Rannoch House Care Home Service Adults 97 Cleveden Road Kelvindale Glasgow G12 0JN Telephone:

Rannoch House Care Home Service Adults 97 Cleveden Road Kelvindale Glasgow G12 0JN Telephone: 0141 276 1894 Inspected by: Tony Valbonesi Linda Kemp Type of inspection: Unannounced Inspection completed on: 29 July 2011

Contents Page No Summary 3 1 About the service we inspected 5 2 How we inspected this service 6 3 The inspection 10 4 Other information 24 5 Summary of grades 25 6 Inspection and grading history 25 Service provided by: Glasgow City Council Service provider number: SP2003003390 Care service number: CS2003001039 Contact details for the inspector who inspected this service: Tony Valbonesi Telephone 0141 843 4230 Email enquiries@scswis.com Rannoch House, page 2 of 27

Summary This report and grades represent our assessment of the quality of the areas of performance which were examined during this inspection. Grades for this care service may change after this inspection following other regulatory activity. For example, if we have to take enforcement action to make the service improve, or if we investigate and agree with a complaint someone makes about the service. We gave the service these grades Quality of Care and Support 4 Good Quality of Environment N/A Quality of Staffing 4 Good Quality of Management and Leadership N/A What the service does well Residents are positive about the service they receive and feel they are listened to. The service makes a lot of effort to try and involve residents and relatives in decision making about the service. What the service could do better We have raised some issues in this report, including how medication is managed, some infection control issues that we found and the limitations of current personal plans. Staff are not receiving regular formal supervision and it is not clear when some staff will receive important training in relation to protecting vulnerable people from harm. What the service has done since the last inspection Since the last inspection, staff have received training in supporting residents' nutritional care needs and best practice paperwork has been introduced in relation to this as well. This meets a requirement we made following the last inspection about how nutrition is managed in the home. A Carers' Committee has been set up with a view to better involving relatives and friends in having a say about how the service can improve. Rannoch House, page 3 of 27

We recognised that some staffing shortages have hindered the manager in her efforts to make improvements in certain areas. Conclusion Overall, we find that residents and carers are satisfied with the service provided and have developed good relationships with staff. The staff team present as courteous and sensitive to residents' individual needs and wishes. Two out of the previous three requirements have not yet been met and this report also contains a few other requirements where we think the service must improve. Who did this inspection Tony Valbonesi Linda Kemp Lay assessor: N/A Rannoch House, page 4 of 27

1 About the service we inspected Rannoch House Care Home is managed by Glasgow City Council Social Work Services and is located within a residential area of Kelvindale in the west end of Glasgow. Before 1 April 2011 this service was registered with the Care Commission. On this date the new scrutiny body, Social Care and Social Work Improvement Scotland (SCSWIS), took over the work of the Care Commission, including the registration of care services. This means that from 1 April 2011 this service continued its registration under the new body, SCSWIS. The Home provides 24 hour accommodation, care and support for a maximum of 40 older people. Two places are designated for providing short breaks/respite care. On the days of the Inspection there were 39 residents living in the Home. The care home is on four levels. All accommodation used by residents is located on the ground, first and second floors of the Home. Single bedrooms have wash hand basins. Communal toilet/bath and shower facilities are available on each floor. The dining room is located on the ground floor and a lift is available to access all floors. Each floor has small sitting areas available, and the large lounge used by the majority of residents is on the ground floor beside the dining room. Residents have the use of a conservatory area for smoking. The main staff offices are also based on the ground floor. The laundry is located in the basement. The Home does have garden space however this is not easily accessible and has not been made secure for residents. The service aims to provide a warm welcome in a homely, safe, caring and comfortable environment staffed by a team committed to meeting the needs of residents with respect, diplomacy and understanding on an individual basis. Based on the findings of this inspection this service has been awarded the following grades: Quality of Care and Support - Grade 4 - Good Quality of Environment - N/A Quality of Staffing - Grade 4 - Good Quality of Management and Leadership - N/A 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.scswis.com or by calling us on 0845 600 9527 or visiting one of our offices. Rannoch House, page 5 of 27

