Daniel House Care Home Service Adults 243 Nithsdale Road Pollokshields Glasgow G41 5AQ Telephone:

Daniel House Care Home Service Adults 243 Nithsdale Road Pollokshields Glasgow G41 5AQ Telephone: 0141 427 0761 Type of inspection: Unannounced Inspection completed on: 31 July 2014

Contents Page No Summary 3 1 About the service we inspected 5 2 How we inspected this service 7 3 The inspection 11 4 Other information 27 5 Summary of grades 28 6 Inspection and grading history 28 Service provided by: Mainstay Trust Ltd. Service provider number: SP2003000175 Care service number: CS2003000863 If you wish to contact the Care Inspectorate about this inspection report, please call us on 0845 600 9527 or email us at enquiries@careinspectorate.com Daniel House, page 2 of 30

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 5 Very Good Quality of Environment 5 Very Good Quality of Staffing 5 Very Good Quality of Management and Leadership 5 Very Good What the service does well There is an experienced and well established staff team who present as motivated and committed to providing a very good standard of care and support. They are flexible in their approach to ensure the best outcomes for people who use the service. Staff continue to be very good at responding to the changing health needs of the people they support and work in partnership with healthcare professionals to do so. What the service could do better Carers should be informed of actions taken as a result of their feedback. Where a particular need is identified a support plan should be in place. Accident reports should record any follow up. A continuous improvement plan should be developed for the service. What the service has done since the last inspection Managers and staff have worked hard to support people through the Self Directed Support process and Older People's assessments to ensure good outcomes for them. They have made changes to the service in order to put in place a programme of suitable day activities. Daniel House, page 3 of 30

Conclusion Inspection report continued This service continues to provide a very good standard of person-centred care. During what they have described as a difficult year due to the introduction of Self Directed Support, staff and managers have developed an activity programme to suit the individual needs and wishes of the people living in Daniel House. This has resulted in good outcomes for them, and staff and managers are committed to continue to look for ways to provide them with as good a quality of life as possible. Daniel House, page 4 of 30

1 About the service we inspected The Care Inspectorate regulates care services in Scotland. Information in relation to all care services is available on our website at www.scswis.com. This service was previously registered with the Care Commission and transferred its registration to the Care Inspectorate on 1 April 2011. Requirements and recommendations If we are concerned about some aspect of a service, or think it needs to do more to improve, we may make a recommendation or requirement. - A recommendation is a statement that sets out actions the care service provider should take to improve or develop the quality of the service but where failure to do so will not directly result in enforcement. Recommendations are based on the National Care Standards, relevant codes of practice and recognised good practice. - A requirement is a statement which sets out what is required of a care service to comply with the Public Services Reform (Scotland) Act 2010 ("the Act") and secondary legislation made under the Act, or a condition of registration. Where there are breaches of Regulations, Orders or conditions, a requirement may be made. Requirements are legally enforceable at the discretion of the Care Inspectorate. Daniel house is a care home for nine adults with a learning disability. It is located in a quiet residential area on the south side of Glasgow in a large detached Victorian house. There is a well maintained garden area surrounding the house. The service is provided by Mainstay Trust. The stated aim of the organisation is to: "provide appropriate, flexible support, both practically and emotionally, to people with a learning or physical disability and their family carers, which will grow and develop with them from an early age into their senior years". Based on the findings of this inspection this service has been awarded the following grades: Quality of Care and Support - Grade 5 - Very Good Quality of Environment - Grade 5 - Very Good Quality of Staffing - Grade 5 - Very Good Quality of Management and Leadership - Grade 5 - Very Good Daniel House, page 5 of 30

This report and grades represent our assessment of the quality of the areas of performance which were examined during this inspection. Grades for this care service may change following other regulatory activity. You can find the most up-to-date grades for this service by visiting our website www.careinspectorate.com or by calling us on 0845 600 9527 or visiting one of our offices. Daniel House, page 6 of 30

2 How we inspected this service The level of inspection we carried out In this service we carried out a low intensity inspection. We carry out these inspections when we are satisfied that services are working hard to provide consistently high standards of care. What we did during the inspection We wrote this report following an unannounced inspection carried out by one inspector on 9 July 2014 from 10 am to 7 pm. We made a further visit and gave feedback to the manager on 31 July and spoke to relatives of people using the service after that date to conclude the inspection. As part of the inspection we took account of the completed annual return and self assessment forms that we asked the provider to complete and submit to us. During this inspection process we gathered information from various sources including the following: We spoke with: - people who use the service - three relatives - the manager - two support workers - two senior support workers and we observed interactions between staff and people who use the service. We looked at: - registration certificate - insurance certificate - the service's most recent annual return and self assessment - minutes of residents' meetings - two care plans - medication records - risk assessments - minutes of staff meetings - training records - health and safety audit - accident and incident reports - maintenance records - the environment Daniel House, page 7 of 30

