Dumfries & Galloway Services Housing Support Service

Dumfries & Galloway Services Housing Support Service Ladyfield Villas Flat 2B Glencaple Road Dumfries DG1 4TG Telephone: 01387 267915 Type of inspection: Unannounced Inspection completed on: 19 September 2016 Service provided by: Community Integrated Care Service provider number: SP2003002599 Care service number: CS2004073368

About the service The service has been registered since November 2004. The service is operated by Community Integrated Care Ltd, a national social care charity which provides care and support to people across England and Scotland. Dumfries and Galloway Services is a combined care at home and housing support service for adults with learning disabilities. The service currently provides support for service users residing in two supported living schemes in Dumfries along with some outreach work. What people told us Service users were happy with the care and support they received and comments included; "Staff are good company I have a laugh with them". "If I press the alarm they come right away". "They keep me right". "Staff are always great". "I have been on holiday with (staff name) which was smashing!" "The manager and senior are great - very empowering, hands on and they involve you". "I recently had a review with my parents". "I am now 100% involved in doing my own care plan which I wasn't before". "I have been involved in risk assessments for self-medicating and aim to do this independently". "I can choose staff where possible - where we have the same in common". "Staff support me to have an understanding and manage my own bloods". Feedback from the completed questionnaires returned to us by service users included; "The service helps me by going out for coffee and gardening which I like". "Some staff treat me better than others". "If I am upset about something the staff sort it". "The staff know what I want". "I like it here". "The staff are good with me". "The staff treat me nicely". "The staff do a good job". Family members spoke positively of the support their relative received. Comments included; "Brilliant - amazing staff". "Can't speak highly enough of them". "They do a brilliant job". "Very happy with staff". "He is definitely well looked after and supported". "Don't think (name) could be in a better place". "She is really well looked after". "We have a meeting with staff planned to ensure a consistent approach". "I am very happy with the service". page 2 of 18

Self assessment The Care Inspectorate received a fully completed self-assessment from the provider. The provider identified what it thought the service did well and gave examples of where there were areas for improvement. From this inspection we graded this service as: Quality of care and support Quality of staffing Quality of management and leadership 3 - Adequate 4 - Good 3 - Adequate Quality of care and support Findings from the inspection New comprehensive care assessments had been completed for some individuals. This gave a real insight into the person and provided valuable information to influence the support planning and review process. We saw one support plan completed on the new template in which the individual had being actively involved in developing this to ensure they were supported in a way that they preferred and which met their individual outcomes. The service had worked hard at meeting a requirement made at the last inspection to safely support people with epilepsy. This had improved outcomes for individuals through effective support planning, recording of seizures, the administration of rescue medication and staff training. Improvements had been made to record direct feedback from service users and other people to influence the quality of the service. This demonstrated the outcomes from feedback received. The service should ensure that all staff routinely capture feedback effectively. We required the service to demonstrate that individual's health care needs were being met, including contacting relevant professionals and having an auditable trail of all healthcare appointments and referrals. We found good evidence of regular healthcare appointments for each person and that other professionals were contacted where appropriate, such as the learning disability team or diabetes nurse. The new support plan format will capture this much more effectively and the manager should ensure these are completed to maintain effective oversight. We made a requirement and a recommendation at the last inspection about support plans and that these were up to date, reviewed and outcome focussed. We found that the service was updating all plans to a more person centred outcome focussed version. There had been little progress since the last inspection and only one support plan had been completed. (Requirement 1 and recommendation 1) There was a lack of evidence to meet a previous recommendation that any legal powers in place were accurately recorded within the support plan. (Recommendation 2) page 3 of 18

