish care standards and is person focussed and upholds the mission statement and core values of the Congregation of the Sisters of Nazareth. To ensure competent staff through training and development. To aim for continuous improvement". The provider of the service is Nazareth Care Charitable Trust. Nazareth House, Bonnyrigg is one of two care services in Scotland operated by the provider. The provider also operates care home services in England and Wales. What people told us We spoke with ten residents and two relatives in some detail during the inspection, in addition to speaking more briefly with other residents during the inspection. Nine residents or their family members returned care standard questionnaires. We observed how staff responded to residents throughout the inspection. People made the following comments: "My (relative) is very happy in the home. Needs to be more encouraged to drink (their) tea as (they) tend to forget. My (relative's) needs are always attended to and food plenty." "The staff do a good job with all the residents". "Service is excellent. We are very happy with everything that is done for (our relative). (They) are happy too. Very happy with the care (our relative) is receiving. (They) have settled well". "Excellent care. Staff good, pleasant. Communication is good. I'm not aware of relatives meetings. If I had any concerns I would raise them". "These past few years the cleanliness and the furnishings have improved immensely. We have been told that the dining area and the large sitting room is going to be decorated. The staff have improved. They are happier and are being trained to a high standard". "When I'm here, there is always a calm atmosphere and one of peace. The carers are all friendly and welcoming. (My relative) has said they are so very kind. I'm always offered tea or coffee and made welcome. One of the reasons I chose Nazareth House for (my relative) was it was so clean and didn't smell! Her room is lovely and bright. Now (my relative) is settled... and tells me what a lovely place this is and says (they) are happy there." page 2 of 16
"The past year has been difficult for the regular staff and residents coping with shortage of staff and working alongside agency staff, although mostly kind and caring are not able to learn all the foibles of residents. Longterm sick leave of activities coordinator affected frequency of entertainment provided". "I am quite happy here. It's not difficult to live in a comfortable place like this". "I have been living here for many years. It used to be very strict here but now not so much. Don't feel I am living with other folk. Two good chefs-meals are nice. Staff have changed quite a bit over the years, I suppose that is to be expected. Staff are alright. I especially like the night staff. I get up when I want and go to bed at after 10 pm which suits me. Staff are helpful. Can use call bell to call staff. ( Name of staff member) has plenty of time for everyone". " I like living here. I have a nice room and the staff are very good. Food is good". "We are well looked after, staff are good. Food is good which is quite something when catering for so many folk". Self assessment We received a fully completed self-assessment in February 2016. Information from this was taken into account during the inspection. We compared the providers self-assessment document with the findings from the inspection. The providers evaluation was overall consistent with the inspection findings. The provider identified strengths and areas for improvement and had a plan for how the service intended to make the improvements they had identified. From this inspection we graded this service as: Quality of care and support Quality of environment Quality of staffing Quality of management and leadership 3 - Adequate 3 - Adequate 4 - Good 4 - Good Quality of care and support Findings from the inspection Residents we saw looked well cared for in their personal appearance and were wearing their hearing aids and glasses. Residents and relatives told us that the staff were kind and considerate and treated them with respect. Relatives told us that they felt welcomed into the home by staff. We saw that staff took time with residents and appeared to know each resident well. Residents also appeared comfortable with them and appropriate humour was enjoyed during some interactions. Residents and relatives said that there was a high use of agency staff and although they were mostly kind, they did not give the same standard of care as those who knew them well. page 3 of 16
Residents told us they were well looked after and that they felt confident that staff would assist them with any healthcare needs such as helping them with their medication and would contact health professionals when needed. The care documents showed that health professionals were involved in residents care. Oral health was generally good and staff were aware of the importance of helping residents to carry out regular teeth and mouth cleaning. The 'caring for smiles' team from NHS Lothian visited the home regularly and provided staff training and equipment to help staff provide good oral care. Each resident had a care plan which was held in electronic and paper form.the care plans and associated documents such as risk assessments did not match the quality of the care we saw nor did they contain the detailed personalised information which regular staff demonstrated. Following a recent complaint investigation we made requirements. We checked and found that some progress was being made to meet these but the work had not