2 How we inspected this service The level of inspection we carried out In this service we carried out a medium 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 This report was written following an unannounced inspection. The inspection took place over two days, from 28 to 29 July 2011, between 8.45am and 5pm on the first day and 9.30am and 12 noon on the second. It was carried out by two SCSWIS Inspectors, Tony Valbonesi and Linda Kemp. We met seven residents during the inspection. We sent out 15 questionnaires to residents and received three back. We also sent out 10 questionnaires to relatives and received five back. We also examined a number of policies, records and service documents, including: Service Users' Support Pans Minutes from Residents' House Meetings and Open Evenings Minutes from Staff Meetings The Annual Return Welcome brochure Staff training records Self assessment Quality Control Audits Occupancy Agreements Staffing Schedule Consultation log Self assessment survey questionnaires Infection Control Policy Nutrition guidance Complaint records Accident and incident records. During the inspection we spoke with: * Senior staff, * Support care workers * Care assistants. * The manager. Rannoch House, page 6 of 27

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 report continued 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 Rannoch House, page 7 of 27

What the service has done to meet any recommendations we made at our last inspection There were no recommendations made at the last inspection. 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. There was a lot of good information in the self assessment, some of which was similar to our findings during the inspection. Future self-assessments will have the scope to capture the process of how grades and evaluations were reached through participation methods. Taking the views of people using the care service into account We sent out 15 questionnaires to residents and received three back. We also spoke with seven residents during the inspection. Overall residents were satisfied or very satisfied with the service they received. Comments included, "Have everything I need, plenty to do" "Can come and go as I please" "Asked my opinion all the time" "Feel well looked after, staff are lovely, can't do enough for you" "Happy here - prefer to stay in my room" "Staff alright, food alright" "No complaints" "Feel you are listened to" "They ask if we like this or that" "I asked for something else at mealtimes and got it" "New staff are shown what is what" "Not allowed to vegetate. I enjoy embroidery" Rannoch House, page 8 of 27

"Staff trust me and I trust them, for example, if I go out myself I tell them I will be in later" "They know what my likes and dislikes are" "Staff treat you with respect" "Staff will always find time for you" "Very attentive staff" "Food is nice - I am trying to cut down. Waiting on the dietician". Taking carers' views into account We sent out 10 questionnaires to carers and received five back. We also spoke with one carer during the inspection. Overall, feedback from carers was positive. We noticed that three people were not sure about the complaints procedure though we could see that this was publicised in the care home. One person pointed out that there was not good access to the garden and another said they had experienced problems with the laundry. One person did not feel there was enough staff. "Very satisfied with the standard of the service" "Had issues with the laundry but the manager resolved these" "Kept well informed by mum's keyworker" "We were told about the project for the new care homes in 2014" "Feel mum's needs are well met by the staff - mum doing well" "I visit all hours and days of the week and never had any concerns" "Staff are very good and have the right attitude to older people with dementia" "Rannoch House is a very good care home, all the staff are loving and very caring. I do think there should be more staff as they have an awful lot to do. I think they lack staff, especially at night-time". Rannoch House, page 9 of 27

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 Overall grade awarded for this theme: 4 - Good Statement 1 We ensure that service users and carers participate in assessing and improving the quality of the care and support provided by the service. Service strengths We continue to grade this statement as very good, based on our observations, our discussions with the manager, staff, residents, a carer and feedback from questionnaires and records we examined. Residents were very positive about their care and the staff team who supported them. One person told us, "They do not fob you off. If you have a question they will give you an answer". We found examples of where residents views had led to improvements, for instance, in relation to menu planning. One resident who was not happy working with one member of staff raised this as an issue and appropriate action was taken by the manager. We found other examples like this which showed that people's views were listened to and acted upon. Residents told us that they enjoyed their one to one time with their keyworker. One of the residents represented the resident group at meetings and spoke up for their views. We thought this was a very good example of the service encouraging participation. The resident representative told us in a questionnaire that he listened to what residents had to say and, if any problems, he would inform staff. He told us that he discussed inspection reports with residents and was involved in all the residents' meetings. He also took a lead role in organising a carol service at Christmas for residents to enjoy. Residents and relatives had the opportunity to give their views about the quality of the their care through discussion at regular six monthly review meetings. Rannoch House, page 10 of 27