We also required that risk assessments were in place for each service user. There was a new format for risk assessments to link in with the new support plan but these were not completed. Previous risk assessments had not been reviewed since the last inspection. The service must ensure that support plans and risk assessments are completed as a matter of priority for all service users to ensure their needs and outcomes can be met in a safe and consistent manner. (Requirement 2) We required that each service user had a medication support plan and accurate protocols were in place, and where required Section 47 Certificates were up to date. The service had made limited progress on this and we saw that protocols had not been reviewed, some Section 47 Certificates were inaccurate and medication support plans were not in place. The service must ensure this is taken forward as a matter of priority along with support plans to enable individuals to be safely administered their medication. (Requirement 3) Requirements Number of requirements: 3 1. The provider must ensure that support plans are reviewed with individuals and their relatives or representatives, where appropriate, at least six monthly and more frequently if people's needs change significantly or they ask for a review. This is in order to comply with Scottish Statutory Instruments (SSI) 2011/210 Regulation 5(2)(b)(i)&(ii) Timescale for implementation: 8 weeks from receipt on this report. 2. The provider must ensure that comprehensive risk assessments are completed for each service user that is relevant to their particular needs and circumstances and clearly identifies the risks, triggers and control measures in place for each person. Risk assessments must contain clear guidance on what action staff must take in order to manage identified risks safely. Risk assessments should be reviewed and updated as often as required and at least once in each six month period alongside reviews of individual support plans. This is in order to comply with SSI 2011/210 Regulation 4(1)(a) Welfare of Service Users. Timescale for implementation: 8 weeks from receipt of this report. 3. The Provider must ensure that they make the proper provision for the health, welfare and safety of service users. To achieve this, the Provider must take action to ensure; 1) Each service user has an accurate medication support plan and risk assessment in place. 2) Accurate and up to date PRN protocols are in place and administration records evidence time of administration and dosage. 3) Accurate information is documented to record, monitor and evaluate the circumstances prior to, and following the administration of PRN medication. 4) Where required, Section 47 Certificates are accurately completed and up to date. 5) Systems and procedures are in place to routinely monitor and ensure all medication documentation is accurate and up to date. page 4 of 18

This is in order to comply with The Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011 (SSI2011/210) Regulation 4 (1) A provider must (a) make proper provision for the health, welfare and safety of service users. Timescale for implementation: 4 weeks from receipt of this report. In making this requirement we have taken the following National Care Standards, Care at home into account - Standard 7, Keeping well - Healthcare. We have also taken into account "The Keys to Life - Improving Quality of Life for People with Learning Disabilities". Recommendations Number of recommendations: 2 1. The information in personal outcome plans for all service users should be reviewed to ensure that they contain current, accurate and relevant information on the needs and preferences of service users and provides good guidance for staff on how to deliver agreed support safely to achieve identified outcomes. In making this recommendation the following National Care Standards for Housing Support and care at Home Services have been taken into account; Standard 3 - Your Personal Plan (Care at Home) and Standard 4 - Housing Support Planning (Housing Support) 2. The service provider should ensure that where there are any legal powers in place that this is accurately recorded within the relevant sections of the support plan. Where appropriate, agreements of the powers delegated to the care provider by the guardian should be in place. National care standards, Standard 3, Your personal plan; Standard 4 Management and staffing. Grade: 3 - adequate Quality of staffing Findings from the inspection We observed staff to be confident and competent when supporting service users to meet their care and support needs. We saw them to be kind, caring and respectful and to fully involve individuals in their day to day support and offer them individual choices. There had been recent staff shortages which had placed extra pressure on staff, however we were told that following recruitment this had reduced and moral had improved. We made a requirement at the last inspection that staff must receive training appropriate to the work they are to perform. This included undertaking a full training needs analysis to inform a training plan, and training specific to meet individual service user needs. We saw that the service had made good progress on taking this forward. A training matrix was now in place which accurately identified training needs and where training was attended. page 5 of 18

All staff had attended Adult Support and Protection training which we considered would improve outcomes for individuals to ensure they were safe and protected from risk and abuse. Training in the Management of Actual or Potential Aggression (MAPA) was also up to date which ensured that staff could support individuals in a safe and consistent way. The service must consider further developing the training plan to include training requested by staff such as autism and schizophrenia. Given the role and responsibility of staff when carrying out the care and support, the service should support staff to have an awareness of infection control and food hygiene. Although there had been good progress made to ensure all staff had attended the appropriate training, we saw that medication training for a high number of staff was not completed. The manager was aware of this and planned to carry this out as soon as possible, however in the interim had been completing practice workbooks with staff. (Recommendation 1) At the last inspection we asked the service to consider how to support the recommendations from the Keys to Life to improve the lives of the people they support. Although the staff within the service were aware of the Keys to Life Strategy and could give examples of how they supported the recommendations from this, there was limited evidence to demonstrate this. Managers had completed a presentation at their meeting, however they must consider how they can demonstrate how they are supporting the recommendations within the day to day care and support. (Recommendation 2) Support systems for staff needed to be improved. Individual supervision meetings were not taking place routinely and appraisals had not yet been started. The manager told us that appraisals called "you can" were about to be rolled out which would incorporate regular supervisions and one annual appraisal. It is important that staff are regularly supported within their role and given feedback on their performance and the service should take this forward as a matter of priority. Staff meetings were not taking place routinely mainly due to the recent staff shortages. Given the recent recruitment, the service must ensure that existing, and new staff members are given the opportunity to attend staff meetings on a regular basis. (Recommendation 3) Requirements Number of requirements: 0 Recommendations Number of recommendations: 3 1. The service should ensure that the training plan is regularly evaluated to identify gaps/requests in training. Formal Medication training should be completed without delay and staff should be supported to have an awareness of infection control and food hygiene. National care standards, Care at home - Standard 4 Management and staffing. page 6 of 18