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 Daniel House, page 8 of 30

What the service has done to meet any recommendations we made at our last inspection 1. The provider should ensure that when an alteration is made to medication records it is clear who has done so, the reason for the change and who has authorised it. National Care Standards, Care homes for people with learning disabilities, Standard 15: Keeping well - medication Met. A communication log was now in place for senior support workers to track any changes. 2. The manager should develop a continuous improvement plan which reflects the findings of quality assurance processes and the involvement of stakeholders (including residents, carers, staff and external agencies) from participation and feedback methods such as complaints, meetings, forums and questionnaire responses. National Care Standards, Care homes for people with learning disabilities, Standard 5: Management and staffing arrangements Not met. See Quality Theme 4, Statement 4 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. The Care Inspectorate received a fully completed self-assessment document from the provider. We were satisfied with the way the provider completed this and with the relevant information included for each heading that we grade the service under. Daniel House, page 9 of 30

The provider identified what they thought the service did well, some areas for development and any changes it planned. The service had asked carers for their views under each of the quality themes and this had been used to inform the self assessment which contained a range of information which mostly reflected what we found on our visit. Taking the views of people using the care service into account During this inspection we met six people who use the service. Those we spoke to told us they liked living at Daniel House. We also observed how staff interacted with service users. Everyone appeared relaxed and comfortable with staff who clearly knew them well and responded respectfully to their needs. We issued six Care Service Questionnaires to people who use the service before the inspection and received five completed by relatives on their behalf. All responses were very positive. These are some of the comments we received: "Daniel House has been my relative's home for approximately 25 years, the level of care is excellent." "Mostly I am supported to choose new things to do." "Would like to have a holiday." Taking carers' views into account During the inspection we spoke with three relatives of people who use the service. All were very happy with the standard of care provided by the service. These are some of their comments: "They go the extra mile. People living there have a good quality of life. My relative is very contented." "Staff have a good rapport with the residents, they know their wee traits." "My relative has benefitted from living there." "We're more than pleased with the way our relative is looked after by all the staff." "The manager and some of the staff have been there a long time and know my relative well." Daniel House, page 10 of 30

3 The inspection We looked at how the service performs against the following quality themes and statements. Here are the details of what we found. Quality Theme 1: Quality of Care and Support Grade awarded for this theme: 5 - Very 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 found that this service was very good at involving the people who use it in the assessment and development of their care and support. We decided this after talking with people who use the service, carers, managers and staff. We also looked at support plans and the minutes of service user meetings and other written evidence. This service continued to support the people who use it and their relatives to participate in assessing and improving the quality of the service. The support plans we sampled showed evidence that they were focused on making sure the service provided an individual approach to care and support. We saw good use of photographs to guide staff on how to provide the support consistently for some people. Personal preferences were clearly recorded and there was evidence that showed staff had included people and their relatives in their planning as far as they were able. People who use the service and relatives were fully involved in the recent assessment process for Self Directed Support and Older Adults assessments. Those we spoke to confirmed that they attended regular reviews and were asked for their views not only on their relative's care plan but also on staff supporting them. We sampled minutes from some residents' meetings which showed good involvement that ultimately influenced some service development. We saw many examples where suggestions from them had been actioned, showing us that people were being listened to. These included: - activities which were incorporated into rota planning - weekly aromatherapy sessions were now being held Daniel House, page 11 of 30