Both residents and relatives had the opportunity to assess and grade the service they received during regular group meetings. Monthly house meetings took place and Open House Evenings with carers had become an effective way to speak and listen to carers. From this, a new carers' Committee had been established and, along with the Residents' committee, provided good opportunities for people to assess the quality of care and support that the service offered and influence decision making. The service provider had plans to build new large scale care homes in the coming years to replace its existing ones. We could see that residents and carers had been consulted about this and were being kept informed of progress. A self assessment survey was used with residents, carers and outside agencies as another method of participation. The benefit of this was that it gave people the opportunity to grade the quality of the service provided and this influenced the service's overall evaluation of its own performance. Areas for improvement Inspection report continued The service should continue to maintain and develop its very good performance under this quality statement. There was scope to look at ways to involve someone from outwith the service to help gather residents' views, for instance, at their House Meetings. We looked at minutes of meetings for carers and residents. We found that they would be of more value if they included follow up on issues discussed previously and provided action plans from the issues discussed. We also found that they could be clearer in showing the discussion and exchange of views by residents and carers. Consequently, the service was not taking full advantage of the minutes to evidence its very good approach to participation through meetings. Self assessment surveys would do well to include the date when they were issued and whether they were issued to residents, carers, staff, external agencies or other interested parties as this would help with the analysis of the responses. Performance under the theme of participation and in terms of general quality assurance would be improved through the development of a written action plan for continuous improvement. Such a plan would be of value in showing the collated findings from management's own quality assurance systems and the involvement of all stakeholders, (residents, carers, external agencies and other interested parties) through the outcomes of meetings, individual consultation, collated self assessment survey findings, complaint activity, and so on. Such a plan would provide a benchmark for measuring continuous improvement within the home. The reintroduction of the home's newsletter or "You Said, We Did" displays are two suggested ways to feedback the findings of participation methods and the resulting improvement plan to all those involved. (See Recommendation 1 under Quality theme 1, statement 1) Rannoch House, page 11 of 27

Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 1 Recommendations Inspection report continued 1. The manager should develop a continuous improvement plan which reflects the involvement of all stakeholders and addresses issues raised from stakeholder feedback and the findings of effective quality assurance systems with action plan, timescales and evaluation of progress. National Care Standards (NCS) Care Homes for Older People, Standard 4: Management and Staffing and Standard 11: Expressing Your Views Statement 3 We ensure that service user's health and wellbeing needs are met. Service strengths We continue to grade this statement as adequate based on our observations, our discussions with the manager, staff, residents, a carer and feedback from questionnaires and records we examined. People we spoke with told us that staff paid good attention to health and well being. As well as a GP who could be called if a person took unwell, we could see that there were visits by a range of other health care professionals including the Chiropodist, Community Psychiatric Nurse (CPN) and District Nurse. Consequently, the home worked in partnership with other agencies in the best interest of residents' health and wellbeing. We could see that residents were maintaining their weight. A previous requirement in relation to improving the attention given to residents' nutritional health care needs was met. Since the last inspection, staff had received training in the use of the malnutrition universal screening tool (MUST) which is recognised as a good tool in keeping an eye on residents' weight and nutritional needs. The paperwork for the MUST tool was now in place within residents' care plans and we could see from the records that we looked at that this was being used appropriately. Nutritional policy and procedural guidance was available to staff to help them focus on meeting residents' eating and drinking needs. Menus were nutritionally balanced to meet residents' needs and food preferences. People we spoke with told us that enjoyed the food and we could see that they were involved in developing menu options. We observed a positive atmosphere around the home and saw many good examples of staff interacting with residents in a way which encouraged their wellbeing. Rannoch House, page 12 of 27

Where it was identified that residents needed assistance from an outside agency or were inappropriately placed we could see that prompt measures were taken to seek referrals with social work and other agencies. There was a good range of equipment in the home such as specialist mattresses and moving and assisting equipment. Consequently, residents were well served by the home's aids and adaptations. Whilst an incident with medication management had happened just prior to the inspection and was being investigated, we noticed that appropriate attention was usually given to recording the administration and ordering of medicines. The storage of medication did not highlight any concerns either. The medication system was checked every so often by the local pharmacist to ensure that any areas needing attention were identified and addressed. Areas for improvement Inspection report continued Some aspects of the management of medication within the home were not in keeping with the provider's own policy or best practice guidance, such as "The Handling of Medicines in Social Care" (http://www.rpharms.com/support-pdfs/ handlingmedsocialcare.pdf). In particular, staff were observed giving out medication during mealtime and often not paying adequate attention to ensuring that the resident took their medicine. (See Requirement 1 under Quality theme 1, statement 3) We noticed that the two people dealing with medications were being constantly interrupted during this task and we could see how this had the potential to lead to mistakes being made. Giving out medicine during the meal should be reviewed and there was merit in having one person deal with medicines rather than two so that the person dispensing the medication was also responsible for administering and recording that this happened. This is in line with best practice guidance and would provide a safer system of medication management. The manager was keen to introduce a protected mealtime initiative whereby the focus was on supporting residents with their meals and not distracted by other activities such as speaking with people visiting the service or taking phone calls, etc. We would encourage this to happen as soon as possible. We also recommend that the service obtain advice from the GP, pharmacist or nurse for each individual resident who may be in receipt of homely remedies medication, for instance, to ensure these do not interact in a negative way with prescribed medicines. They should also keep records of the purchase, administration and disposal of homely remedies in line with best practice guidance referred to above. (See Recommendation 1 under Quality Theme 1, statement 3) We made a requirement following the last inspection regarding the content of personal plans so that they provided clear information for staff and residents regarding how identified support plans would be met. This requirement was not met. Rannoch House, page 13 of 27