2. The service provider should consider how to support the recommendations from the Keys to Life and the Winterbourne View Report to improve the lives of the people they support. National care standards, Care at home, Standard 4 - Management and staffing. We have signposted the Provider to the following best practice guidance; "The Keys to Life" - http://www.gov.scot/resource/0042/00424389.pdf "The Keys to Life Easy Read Version" - http://www.gov.scot/resource/0042/00424500.pdf "Transforming care: A national response to Winterbourne View Hospital" - https://www.gov.uk/government/uploads/system/uploads/ attachment_data/file/213215/final-report.pdf "Scottish Human Rights Commission, Care about Rights?" - http://scottishhumanrights.com/careaboutrights/welcome-embedding 3. The service should ensure that regular, consistent and effective support systems are in place for all staff. This should include supervision meetings, appraisals and team meetings. National care standards, Care at home - Standard 4 Management and staffing. Grade: 4 - good Quality of management and leadership Findings from the inspection We found that service users' and families views and feedback were listened to and responded to. The service had improved how they recorded comments, compliments and complaints since the last inspection and we could see the outcomes from these. Some care reviews had taken place for service users which gave them and their family the opportunity to feedback on the quality of the service provided. From minutes we could see that the service were sensitive and responsive to service users and their families choices and suggestions. Since the last inspection there was a new registered manager in post and a restructure of the senior management team had taken place. At the time of inspection the service had just recruited a new Head of Service for the South of Scotland, however the post of Service Manager was still to be filled. Given that the manager for the service was in an acting position, we considered that this had influenced the quality and frequency of support to them, in particular working towards the requirements and recommendations made at the last inspection. Staffing shortages had also been filled by the senior team member, therefore this negatively impacted on them being able to carry out their senior duties, such as support planning, supervision, appraisals and team meetings. The appointment of a new Service Co-Ordinator for the service was spoken of in positive terms as this would further support the prompt roll out of support plans and risk assessments and other administrative tasks. page 7 of 18

We made a requirement at the last inspection that comprehensive accident and incident procedures were in place. On the whole, accidents and incidents were recorded and we could see the actions taken following any incident, for example arranging a care review. However, we found that there had been a significant incident that was not recorded through the service's procedures. As at the last inspection the service were still unable to give us a policy on accident and incident procedures. There was also a lack of evidence that incidents were being monitored or evaluated for individual service users to inform support planning and risk assessments. (Requirement 1) We made a recommendation that regular monitoring was taking place to ensure areas for improvement were identified and appropriate action taken. Although there were systems in place to audit and monitor the service referred to as the Service Quality Assessment Tool (SQAT) this had not been undertaken since the last inspection. Given our findings at this inspection, we considered there to be a lack of monitoring and oversight in all areas of the service for example, support planning, risk assessments, supervision, appraisals, team meetings, and accident and incidents. It is important that all areas of the service are audited and evaluated to enable the service to identify areas of improvement and develop an action plan from this. (Recommendation 1) We recommended that further ways for relatives, carers and other stakeholders to give feedback were developed. Although new questionnaires had been developed, these had not been distributed. The service should consider new and innovative ways to take this forward. (Recommendation 2) Requirements Number of requirements: 1 1. The service provider must ensure that there are robust and comprehensive accident and incident systems and procedures in place. To achieve this, the Provider must take action to ensure; - An accident and incident policy and procedure is in place and regularly reviewed. - All accidents and incidents are accurately recorded, and readily available at all times, including during inspection. - All accidents and incidents are monitored and evaluated and any follow up actions fully recorded. - All staff are fully aware of, and understand the accident and incident policy and procedures and are able to demonstrate this in practice. This is in order to comply with The Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011 (SSI2011/210) Regulation 4 (1) (a) A provider must make proper provision for the health, welfare and safety of service users. Timescale for completion: 4 weeks from receipt of this report. In making this requirement the following National Care Standards, Care at home, have been taken into account: Standard 4 Management and staffing. We have also taken into account "The Keys to Life - Improving Quality of Life for People with Learning Disabilities". page 8 of 18