- changes to the menu to suit an individual - staff were looking into the possibility of holidays for those who wanted one Any issues raised at residents' meetings continued to be taken forward for discussion at staff meetings which ensured that they were followed up. There have been many changes to the service following the review of day services by the local authority which has resulted in fewer centre-based day placements. The organisation had responded well to this by providing a programme of day activities for people who use the service and we saw they were consulted on the types of activities they would like to take part in. For those who were unable to state a preference staff told us that they were trying a number of activities to see if they were suitable and how the person responded. Some people who use the service had attended a forum at the organisation's head office to review current activities and make suggestions for new ones. This was a small service and staff knew the people who use it very well. There was a keyworker system in place and each person was supported by a link group, a small group of staff whose role was to link in with families and professionals involved in their care and support. The director continued to keep families up to date with progress in the service. For example the most recent update gave them information on the outcome of the Self Directed Support assessment process and plans for moving forward for people who no longer received budgets for day care. Following comments from a relative at the last inspection the service had invited families to a carol concert at the house and there were plans for other events. One relative told us that they are welcomed at the house whenever they want to go. Relatives had been asked to complete a family questionnaire and grade the service - responses were included in the self-assessment we ask services to submit before each inspection. This gave them the opportunity to give their views on each of the quality themes we grade them on at inspection namely care and support, environment, staffing and management and leadership. The comments we saw were very positive with a few suggested areas that could be improved upon. Areas for improvement Inspection report continued It was unclear how the service had responded to the improvements suggested by relatives in the family questionnaires described above. We would expect relatives to be informed of any changes made as a result of their feedback or the reason why change was not possible. (See Recommendation 1) Daniel House, page 12 of 30

Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 1 Recommendations Inspection report continued 1. The manager should ensure that carers are given feedback following consultation with them. National Care Standards, Care homes for people with learning disabilities, Standard 11: Expressing your views Daniel House, page 13 of 30

Statement 3 We ensure that service users' health and wellbeing needs are met. Service strengths Inspection report continued We found that performance by this service was very good in the areas covered by this statement. We concluded this after we looked at care plans and related recordings and spoke with staff, the manager and relatives about health and wellbeing. Care plans we sampled gave very good information about people's health needs and information on the best way to support them. Staff knew the people they supported well and continued to respond promptly to any changes in their health needs. For example, for one person who had an increased risk of falls due to their deteriorating mobility, staff had made changes to their environment to allow easier access and had involved the physiotherapist and made a referral to the occupational therapist to ensure the person received the appropriate support. A very detailed risk assessment was in place. We saw good use of photographs showing staff how to support the person when eating and drinking which meant that they could offer the support in a consistent way. Staff continued to ensure that people's health was monitored through regular routine health and wellbeing checks such as those by optician, dentist and chiropodist. We reported at the last inspection that people were being offered regular bowel screening and since then a member of staff had received training in bowel health which was passed on to all staff which meant that they too would have an awareness of it. We saw from records that the service had good links with a range of healthcare professionals in response to people's needs such as GP, nurse, occupational therapist, physiotherapist and speech and language therapist and that their advice was carried out by staff. Staff continued to carry out regular physiotherapy programmes for people with mobility issues as well as encouraging them to walk daily. We heard of some very good outcomes for people due to the support that staff were able to provide to meet their health needs. For example one person was able to leave hospital shortly after having a hip operation because staff carried out daily exercises with the support of the physiotherapist and helped the person to regain their confidence in walking and climbing stairs. Medication was reviewed by the GP annually or more often if required to ensure that people continued to receive it appropriately. This service continued to be committed to supporting people to live as busy a life as possible doing things they enjoyed and therefore maintaining their physical and mental wellbeing. This was particularly evident in the service's very good response to changes in the provision of day services by the local authority and the personalisation process since the last inspection. Staff now provided a varied programme of day and Daniel House, page 14 of 30

evening activities for all service users as well as one-to-one support for those who had received funding for it. The service had made changes to shift times to support this. Staff we spoke to told us that although they had been through a challenging time supporting people to find suitable affordable activities they felt that in general the changes had been positive and that people were busier than ever. Areas for improvement As we said above staff were very knowledgeable about the people they supported and were aware of their individual needs. However where there was a specific need such as dementia or diabetes we would expect to see a support plan to guide staff so that the need could be met consistently. (See Recommendation 1) It was good to see that quality checks were being made on medication at the start of each shift to ensure that it had been administered and that records had been signed. However we saw several occasions where these checks had identified a missing signature but there was no evidence that this had been followed up. We discussed this with the manager who will look at how to ensure follow up is recorded and we will check it at the next inspection. We also discussed with the manager the variable quality of recording by staff in residents' care notes. We found that although some provided good detail and evaluation of how the person had reacted to a particular activity or situation others did not. We will follow up at the next inspection how this has been addressed. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 1 Recommendations Inspection report continued 1. Where a need has been identified a support plan should be in place with relevant information in enough detail to guide staff on how best to support the person. National Care Standards, Care homes for people with learning disabilities, Standard 6: Support arrangements Daniel House, page 15 of 30