For instance we found a lack of detail in personal plans regarding the assessment and care planning around falls, pressure sore prevention and support for people who experience behaviour changes and agitation. The manager advised that new care planning paperwork was due to be rolled out in the coming months by the provider, which intended to address these weaknesses. In the meantime, this requirement is repeated. (See Requirement 2 under Quality theme 1, statement 3). The previous inspection report included a requirement that the provider review the current assessment and dependency tool to ensure mental health and emotional needs are included as is any change in needs resulting from re-admission to hospital. This requirement was not met, but as noted above, the provider had an action plan to address this which it was taking forward in the coming months. (See Requirement 3, under Quality Theme 1, statement 3). Under new regulations, care homes such as Rannoch House will now require to carry out 4 weekly assessments of staffing to demonstrate that service users needs are being assessed and appropriate staffing levels are put in place. We will review this during future visits. The manager had systems in place to check the environment and standards of cleaning, but we noticed that these had missed a few infection control issues. This included, damaged floor coverings in shower areas, unclean equipment such as shower and bath chairs and damaged storage units in bathrooms. The manager agreed to address these issues right away. There were opportunities for physical exercise, but there was scope to provide more opportunities in this area and getting people moving. The manager advised us that the provider was aware of the benefits shown from recent research regarding physical exercise and would be shortly rolling out a programme of activities for staff to take forward with residents. We will review progress during the next inspection. Residents' care plans did not contain appropriate certificates to meet the current mental health act legislation with regards to incapacity. (See Requirement 4 under Quality Theme 1, statement 3) Grade awarded for this statement: 3 - Adequate Number of requirements: 4 Number of recommendations: 1 Requirements 1. The Provider must improve the management of medication within the home. To achieve this the manager must ensure that staff observe on each and every occasion when service users have taken prescribed medication before they record that the medicine had been taken. Rannoch House, page 14 of 27

This is in order to comply with: SSI 2011/210 Regulation 4a) a requirement about Welfare of Service users. Timescales: Immediate on receipt of this draft report. Inspection report continued 2. The content of personal plans must be reviewed so that they provide clear and detailed support plans which are then evaluated regularly to confirm outcomes for residents, for instance in relation to pain, falls, pressure sore prevention and behaviour changes. This should also include information on the most recent review. This is to comply with: SSI 2011/210 regulation 4(1)(a) - Welfare of service users. In making this requirement we have taken into account, National care Standards Care Homes for Older people, Standard 13: keeping Well. Timescale: as agreed in the provider's action plan. 3. The Provider must review the current assessment and dependency tool to ensure mental health and emotional needs are included as is any change in needs resulting from readmission to hospital. This is in order to comply with: SSI 2011/210 regulation 4(1)(a) - Welfare of Service Users In making this requirement we have taken into account, National Care Standards Care Homes for Older People, Standard 13: Keeping Well. Timescale: as agreed in the Action plan. 4. The provider must ensure that the proper legal processes are followed with regards to the Adults with Incapacity Act and that staff have training on the principles of this legislation. This is in order to comply with: SSI 2011/210 regulation 4(1)(a) - Welfare of Service Users. In making this requirement we have taken into account, NCS Care Homes for Older People, Standard 4: Management and Staffing Arrangements Timescale: within 4 months of the receipt of this report. Recommendations 1. The manager should review the current arrangements for administering medications at mealtimes so that interruptions are minimised and medication administration is carried out and recorded by one person. In addition, the service should obtain advice from the GP, pharmacist or nurse for each individual resident who may be in receipt of homely remedies medication and keep records of the purchase, administration and disposal of homely remedies in line with best practice guidance referred to in this report. NCS Care Homes for Older People, Standard 15: Keeping Well -Medication Rannoch House, page 15 of 27