Recommendations Number of recommendations: 2 1. The provider needed to ensure that regular monitoring took place to ensure that actions identified were followed through and practice reflected organisational policies and procedures and was consistent with best practice. In making this recommendation the following National Care Standards for Housing Support and Care at Home Services have been taken into account; Standard 3 - Management and Staffing Arrangements (Housing Support) and Standard 4 - Management and Staffing (Care at Home) 2. The provider needed to widen access for relatives, carers and other stakeholders to provide a range of ways in which they can give feedback on the service and make suggestions for service improvement. In making this recommendation the following National Care standards for Housing Support and Care at Home Services have been taken into account; Standard 3 - Management and Staffing Arrangements, Standard 8 - Expressing your Views (Housing Support Services) and Standard 4 Management and Staffing and Standard 11 Expressing your Views (Care at Home Services) Grade: 3 - adequate 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 support plans are reviewed with individuals and their relatives or representatives, where appropriate, at least six monthly and more frequently if people's needs change significantly or they ask for a review. This is in order to comply with Scottish Statutory Instruments (SSI) 2011/210 Regulation 5(2)(b)(i)&(ii) Timescale for implementation: 8 weeks from receipt on this report. This requirement was made on 22 July 2015. Action taken on previous requirement We have discussed progress made on meeting this requirement under Quality of care and support in this report. Not met page 9 of 18

Requirement 2 The provider must ensure that comprehensive risk assessments are completed for each service user that is relevant to their particular needs and circumstances and clearly identifies the risks, triggers and control measures in place for each person. Risk assessments must contain clear guidance on what action staff must take in order to manage identified risks safely. Risk assessments should be reviewed and updated as often as required and at least once in each six month period alongside reviews of individual support plans. This is in order to comply with SSI 2011/210 Regulation 4(1)(a) Welfare of Service Users. Timescale for implementation: 8 weeks from receipt of this report. This requirement was made on 22 July 2015. Action taken on previous requirement We have discussed progress made on meeting this requirement under Quality of care and support in this report. Not met Requirement 3 The Provider must ensure that they make the proper provision for the health, welfare and safety of service users. To achieve this, the Provider must take action to ensure; 1) All staff who support service users with epilepsy must have up to date and appropriate training including the administration of rescue medication where appropriate. 2) Where appropriate, each service user must have an individual epilepsy care plan in place. This should include but not limited to; - records of triggers and seizure warnings. - descriptions of seizures including length and recovery. - frequency of seizures. - pattern of seizures. - prescribed medication. - epilepsy risk indicators/assessment. 3) All seizure activity is accurately recorded on weekly/monthly/annual recording charts and regularly evaluated to inform the care plan. 4) There are clear protocols for the administration of rescue medication. 5) Clear and accurate details of any clinical specialist and frequency of reviews are recorded. This is in order to comply with The Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011 (SSI2011/210) Regulation 4 (1) A provider must (a) make proper provision for the health, welfare and safety of service users: Regulation 15 (a) Staffing - a provider must ensure that at all times suitably qualified and competent persons are working in the care service: (b) (i) ensure that persons employed in the provision of the care service receive training appropriate to the work they are to perform. Timescale for implementation: 6 weeks from receipt of this report. In making this requirement we have taken the following National Care Standards, Care at home into account - Standard 7, Keeping well - Healthcare. We have also taken into account "The Keys to Life - Improving Quality of Life for People with Learning Disabilities". page 10 of 18