Quality Theme 2: Quality of Environment Grade awarded for this theme: 5 - Very Good Statement 1 We ensure that service users and carers participate in assessing and improving the quality of the environment within the service. Service strengths The performance for service user involvement under this statement was found to be very good. Most of the evidence relating to this has been included under Quality Theme 1, Statement 1. Carers were asked for their views on the environment in the service's family questionnaires and invited to grade all areas of the service to include in the self assessment the manager submitted to the Care Inspectorate before this inspection. We saw that carers had graded the environment as 'very good' or 'excellent'. People who use the service continued to be consulted about any improvements to the environment such as when purchasing new furniture. Also we heard that following a complaint by a person using the service about the potholes in the garden the organisation has agreed to make improvements. Areas for improvement The manager told us that people using the service will be consulted on plans for future improvements such as the upstairs bathroom. The areas for improvement have been included under Quality Theme 1, Statement 1. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0 Daniel House, page 16 of 30

Statement 2 We make sure that the environment is safe and service users are protected. Service strengths We found performance by this service to be very good in the areas we looked at under this statement. The service continued to have various measures in place to ensure the safety of the people living there: - Visitors to the service were required to sign in. Inspection report continued - Regular health and safety checks were carried out such as water checks, weekly fire alarm checks, monthly emergency lighting checks and regular fire evacuations. - Staff received regular fire training which included the use of fire extinguishers. - Regular maintenance checks were carried out on electrical appliances, boiler and gas. Smoke detectors and the boiler were vacuumed regularly to remove any accumulation of dust. - Any faults or repairs were reported in the repairs log and generally dealt with promptly. - The manager had recently completed a health and safety audit to identify any areas that needed to be improved. - There were good risk assessments in place for the environment and kitchen. As we found at the last inspection individual risk assessments for all daily living activities for people using the service were person centred and detailed and were reviewed regularly. Those we looked at were signed to show the agreement of those involved. - Automatic door closers allowed people with mobility aids to move about the home freely and safely. - Staff had received training in health and safety, food hygiene, first aid, infection control and adult protection, all of which helped to ensure the safety and protection of people using the service. - Accidents and incidents were recorded and where necessary appropriate notifications made to the Care Inspectorate. The manager monitored accidents and incidents to identify patterns or trends. Daniel House, page 17 of 30

Areas for improvement Since the last inspection staff were using a different form for recording accidents which did not have space to record follow-up actions. So that all staff could be made aware of what had happened and what action had been taken to minimise the risk of the same happening again we thought it was important to include this information on the accident form and so have made a recommendation about it here. (See Recommendation 1) Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 1 Recommendations 1. Accident records should include any follow-up actions taken. Inspection report continued National Care Standards, Care homes for people with learning disabilities, Standard 5: Management and staffing arrangements Daniel House, page 18 of 30

Quality Theme 3: Quality of Staffing Grade awarded for this theme: 5 - Very 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 found that this service was very good at involving the people who use it in having their say on the quality of staffing. We decided this after talking with people who use the service and looking at support plans, reviews and questionnaires. Some of the strengths for this statement are included under Quality Theme 1, Statement 1. In addition to this: Carers were asked for their views on staff in the service's family questionnaires and invited to grade all areas of the service to include in the self assessment the manager submitted to the Care Inspectorate before this inspection. We saw that one carer had graded staff as 'good' and four had graded staff as 'excellent'. The provider continued to ask for service user, carer and staff nominations for their Staff Recognition Award which this year had been developed further to include questions on what the service should be doing and what they could do differently. This gave people the opportunity to give their views on all areas of the service. We were pleased to see that a feedback report gave people information on what had been said and what managers were doing to respond to and address the points that had been raised. Carers were asked for their views on the staff who supported their relative as part of the six-monthly review process. We received very positive comments from relatives about staff. These included: "They go the extra mile. People living there have a good quality of life. My relative is very contented." Daniel House, page 19 of 30

"Staff have a good rapport with the residents, they know their wee traits." "We're more than pleased with the way our relative is looked after by all the staff." Areas for improvement See Quality Theme 1, Statement 1. The evidence for this statement could be strengthened by using feedback from carers in supervision and appraisal to assist with staff professional development. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0 Inspection report continued Daniel House, page 20 of 30