Statement 6 People who use, or would like to use the service, and those who are ceasing the service, are fully informed as to what the service provide. Service strengths We have graded this statement as very good, based on our observations, our discussions with the manager, staff, residents, a carer and feedback from questionnaires and records we examined. People we spoke with had no issues about the information they received from the service. We could see that new residents received a helpful welcome brochure which provided a lot of information on every aspect of the service. This was backed up by a comprehensive occupancy agreement which the resident or their representative signed. This agreement made it clear what the person's rights and responsibilities were and this meant that the person was left in no doubt about what they could expect when coming to live here. We spoke with one person who was on her second week of respite and she was full of praise regarding how she was introduced to the service and how her short stay was going. Families and prospective service users were encouraged to visit the home prior to deciding on staying on a permanent basis. This helped inform the choices about moving in. After the first four weeks of living in the care home, a meeting was held to agree future plans with the service user and others. In addition, we could see that regular reviews were held with each resident to ensure that their care and support needs were on track and any changes were discussed with the person, their relatives and other interested parties. Where appropriate, we saw evidence of good care planning in relation to palliative care. Our observations of staff practice indicated that they were sensitive to residents' needs and issues such as end of life care. We saw an example during the inspection of the service working closely with other agencies where the person needed more enhanced support and attention. Areas for improvement Inspection report continued There was scope to provide systems of communication designed specifically for engaging with people with dementia. Written information in a range of suitable and meaningful formats for those residents who had communication difficulties or cognitive impairment should also be explored. (See recommendation 1 under Quality theme 1, statement 6) Rannoch House, page 16 of 27

Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 1 Recommendations 1. The service should introduce systems of communication designed specifically for engaging with people with dementia. Written information in a range of suitable and meaningful formats for those residents who had communication difficulties or cognitive impairment should also be explored. NCS Care Homes for Older People, Standard 6: Support Arrangements and Standard 11: Expressing Your Views Rannoch House, page 17 of 27

Quality Theme 2: Quality of Environment - NOT ASSESSED Rannoch House, page 18 of 27

Quality Theme 3: Quality of Staffing Grade awarded for this theme: 4 - Good Statement 1 We ensure that service users and carers participate in assessing and improving the quality of staffing in the service. Service Strengths We have graded this statement as very good, based on our observations, our discussions with the manager, staff, residents, a carer and feedback from questionnaires and records we examined. Residents spoke freely about staffing arrangements and comments were mainly positive. We found that managers responded to concerns residents had about the quality of staff practice. Residents had ample opportunity to discuss their level of staff support on a day to day basis, at keyworker meetings, house meetings and during review meetings. We could see from records that residents and carers were kept up to date about any staff changes and staff training. The strengths noted under Quality Theme 1, statement 1 are also relevant here. Areas for improvement Participation under this quality statement would further improve if the service looked at how it used feedback from residents as a way of encouraging their involvement in assessing the quality of staff members in matters such as recruitment and selection and staff appraisal and supervision. This could be done for example, through formal observational monitoring of staff practice and through direct feedback from residents about individual staff practice, attitude, and performance. The statement should be read along with comments under Quality Theme 1, Statement 1. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0 Rannoch House, page 19 of 27

Statement 3 We have a professional, trained and motivated workforce which operates to National Care Standards, legislation and best practice. Service strengths We have graded this statement as adequate, based on our observations, our discussions with the manager, staff, residents, a carer and feedback from questionnaires and records we examined. Staff we spoke with were well motivated and gave the impression that they worked as a team. They were supported by regular team meetings and good training opportunities. This benefited residents as staff had a clearer idea about their role and what was expected of them. Staff had the opportunity to undertake qualifications which were required for registration with the Scottish Social Services Council (SSSC). New staff received appropriate support and monitoring of their practice through the induction training programme. Staff told us that management were approachable and that they had open lines of communication between all management and staff levels within the home. Areas for improvement Inspection report continued The manager recognised that progress in some areas had been slow due to a lack of admin support over previous months and staff shortages within the home. The issue of admin support had recently been addressed and the expectation was that administrative functions would now get back on track. Staffing shortages had affected the frequency of formal staff supervision. Staff therefore had not been given full opportunity to reflect on their practice. (See Recommendation 1 under quality Theme 3, statement 3). The service had been relying on the use of agency staff to fill some gaps in staff cover and managers had noticed the negative effect this had on continuity of care. Agency staff did not receive the same level of training as permanent staff as it was not always clear to managers how long they would be working in the service. (See Recommendation 1 under Quality Theme 3, statement 3) The manager pointed out that staffing levels at times had challenged staff to provide a consistent standard of care and support, given the high dependency needs of some residents within the home. The Adult Support and Protection (Scotland) Act 2007 was introduced to protect people at risk of being harmed. Rannoch House, page 20 of 27