been completed. Some examples we found were: - Care plans which were not updated to reflect that a resident had fallen. - No care plan for a resident who was at risk of leaving the home and would be unable to find the way back. - Management of health needs such as diabetes were not detailed in the individuals care plan. Overall care plans records did not show that care was being evaluated to check if the planned care was working. They also needed to be more person-centred and detailed. We have revised the timescales of the requirements made as a result of the complaint to allow the service to complete the work which they had started. See requirements 1,2,3,4,5. Some language used to describe residents symptoms within the care plan was not what we would expect to see. For example "uncooperative" and "challenging behaviour". We identified that staff needed training in dementia care. Residents who have symptoms of stress and distress needed a care plan to help staff give effective and consistent care. This was a recommendation made at the last inspection. We have made this a requirement. See requirement 6. Do not attempt cardio-pulmonary resuscitation (DNACPR) and adult with incapacity certificates (AWI) were in place for some residents. These documents are used to protect residents and guide the service on their responsibilities for care and treatment. Some of these needed to be reviewed as they were out of date. The staff had already identified that this work was needed and had contacted the G.P. Some adult with incapacity certificates did not have a treatment plan attached. The treatment plan helps staff know what decision-making care that it covers. While these documents are the responsibility of medical staff we have suggested that the manager keeps an overview by way of a register. This is a good way to easily check that important documents are up to date and reviewed by the GP as needed. The manager agreed to complete this work. Oral medicines were recorded and given as prescribed. However treatment with topical medicines such as creams and ointments needed to be improved as there were gaps in recording that these had been given. More care was needed when handwritten changes were made to medication administration records to show the dates when the medicine started and include the signature of who had made the changes. Better records were needed where other health care professionals administered medicines. This ensures the service are able to track and monitor the residents care. Better records of the times that regular analgesia is given would help ensure residents pain can be managed and appropriately spaced. Although the manager was using a pain assessment tool for some residents, this was not suitable or residents with dementia. See requirement 2. Covert medication is the administration of medicines in a disguised form resulting in an individual unknowingly taking medicine. Giving medicines covertly is only considered when an individual does not have capacity to make a decision about the medicine and the treatment is considered essential. When this happens there is a strict page 4 of 16
protocol to follow. This makes sure that individuals rights are considered and respected and the procedure is lawful. We checked the care of one resident who was receiving medication covertly and found that improvements were needed. For example completion of the care pathway should be by a medical practitioner and staff needed to get advice from a pharmacist about how the medication can be safely disguised. See requirement 5. Medicine storage needed reviewed to ensure medicines were stored at the correct temperature and storage areas could be easily cleaned. Food provision was very good in the home. Food was prepared fresh, on site and there was home-baking everyday. There was good involvement of residents in the menu with regular discussions about meals and mealtimes. Changes were made as a result of the discussions and the changes were evaluated to check if the residents liked the changes. The catering staff took pride in providing the residents with good food which was well presented. They knew any residents who were loosing weight and fortified their diet in accordance with their preferences. Mealtimes were well managed by staff in the dining room with senior staff oversight. This meant mealtimes were pleasant experiences for residents and we saw that they received the support they needed from staff and from adaptive equipment such as plate guards. Residents and relatives were very positive about the quality of the food and service. A nutritional assessment of the menus had not been carried out and we have asked the manager to do so. Communication between care staff and the kitchen was good and staff worked well together. Adult Support and Protection legislation in Scotland is designed to protect adults at risk. The legislation is different in England. We saw that the provider had a Scottish policy but this contained the wrong information to help staff understand and report any suspected abuse appropriately. We have made a requirement. See requirement 7. Requirements Number of requirements: 7 1. The provider must ensure that residents are cared for in a safe environment and that any risk of a fall is minimised. In order to achieve this, the provider must ensure that: (a) staff conduct falls risk assessments in line with the provider's policy (b) staff are familiar with the chosen falls risk assessment tool (c) that a plan of care is put in place to address any identified risk (d) the plan of care is reviewed at six monthly intervals or following a fall. (e) the provider must also introduce an audit system and be able to evidence that staff are competent in this area, providing training where necessary. (f) they supply and communicate clear written guidance for staff on what to do upon finding a resident who has fallen. This is in order to comply with:the Social Care and Social Work Improvement Scotland (Requirement for Care Services) Regulations 2011 (SSI 2011/210), regulations 4(1)(a) & 15(b)(i). Timescale for implementation: Items (a), (b), (c), (d)and (f) must be implemented on receipt of this report. Item (e) by 31 December 2016. 