Statement 3 We have a professional, trained and motivated workforce which operates to National Care Standards, legislation and best practice. Service strengths Inspection report continued We found that performance by this service was very good in this area. We decided this after talking with people who use the service and/or their relatives, managers and staff and looking at evidence relating to the quality of staff training, supervision and team meetings. As we said elsewhere in this report there had been many changes since the last inspection to the way staff were providing support. We found that staff morale was good and that they were now seeing the benefits from these changes following a difficult time where there were concerns about people being moved to other services and about their jobs. Those we spoke to told us that the job was very different - they were out and about a lot more supporting people in their day activities - but there was also more scope for them to be involved in making suggestions. They told us that they continued to get good support from each other and the manager. There continued to be a commitment by the provider to ensure that staff skills were continuously updated and developed, and staff told us they could request training specific to the needs of the people using the service. Staff were aware of the requirement for them to register with the Scottish Social Services Council, the body responsible for ensuring that people working in social care services were suitably qualified. A programme of Scottish Vocational Qualification (SVQ) Awards was in place for staff to complete the necessary qualifications for registration. Staff told us that they received regular one-to-one supervision with their line manager. This meant that they had regular opportunities to discuss their individual work practice, professional development and any other issues, and we heard of examples where practice issues had been raised with staff at supervision. Team meetings were held regularly and from the minutes we sampled we saw that a range of topics were discussed including health and safety and service user, practice and staff issues. To ensure that issues raised at previous meetings had been followed up an update was provided. We heard that senior support workers met before each team meeting to identify any issues for discussion with the staff team but that these meetings were not recorded. Notes of these meetings would provide good evidence of seniors' input into meetings and indeed how they took forward any issues identified by support workers. There continued to be a steady staff team in this service, many of whom had worked Daniel House, page 21 of 30

there for many years. This ensured consistency of care for the people who use the service. Areas for improvement As at the last inspection we found that night staff did not all attend team meetings. We discussed this again with the manager and suggest that attempts to encourage everyone's attendance at meetings continue as it is important for all staff to discuss issues and keep up to date with developments in the service. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0 Inspection report continued Daniel House, page 22 of 30

Quality Theme 4: Quality of Management and Leadership Grade awarded for this theme: 5 - Very Good Statement 1 We ensure that service users and carers participate in assessing and improving the quality of the management and leadership of the service. Service strengths We found that this service was very good at involving the people who use it in having their say on how the service was developed. We decided this after talking with people who use the service, staff and managers and looking at supporting documentation. Some of the strengths for this statement are included under Quality Theme 1, Statement 1. In particular we saw that as a result of feedback from a relative the service had arranged and invited families to social events. One relative commented in the family questionnaire that they were kept informed of the service and future plans via newsletters, review meetings and social gatherings. We saw that the Director had sent a letter to families to update them on the outcomes of the Self Directed Support process. Carers were asked for their views on management in the service's family questionnaires and invited to grade all areas of the service to include in the self assessment the manager submitted to the Care Inspectorate before this inspection. We saw that one carer had graded management as 'very good' and four had graded management as 'excellent'. People who use this service and their relatives were invited and encouraged to take part in this inspection. The manager was well known in the service by people living there and their families. Relatives we spoke to told us they found the manager approachable and that they would not hesitate to contact her if they had any concerns. Areas for improvement The areas for improvement under Quality Theme 1, Statement 1 also apply here. Daniel House, page 23 of 30

Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0 Inspection report continued Daniel House, page 24 of 30

Statement 4 We use quality assurance systems and processes which involve service users, carers, staff and stakeholders to assess the quality of service we provide Service strengths Inspection report continued We found that performance by this service was very good in this area. We decided this after talking with people who use the service, managers and staff and looking at evidence relating to how the service monitored and audited quality. We could see that the service used a range of approaches to monitor how the service was performing and to identify areas where improvements could be made. This helped to ensure that staff provided a good quality of service: The participation methods such as service user meetings, reviews, questionnaires and forums as well as Staff Recognition Awards described elsewhere in this report gave opportunities for people who use the service and their relatives to give their views on all areas of the service. The responses from family questionnaires were used to inform the self assessment we ask services to submit to us before each inspection. As at the last inspection regular staff meetings gave staff opportunities to be involved in the development of the service and to have their say on how it could be improved. Staff had been involved in discussions about how the service would develop following the introduction of Self Directed Support and the Personalisation process described elsewhere in this report. They told us that there were now more opportunities for them to make suggestions about possible activities people might enjoy. Senior support workers continued to work alongside support workers and monitor staff practice and the running of the service on a day to day basis. Care plan evaluation sheets were used to record if any information was missing or had been changed in care plans. This meant that all staff were made aware of changes. Staff supervision notes were monitored externally by a Director to ensure that any actions identified were completed. The regular checks and audits we reported under Quality Theme 2, Statement 2 ensured that the environment was safe. Accidents and incidents continued to be monitored by the manager and reported to the Board of Directors. The service was externally monitored by the Board of Directors. The manager continued to feed back the outcomes from monitoring and auditing systems to the director and prepare a monthly report for the Board so that they were kept up to date with developments in the service. Mainstay, the provider, has been awarded the Investors in People Bronze Award. Daniel House, page 25 of 30