This requirement was made on 22 July 2015. Action taken on previous requirement We have discussed progress made on meeting this requirement under Quality of care and support in this report. Met - within timescales Requirement 4 The Provider must make proper provision for the health, welfare and safety of all service users. To achieve this, the provider must take action to; 1) Ensure prompt action is taken to contact the relevant professionals in response to any changes in service user's health care or support needs. 2) Keep a clear and accurate record of all healthcare appointments, requested, attended and the outcome of any such appointment. 3) Ensure there is a clear, auditable trail of health care referrals and appointments that clearly link in to the support plan, risk assessments and incident reports. This is in order to comply with The Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011 (SSI2011/210) Regulation 4 (1) A provider must (a) make proper provision for the health, welfare and safety of service users: Timescale for implementation: 1 week from receipt of this report. In making this requirement we have taken the following National Care Standards, Care at home into account - Standard 7, Keeping well - Healthcare. We have also taken into account "The Keys to Life - Improving Quality of Life for People with Learning Disabilities". This requirement was made on 22 July 2015. Action taken on previous requirement We have discussed progress made on meeting this requirement under Quality of care and support in this report. Met - within timescales Requirement 5 The Provider must ensure that they make the proper provision for the health, welfare and safety of service users. To achieve this, the Provider must take action to ensure; 1) Each service user has an accurate medication support plan and risk assessment in place. 2) Accurate and up to date PRN protocols are in place and administration records evidence time of administration and dosage. 3) Accurate information is documented to record, monitor and evaluate the circumstances prior to, and following the administration of PRN medication. 4) Where required, Section 47 Certificates are accurately completed and up to date. 5) Systems and procedures are in place to routinely monitor and ensure all medication documentation is accurate and up to date. page 11 of 18

This is in order to comply with The Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011 (SSI2011/210) Regulation 4 (1) A provider must (a) make proper provision for the health, welfare and safety of service users. Timescale for implementation: 4 weeks from receipt of this report. In making this requirement we have taken the following National Care Standards, Care at home into account - Standard 7, Keeping well - Healthcare. We have also taken into account "The Keys to Life - Improving Quality of Life for People with Learning Disabilities". This requirement was made on 22 July 2015. Action taken on previous requirement We have discussed progress made on meeting this requirement under Quality of care and support in this report. Not met Requirement 6 The Provider must ensure that staff employed in the provision of the care service receive training appropriate to the work they are to perform. To achieve this, the Provider must take action to; 1) Undertake a full training needs analysis for each member of staff that is clearly linked to supervision and appraisal. 2) The outcome of this analysis should be used to inform a comprehensive training plan for mandatory training and identified training to meet individual service user needs. 3) The training plan must include but is not limited to; - Adult Support and Protection - Mental Health Awareness - Epilepsy Awareness and Administration of Rescue Medication. - Diabetes Awareness. - Continence Awareness. 4) Staff must attend updates as and when required. This is in order to comply with The Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011 (SSI2011/210) Regulation 4 (1) (a) A provider must make proper provision for the health, welfare and safety of service users; Regulation 15 (b) (1) Staffing - a provider must ensure that persons employed in the provision of the care service receive training appropriate to the work they are to perform. Timescale for completion: within 16 weeks from receipt of this report. In making this requirement the following National Care Standards, Care at home, have been taken into account: Standard 4 Management and staffing. We have also taken into account the Scottish Social Services Council, Codes of Practice 3 "As a social service employer, you must provide training and development opportunities to enable social service workers to develop their skills and knowledge". page 12 of 18

We have also taken into account "The Keys to Life - Improving Quality of Life for People with Learning Disabilities". This requirement was made on 22 July 2015. Action taken on previous requirement We have discussed progress made on meeting this requirement under Quality of staffing in this report. Met - within timescales Requirement 7 The service provider must ensure that there are robust and comprehensive accident and incident systems and procedures in place. To achieve this, the Provider must take action to ensure; - An accident and incident policy and procedure is in place and regularly reviewed. - All accidents and incidents are accurately recorded, and readily available at all times, including during inspection. - All accidents and incidents are monitored and evaluated and any follow up actions fully recorded. - All staff are fully aware of, and understand the accident and incident policy and procedures and are able to demonstrate this in practice. This is in order to comply with The Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011 (SSI2011/210) Regulation 4 (1) (a) A provider must make proper provision for the health, welfare and safety of service users. Timescale for completion: 4 weeks from receipt of this report. In making this requirement the following National Care Standards, Care at home, have been taken into account: Standard 4 Management and staffing. We have also taken into account "The Keys to Life - Improving Quality of Life for People with Learning Disabilities". This requirement was made on 22 July 2015. Action taken on previous requirement We have discussed progress made on meeting this requirement under Quality of management and leadership in this report. Not met page 13 of 18