2. The Provider must make sure that residents' pain and symptom management needs are met. In order to achieve this, the Provider must (a) introduce a policy and procedures on pain and symptom management page 5 of 16
(b) assess and document residents' signs and symptoms of pain using a suitable assessment tool (c) document how pain will be managed (d) ensure that staff are familiar with and competent in the use of the chosen pain assessment tool (e) provide staff training on the policy, procedures and the assessment tool (f) introduce an audit system and be able to evidence that staff are competent in the area of pain assessment. This is in order to comply with:the Social Care and Social Work Improvement Scotland (Requirement for Care Services) Regulations 2011 (SSI 2011/210), regulations 4(1)(a) & 15(b)(i). Timescale for implementation: The policy to be introduced with four weeks of receipt of this letter; staff trained in the use of the assessment tool by 30 September 2016 and pain assessment and management plans in place for each resident by 30 October 2016. 3. The Provider must make sure that residents have sufficient to drink each day. In order to achieve this, the Provider must ensure that (a) every resident is screened for the risk of dehydration (b) each resident has a drinking care plan that details (c) identified need and how it will be met (d) the circumstances in which fluid intake will be monitored (e) who will audit and evaluate any monitoring and (f) what action should be taken if concerns are highlighted as a result of the monitoring, including seeking medical advice and or assistance (g) staff should receive training appropriate to their role Services) Regulations 2011 (SSI 2011/210), regulations 4(1)(a) and 15(b)(i). Timescale for implementation: By 31 December 2016. 4. The Provider must make sure that residents are given the appropriate assistance to meet their daily nutritional needs. In order to achieve this, the Provider must ensure that: (a) staff are competent in the implementation of the MUST, providing training where appropriate, and be able to evidence staff competency (b) residents have their nutritional needs fully assessed and documented in their care plan (c) care staff are familiar with the residents' care plans including: (d) food choices and preferences (e) the nature of the assistance required (f) the interventions required when concern is identified, including seeking medical advice and or assistance. This is in order to comply with:the Social Care and Social Work Improvement Scotland (Requirement for Care Services) Regulations 2011 (SSI 2011/210), regulations 4(1)(a) and 15(b)(i). Timescale for implementation: to commence within five days and be concluded by 31 December 2016. 5. The Provider must ensure that: (a) staff responsible for administering medication are aware of the condition for which it was prescribed and have an awareness of both the therapeutic effects and side effects of the medication. (b) where covert medication is given that covert pathways are completed by an appropriate person and pharmacy advice is received about suitable ways to give the medicine. (c) topical medication is given as prescribed and recorded. Services) Regulations 2011 (SSI 2011/210), regulations 4(1)(a) and 15(b)(i). page 6 of 16
Timescale for implementation: (a) to commence at feedback and be concluded by 31 December 2016, (b) and (c) to start at feedback. 6. The provider must ensure that residents who have symptoms of stress and distress have (a) an appropriate care plan and (b) that staff receive training in the management of symptoms of stress and distress. Services) Regulations 2011 (SSI 2011/210), regulation 4(1)(a). Timescale: (a) by 30 October 2016 and (b) By 31 January 2016. 7. The provider must ensure that the adult support and protection policy and procedure contains the correct legislation for Scotland and guides staff to the local inter-agency guidance. Services) Regulations 2011 (SSI 2011/210), regulation 4(1)(a). Timescale: By 31 December 2016. Recommendations Number of recommendations: 0 Grade: 3 - adequate Quality of environment Findings from the inspection Overall there were good records of maintenance checks being carried out and recorded. The smallest of the two lounge areas on the ground floor had recently been refurbished. Residents, relatives and staff were pleased with the standard and quality of the refurbishment and very happy with the finished result. Some work had been done to update one communal bathroom but others needed to be refurbished. Refurbishment was also needed in other staff areas such as the domestic service room, staff room and medicine storage areas. Many other areas of the home also needed to be updated and refurbished. Staff said that there were plans to update the food preparation area and dining room. This needed urgent improvement. Lighting was poor throughout the home which can present a hazard to people with sight loss and cognitive impairment. Some signage was in place but the placement of signs, for example on doors which opened in to the dining room, meant that they were not effective in helping promote independence. page 7 of 16