We spoke briefly to a visiting health professional during the inspection who spoke highly of the service. From the evidence we have seen at this inspection and in talking to the manager and staff we can see that there is a commitment to providing a service that ensures that people continue to receive as good a quality of experience as possible. Areas for improvement At the last inspection we made a recommendation that the manager should develop a continuous improvement plan for this service which should reflect the findings of all quality assurance processes. This would be a good way of showing how stakeholders contributed to helping the service to improve. As this had not yet been developed we have repeated the recommendation here. (See Recommendation 1 under this statement) As at the last inspection we thought the service could do more to give other stakeholders such as visiting professionals the opportunity to comment on the service. We asked the manager to submit an application to the Care Inspectorate to vary the conditions of their registration to reflect changes to the shift times on their staffing schedule and this has now been done. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 1 Recommendations 1. The manager should develop a continuous improvement plan which reflects the findings of quality assurance processes and the involvement of stakeholders (including residents, carers, staff and external agencies) from participation and feedback methods such as complaints, meetings, forums and questionnaire responses. National Care Standards, Care homes for people with learning disabilities, Standard 5: Management and staffing arrangements Daniel House, page 26 of 30

4 Other information Complaints No complaints have been upheld, or partially upheld, since the last inspection. Enforcements We have taken no enforcement action against this care service since the last inspection. Additional Information Action Plan Failure to submit an appropriate action plan within the required timescale, including any agreed extension, where requirements and recommendations have been made, will result in the Care Inspectorate re-grading a Quality Statement within the Quality of Management and Leadership Theme (or for childminders, Quality of Staffing Theme) as unsatisfactory (1). This will result in the Quality Theme being re-graded as unsatisfactory (1). Daniel House, page 27 of 30

5 Summary of grades Quality of Care and Support - 5 - Very Good Statement 1 Statement 3 5 - Very Good 5 - Very Good Quality of Environment - 5 - Very Good Statement 1 Statement 2 5 - Very Good 5 - Very Good Quality of Staffing - 5 - Very Good Statement 1 Statement 3 5 - Very Good 5 - Very Good Quality of Management and Leadership - 5 - Very Good Statement 1 Statement 4 5 - Very Good 5 - Very Good 6 Inspection and grading history Date Type Gradings 19 Jun 2013 Unannounced Care and support 5 - Very Good Environment 5 - Very Good Staffing 4 - Good Management and Leadership 5 - Very Good 11 May 2012 Unannounced Care and support 5 - Very Good Environment 5 - Very Good Staffing 5 - Very Good Management and Leadership 5 - Very Good 3 Dec 2010 Unannounced Care and support Not Assessed Environment 4 - Good Staffing Not Assessed Management and Leadership Not Assessed Daniel House, page 28 of 30

28 Jul 2010 Announced Care and support 5 - Very Good Environment 4 - Good Staffing Not Assessed Management and Leadership Not Assessed 12 Jan 2010 Unannounced Care and support 4 - Good Environment 3 - Adequate Staffing 4 - Good Management and Leadership Not Assessed 4 May 2009 Announced Care and support 4 - Good Environment 3 - Adequate Staffing 4 - Good Management and Leadership 4 - Good 17 Nov 2008 Unannounced Care and support 4 - Good Environment 3 - Adequate Staffing 4 - Good Management and Leadership Not Assessed 19 Jun 2008 Announced Care and support 4 - Good Environment 3 - Adequate Staffing 4 - Good Management and Leadership 4 - Good All inspections and grades before 1 April 2011 are those reported by the former regulator of care services, the Care Commission. Daniel House, page 29 of 30

To find out more about our inspections and inspection reports Read our leaflet 'How we inspect'. You can download it from our website or ask us to send you a copy by telephoning us on 0845 600 9527. This inspection report is published by the Care Inspectorate. You can get more copies of this report and others by downloading it from our website: www.careinspectorate.com or by telephoning 0845 600 9527. Translations and alternative formats This inspection report is available in other languages and formats on request. Telephone: 0845 600 9527 Email: enquiries@careinspectorate.com Web: www.careinspectorate.com Daniel House, page 30 of 30