Support services for vulnerable adults have a duty to ensure the delivery of adult support and protection training to staff at a level appropriate to their role and responsibilities, covering all aspects of risk of harm or abuse. Many of the staff had received Adult Support and protection and others had been given dates for this training. However, we understood that some staff had not received this training or been given a date in the foreseeable future to undertake it. (See Requirement 1 under Quality theme 3, statement 3) Grade awarded for this statement: 3 - Adequate Number of requirements: 1 Number of recommendations: 1 Requirements 1. All staff who come into contact with service users must receive Adult Support and Protection training. This is to comply with: SS12011/210 Regulation 4 (1)(a), Welfare of Users - this requires providers to make proper provision for the health and welfare of service users. Timescale: Within three months from the publication date of this report Recommendations 1. The service should reduce its reliance on the use of agency staff to cover gaps in staffing in the interests of continuity of care and support to residents. NCS Care Homes for Older People, Standard 4: Management and Staffing Arrangements Statement 4 We ensure that everyone working in the service has an ethos of respect towards service users and each other. Service strengths We have graded this statement as very good, based on our observations, our discussions with the manager, staff, residents, a carer and feedback from questionnaires and records we examined. We observed staff interactions with residents and could see that they were courteous, friendly and respectful. We saw that staff showed consideration for residents' dignity and privacy. Staff had a good knowledge of residents' individual needs and wishes and were person centred in their practice. Rannoch House, page 21 of 27

The resident representative role which was undertaken by one of the people who used the service was a good example of how the service respected and encouraged residents' self advocacy. Staff undertook different training courses such as Diversity training and Anti-Racist training which helped them reflect on their attitudes and practice in relation to respect towards people from different cultures and backgrounds. Staff had access to the National Care Standards, SSSC Codes of Practice and other best practice guidance. Areas for improvement The service should continue to develop staff awareness of best practice guidance though a range of resources such as the SCSWIS website, online Human Rights training(http://www.scottishhumanrights.com/careaboutrights) and the Care for Older People online portal which provides access to learning resources on topics such as nutirtion, stroke, dementia and much more (accessed via www.knowledge.scot.nhs.uk or www.ssks.org.uk). We found that information in residents' Life Story records was very good but that staff could do more to show how this information was used to develop care plans around people's interests, personal goals and retaining links with their past. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0 Inspection report continued Rannoch House, page 22 of 27

Quality Theme 4: Quality of Management and Leadership - NOT ASSESSED Rannoch House, page 23 of 27

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 None. 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). Rannoch House, page 24 of 27

5 Summary of grades Quality of Care and Support - 4 - Good Statement 1 Statement 3 Statement 6 5 - Very Good 3 - Adequate 5 - Very Good Quality of Environment - Not Assessed Quality of Staffing - 4 - Good Statement 1 Statement 3 Statement 4 5 - Very Good 3 - Adequate 5 - Very Good Quality of Management and Leadership - Not Assessed 6 Inspection and grading history Date Type Gradings 27 Jan 2011 Unannounced Care and support 4 - Good Environment Not Assessed Staffing Not Assessed Management and Leadership 4 - Good 21 Sep 2010 Announced Care and support 2 - Weak Environment Not Assessed Staffing Not Assessed Management and Leadership 3 - Adequate 16 Feb 2010 Unannounced Care and support 5 - Very Good Environment 5 - Very Good Staffing 4 - Good Management and Leadership 4 - Good 13 Aug 2009 Announced Care and support 5 - Very Good Environment 4 - Good Rannoch House, page 25 of 27

Staffing Management and Leadership 4 - Good 4 - Good 27 Feb 2009 Unannounced Care and support 4 - Good Environment 3 - Adequate Staffing 3 - Adequate Management and Leadership 3 - Adequate 22 Sep 2008 Announced Care and support 4 - Good Environment 3 - Adequate Staffing 3 - Adequate Management and Leadership 3 - Adequate All inspections and grades before 1 April 2011 are those reported by the former regulator of care services, the Care Commission. Rannoch House, page 26 of 27

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 SCSWIS. You can get more copies of this report and others by downloading it from our website: www.scswis.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@scswis.com Web: www.scswis.com Rannoch House, page 27 of 27