Access to the garden was poor for residents despite the home being set in beautiful and substantial grounds. The garden project had developed plans but there were no timescales or dates set for the work to be carried out. The call system used to alert staff when residents needed assistance was out of date and difficult for residents to access. A new call system was planned but again there was no date available of planned installation. We have assessed the environment as adequate because some of the areas we have identified have already been identified by the manager and provider. Steps have been taken to address some of the areas we have highlighted. However more progress needs to be made to ensure residents are safe and protected as well as providing an environment which promotes independence and access to outdoor space. We have made a requirement about the environment, see requirement 1. Requirements Number of requirements: 1 1. The provider must ensure the environment is safe and provides residents with a good quality of care and quality of life. In order to achieve this the provider should develop an action plan with timescales for the refurbishment of the indoor and outdoor living spaces of the home. This must include but should not be limited to pull cord replacement, refurbishment and upgrade of the medication room, the domestic services room and sluice areas, communal bathrooms, the dining room and server, access to outdoor space, the garden, the provision of adequate lighting and replacement of the call bell system. Services) Regulations 2011 (SSI 2011/210), regulation 4(1)(a). Timescale: An action plan to be submitted to the Care Inspectorate by 30 November 2016. Recommendations Number of recommendations: 0 Grade: 3 - adequate Quality of staffing Findings from the inspection Recruitment of staff was in progress to fill a number of care staff vacancies in the home. Some new appointments had been made but these staff had not yet started. This had resulted in a high reliance on use of agency staff. While requests had been made for the same agency staff to return, to help with familiarity for residents, this had not always been possible. Residents and relatives made comments to us that they found the agency staff mostly kind but that they did not know their individual needs and preferences as well as the permanent staff. Agency staff did not have independent access to electronic care records and we found that paper records did not always contain all of the information needed to care for residents. Staff recruitment files were well set out and information was organised. There was a clear record of decision making when employing staff. Relevant checks such as references and police checks were carried out. The page 8 of 16
files could be improved by more attention to detail such as completing the checklist at the front of each file to show that police checks had been sent for and returned. We discussed with the manager that volunteers need to have completed the relevant police checks and the manager agreed to arrange this. The manager carried out checks of the Scottish Social Services Council register to make sure staff were appropriately registered to work in a care home. We discussed with the manager that it is the providers responsibility to ensure that all staff have an appropriate registration, including those supplied by an agency. The manager did not check agency staff were registered and agreed to put a system in place to check workers are appropriately registered before they work in the home. Some staff had received dementia awareness training. The manager was aware of the need to ensure that all staff had dementia training suitable for their role which met the Promoting Excellence Framework. This is training provided by the NHS and Scottish Government to promote an understanding of dementia in the wider community, but also to ensure that all staff working in social care are trained to an appropriate level in dementia care. Providing and supporting staff with more comprehensive training could improve the assessment of care and create an environment that helps residents retain their ability to be independent. See requirement 1. There was a staff training record. We discussed with the manager the need for a more comprehensive training needs analysis and plan for training as well as the record of completed training. This helps to ensure staff are equipped for their role and have opportunities for development. The manager was working to develop staff training. We made a requirement at the last inspection which is made again. See requirement 1. We saw that staff practice was good. They were caring and respectful to residents and in the way that they helped them. Staff created a pleasant atmosphere in the home. Residents and staff told us that the activity coordinator was very good. We saw that staff worked hard to provide activities on the days of this inspection. Requirements Number of requirements: 1 1. The provider must ensure that staff are trained to carry out their duties and that accurate training records are maintained. In order to achieve this the provider must: a) Ensure that there is a programme of mandatory training for all staff and that staff are aware of this. b) Ensure that staff, without current updates, have refresher training planned. c) Carry out a training needs