What the service has done to meet any recommendations we made at or since the last inspection Previous recommendations Recommendation 1 The provider needed to widen access for relatives, carers and other stakeholders to provide a range of ways in which they can give feedback on the service and make suggestions for service improvement. In making this recommendation the following National Care standards for Housing Support and Care at Home Services have been taken into account; Standard 3 - Management and Staffing Arrangements, Standard 8 - Expressing your Views (Housing Support Services) and Standard 4 Management and Staffing and Standard 11 Expressing your Views (Care at Home Services) This recommendation was made on 22 July 2015. Action taken on previous recommendation We have discussed progress on this under Quality of management and leadership in this report. This recommendation is: Not met. Recommendation 2 The manager should consider how to record direct feedback from service users and other people involved with this service so that the quality of service provided by Dumfries & Galloway Services can be assessed and suggestions for improvement taken into account. In making this recommendation the following National Care Standards for Housing Support and Care at Home Services have been taken into account; Standard 3 - Management and Staffing Arrangements, Standard 8 - Expressing your Views (Housing Support Services) and Standard 4 Management and Staffing and Standard 11 Expressing your Views (Care at Home Services) This recommendation was made on 22 July 2015. Action taken on previous recommendation We have discussed progress on this under Quality of care and support in this report. This recommendation is: Met. Recommendation 3 The information in personal outcome plans for all service users should be reviewed to ensure that they contain current, accurate and relevant information on the needs and preferences of service users and provides good guidance for staff on how to deliver agreed support safely to achieve identified outcomes. In making this recommendation the following National Care Standards for Housing Support and care at Home Services have been taken into account; Standard 3 - Your Personal Plan (Care at Home) and Standard 4 - Housing Support Planning (Housing Support) This recommendation was made on 22 July 2015. page 14 of 18

Action taken on previous recommendation We have discussed progress on this under Quality of care and support in this report. This recommendation is: Not met. Recommendation 4 The service provider should ensure that where there are any legal powers in place that this is accurately recorded within the relevant sections of the support plan. Where appropriate, agreements of the powers delegated to the care provider by the guardian should be in place. National care standards, Standard 3, Your personal plan; Standard 4 Management and staffing. This recommendation was made on 22 July 2015. Action taken on previous recommendation We have discussed progress on this under Quality of care and support in this report. This recommendation is: Not met. Recommendation 5 The service provider should consider how to support the recommendations from the Keys to Life and the Winterbourne View Report to improve the lives of the people they support. National care standards, Care at home, Standard 4 - Management and staffing. We have signposted the Provider to the following best practice guidance; "The Keys to Life" - http://www.gov.scot/resource/0042/00424389.pdf "The Keys to Life Easy Read Version" - http://www.gov.scot/resource/0042/00424500.pdf "Transforming care: A national response to Winterbourne View Hospital" - https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/213215/final-report.pdf "Scottish Human Rights Commission, Care about Rights?" - http://scottishhumanrights.com/careaboutrights/ welcome-embedding This recommendation was made on 22 July 2015. Action taken on previous recommendation We have discussed progress on this under Quality of staffing in this report. This recommendation is: Not met. Recommendation 6 The provider needed to ensure that regular monitoring took place to ensure that actions identified were followed through and practice reflected organisational policies and procedures and was consistent with best practice. In making this recommendation the following National Care Standards for Housing Support and Care at Home Services have been taken into account; Standard 3 - Management and Staffing Arrangements (Housing Support) and Standard 4 - Management and Staffing (Care at Home) This recommendation was made on 22 July 2015. page 15 of 18

Action taken on previous recommendation We have discussed progress on this under Quality of management and leadership in this report. This recommendation is: Not met. Complaints There have been no complaints upheld since the last inspection. Details of any older upheld complaints are published at www.careinspectorate.com. Enforcement No enforcement action has been taken against this care service since the last inspection. Inspection and grading history Date Type Gradings 16 Jun 2015 Unannounced Care and support 3 - Adequate Environment Not assessed Staffing 3 - Adequate Management and leadership 3 - Adequate 22 May 2014 Announced (short notice) Care and support 4 - Good Environment Not assessed Staffing 4 - Good Management and leadership 4 - Good 15 Mar 2013 Announced (short notice) Care and support 6 - Excellent Environment Not assessed Staffing 6 - Excellent Management and leadership 6 - Excellent 30 Nov 2010 Announced Care and support 5 - Very good Environment Not assessed Staffing Not assessed Management and leadership Not assessed page 16 of 18

Date Type Gradings 25 Mar 2010 Announced Care and support 5 - Very good Environment Not assessed Staffing 4 - Good Management and leadership Not assessed 4 Jul 2008 Announced Care and support 4 - Good Environment Not assessed Staffing 5 - Very good Management and leadership 4 - Good page 17 of 18

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 18 of 18