analysis d) Prepare a training plan to meet the identified needs of staff and residents e) Implement the training plan. This is to comply with: The Social Care and Social Work Improvement (Requirements for Care Services)Regulations 2011 SSI 2011/210, regulation 4(1) (a) - health and welfare, regulation 15 - to ensure that people employed have training appropriate to the work they are to perform and to ensure that there is a competent workforce, Regulations 2011 SSI/114 Regulation 19(2) (a) - records of staff training. National Care Standards Care Homes for Older People - Standard 5 - Management and Staffing Arrangements. Timescale for meeting this requirement: a), b), c) and d) To commence on receipt of this report and for completion by 30 November 2016, e) To commence on receipt of the report for completion by 31 March 2017. page 9 of 16
Recommendations Number of recommendations: 0 Grade: 4 - good Quality of management and leadership Findings from the inspection The home manager had been in post for a year and had worked hard alongside the deputy manager to stabilise the staff team and build staff confidence after a series of changes of manager. There was a service quality manager and the provider had appointed a new director of care and nursing to support the manager in her role and develop quality systems to improve care. Staff meetings were productive and helped to communicate important information between maintenance, kitchen and care staff. Staff who returned questionnaires were positive about the contribution of the manager in making improvements and listening to staff ideas. Residents helped make decisions about the running of the home. We saw involvement in the colour schemes and redecoration plans, proposals for the design of a garden and in ideas for both individual and group activities. The complaints log was difficult to follow and understand the steps taken from receipt of complaint to resolution. The manager agreed to review the way complaints were recorded to improve this. The service needed to develop and implement a range of audits and a way to take action from the findings of the audits in order to improve the quality of care and support. This could help drive improvements in care planning and topical medication administration for example. Requirements Number of requirements: 0 Recommendations Number of recommendations: 0 Grade: 4 - good page 10 of 16
What the service has done to meet any requirements we made at or since the last inspection Previous requirements Requirement 1 The Provider must ensure that staff are trained to carry out their duties and that accurate training records are maintained. In order to achieve this the provider must: a) Ensure that there is a programme of mandatory training for all staff and that staff are aware of this. b) Ensure that staff, without current updates, have refresher training planned. This is to comply with: The Social Care and Social Work Improvement (Requirements for Care Services) Regulations 2011 SSI 2011/210 Regulation 4(1) (a) - health and welfare. Regulations 2011 SSI 2011/210 Regulation 15 - to ensure that people employed have training appropriate to the work they are to perform and to ensure that there is a competent workforce. Regulations 2011 SSI/114 Regulation 19(2) (a) - records of staff training National Care Standards Care Homes for Older People - Standard 5 - Management and Staffing Arrangements. Timescale for meeting this requirement: To commence on receipt of this report and for completion by 30 November 2015. This requirement was made on 17 November 2015. Action taken on previous requirement Although a record was being kept of training completed there was no evidence of a recorded training needs analysis or training plan being kept. We have made this requirement again amending the wording to reflect our findings at this inspection. Not met Requirement 2 The Provider must ensure that residents are cared for in a safe environment and that any risk of a fall is minimised. In order to achieve this, the Provider must ensure that: - staff conduct falls risk assessments in line with the Provider's policy - staff are familiar with the chosen Falls Risk Assessment tool - that a plan of care is put in place to address any identified risk - the plan of care is reviewed at six monthly intervals or following a fall. The Provider must also introduce an audit system and be able to evidence that staff are competent in this area, providing training where necessary. Services) Regulations 2011 (SSI 2011/210), regulations 4(1)(a) & 15(b)(i). page 11 of 16
This requirement was made on 19 July 2016. Action taken on previous requirement The timescales for completion of this work had not yet been reached. The progress made was not sufficient for us to meet this requirement and it is made again. Not met Requirement 3 The Provider must make sure that residents' pain and symptom management needs are met. In order to achieve this, the Provider must - introduce a policy and procedures on pain and symptom management - assess and document residents' signs and symptoms of pain using an accredited assessment tool - document how pain will be managed - ensure that staff are familiar with and competent in the use of the chosen pain assessment tool - provide staff training on the policy, procedures and the assessment tool - introduce an audit system and be able to evidence that staff are competent in the area of pain assessment. Services) Regulations 2011 (SSI 2011/210), regulations 4(1)(a) & 15(b)(i). This requirement was made on 19 July 2016. Action taken on previous requirement The timescales for meeting this requirement had not yet been reached. We discussed the proposed assessment tool and found that it was unsuitable for people with a cognitive impairment. We have made the requirement again amending the wording to reflect that the pain assessment tool must be suitable. Not met Requirement 4 The Provider must ensure that residents have access to appropriate healthcare advice at all times. In order to achieve this, the Provider should review and amend, where necessary, any existing staff guidance that details what action they should take on finding a resident who has fallen. Services) Regulations 2011 (SSI 2011/210), regulations 4(1)(a). This requirement was made on 19 July 2016. Action taken on previous requirement This is not met and has been added to requirement 2 in Quality of care and support. Not met Requirement 5 The Provider must make sure that residents have sufficient to drink each day. In order to achieve this, the Provider must ensure that page 12 of 16
- every resident is screened for the risk of dehydration - each resident has a drinking care plan that details - identified need and how it will be met - the circumstances in which fluid intake will be monitored - who will audit and evaluate any monitoring and - what action should be taken if concerns are highlighted as a result of the monitoring, including seeking medical advice and or assistance - staff should receive training appropriate to their role Services) Regulations 2011 (SSI 2011/210), regulations 4(1)(a) & 15(b)(i). This requirement was made on 19 July 2016. Action taken on previous requirement While we saw resident being offered drinks regularly throughout the day the care plans did not identify residents at risk of dehydration or provide detail of how the risk would be minimised. There was no evaluation of care to check if the planned actions were working and staff had not yet received training. Lack of a training needs analysis and plan means that we could not be sure that training would take place. We have made this requirement again. Not met Requirement 6 The Provider must make sure that residents are given the appropriate assistance to meet their daily nutritional needs. In order to achieve this, the Provider must ensure that: - staff are competent in the implementation of the MUST, providing training where appropriate, and be able to evidence staff competency - residents have their nutritional needs fully assessed and documented in their care plan - care staff are familiar with the residents' care plans including - food choices and preferences - the nature of the assistance required - the interventions required when concern is identified, including seeking medical advice and or assistance. Services) Regulations 2011 (SSI 2011/210), regulations 4(1)(a) & 15(b)(i). This requirement was made on 19 July 2016. Action taken on previous requirement Food provision was good in the home. However records did not contain enough detail to ensure that effective care was consistently given and there was no evaluation to check that care was working. We saw residents receive appropriate assistance but the care plans did not describe this detail. This is important because of the high number of agency staff who rely on the care plans to guide their practice. Not met Requirement 7 The Provider must make sure that staff responsible for administering medication are aware of the condition for which it was prescribed and have an awareness of both the therapeutic effects and side effects of the medication. page 13 of 16
Services) Regulations 2011 (SSI 2011/210), regulations 4(1)(a) & 15(b)(i). This requirement was made on 19 July 2016. Action taken on previous requirement We have made a new requirement about medication which also includes our findings from this inspection. Not met What the service has done to meet any recommendations we made at or since the last inspection Previous recommendations Recommendation 1 The provider should develop an initial care plan to set out guidance for staff on how to manage stressed and distressed behaviour in the initial stages of assessment. This should be re - evaluated when further information is available. National Care Standards, Care Homes for Older People, Standard 5, Management and staffing arrangements. This recommendation was made on 17 November 2015. Action taken on previous recommendation We did not see that those who needed one had a care plan to help manage symptoms of stress and distress. We have made a requirement. See requirement 6 in Quality of care and support. Complaints Please see Care Inspectorate website (www.careinspectorate.com) for details of complaints about the service which have been upheld. Enforcement No enforcement action has been taken against this care service since the last inspection. page 14 of 16
Inspection and grading history Date Type Gradings 5 Aug 2015 Unannounced Care and support 4 - Good Environment 4 - Good Staffing 4 - Good Management and leadership 5 - Very good 9 Jan 2015 Unannounced Care and support 3 - Adequate Environment 2 - Weak Staffing 3 - Adequate Management and leadership 3 - Adequate 29 Jul 2014 Unannounced Care and support 2 - Weak Environment 2 - Weak Staffing 2 - Weak Management and leadership 3 - Adequate page 15 of 16
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 www.careinspectorate.com Contact us Care Inspectorate Compass House 11 Riverside Drive Dundee DD1 4NY enquiries@careinspectorate.com 0345 600 9527 Find us on Facebook Twitter: @careinspect 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 16 of 16