M and J (Marie and Janos) Care & Support at Home Housing ...

M and J (Marie and Janos) Care &Support at HomeHousing Support ServiceLeven Valley Enterprise CentreCastlehill RoadDumbartonG82 5BN

Inspected by: Colin McCracken

Tony Valbonesi

Type of inspection: Announced (Short Notice)

Inspection completed on: 14 February 2014

ContentsPage No

Summary 31 About the service we inspected 52 How we inspected this service 73 The inspection 144 Other information 275 Summary of grades 286 Inspection and grading history 28

Service provided by:Progressive Care & Support Limited

Service provider number:SP2011011509

Care service number:CS2011285423

Contact details for the inspector who inspected this service:Colin McCrackenTelephone 0141 843 6840Email [email protected]

Inspection report continued

M and J (Marie and Janos) Care & Support at Home, page 2 of 29

SummaryThis report and grades represent our assessment of the quality of the areas ofperformance which were examined during this inspection.

Grades for this care service may change after this inspection following otherregulatory activity. For example, if we have to take enforcement action to make theservice improve, or if we investigate and agree with a complaint someone makesabout the service.

We gave the service these grades

Quality of Care and Support 3 Adequate

Quality of Staffing 3 Adequate

Quality of Management and Leadership 3 Adequate

What the service does wellThe service provides a support service to people in rural communities which helpthem to remain living in their own homes.

What the service could do betterThe service has introduced large risk assessment into the care planning process sincethe last inspection. However these did not include much in the way of analysis andwere not focused around the service that staff were being asked to provide. Theservice should look to develop their risk assessments so that they guide staff whenassisting individuals with the agreed support.

What the service has done since the last inspectionThe service has reviewed its management structures so that the various managerswithin the service are clear about their roles and responsibilities. At the lastinspection these were not clear and many of the problems identified in the last reportstemmed from this. The service has improved as a result.

ConclusionThe service has made steady progress since the last inspection. It continues to behighly thought of by the people who use the support but it is now better organisedand as a result people are receiving more consistency in the care that they receive.There were 11 recommendations made in the last inspection report, only one remainsoutstanding.



Who did this inspectionColin McCrackenTony Valbonesi



1 About the service we inspectedThe Care Inspectorate regulates care services in Scotland. Information about all careservices is available on our website at www.careinspectorate.com

Requirements and recommendations

If we are concerned about some aspect of a service, or think it could do more toimprove its service, we may make a recommendation or requirement.

A recommendation is a statement that sets out actions the care service providershould take to improve or develop the quality of the service but where failure to do sowill not result in enforcement. Recommendations are based on the National CareStandards, relevant codes of practice and recognised good practice.

A requirement is a statement which sets out what is required of a care service tocomply with the Public Services Reform (Scotland) Act 2010 and Regulations or Ordersmade under the Act or a condition of registration. Where there are breaches of theRegulations, Orders or conditions, a requirement must be made. Requirements arelegally enforceable at the discretion of the Care Inspectorate.

M and J (Marie and Janos Nagy) Care and Support at Home was registered with theCare Inspectorate on 30 March 2012 to provide a combined Housing Support and Careat Home service. The service is offered to a wide range of people with varying needs.

The aims and objectives of the service include: "to provide care and support forpeople to live as independently as possible within the community in ways that reflecttheir choices and to help realise lifestyles which are meaningful and fulfilling to thoseconcerned."



Based on the findings of this inspection this service has been awarded the followinggrades:

Quality of Care and Support - Grade 3 - AdequateQuality of Staffing - Grade 3 - AdequateQuality of Management and Leadership - Grade 3 - Adequate

This report and grades represent our assessment of the quality of the areas ofperformance which were examined during this inspection.

Grades for this care service may change following other regulatory activity. You canfind the most up-to-date grades for this service by visiting our websitewww.careinspectorate.com or by calling us on 0845 600 9527 or visiting one of ouroffices.



2 How we inspected this service

The level of inspection we carried outIn this service we carried out a medium intensity inspection. We carry out theseinspections where we have assessed the service may need a more intense inspection.

What we did during the inspectionThe inspection was carried out by two Inspectors; Colin McCracken and TonyValbonesi. The inspection was announced at short notice, by this we mean we gavethe manager 48 hours notice that we were going to carry out the inspection. Theinspection took place over 2 days; between the hours of 10a.m. and 5.30p.m. on the12 of February and from 10a.m. till 3p.m. on the 14 of February 2014. Feedback wasgiven to the manager at the end of the second day of the inspection.

Prior to the last inspection we sent out Care Standards questionnaires to the serviceto pass out to service users. We also sent out staff questionnaires. These giveindividuals the chance to contribute to the inspection and to do so anonymously ifthey wish. The feedback from these was generally positive although they did highlightthat in certain areas there were issues around the number of different carers whosupported individuals and the time keeping of the support visits. At this inspection wevisited 6 people who use the service who lived in the areas which had previouslybeen identified as being problematic in terms of these two issues.

As this was the second inspection of the service in the last 6 months the focus wason the recommendations and requirements placed on the service in the lastinspection report. This is available on-line or copies can be sent out to individuals bycontacting the Care Inspectorate office on 0141 843 6840.

During the inspection we had individual discussions with a range of people including:

- The registered manager- The co-ordination manager- The training manager- The co-ordinator for the Clydebank region- Contract compliance officers for 2 different local authorities- 6 service users- 2 relatives



We also carried out a review of a range of policies, procedures, records and otherdocumentation, including the following;

- Care plans- The service's incident and accident book- Service information pack- Provider's aims and objectives- Newsletters- Welcome Pack- Employee Induction procedure- Staff meetings- Staff personnel files- Supervision minutes- Complaints folder- Training records- Medication policy- Questionnaires and the service's evaluation of them.

Grading the service against quality themes and statementsWe 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'. Undereach quality theme are 'quality statements' which describe what a service should bedoing well for that theme. We grade how the service performs against the qualitythemes and statements.

Details of what we found are in Section 3: The inspection

Inspection Focus Areas (IFAs)In any year we may decide on specific aspects of care to focus on during ourinspections. These are extra checks we make on top of all the normal ones we makeduring inspection. We do this to gather information about the quality of these aspectsof care on a national basis. Where we have examined an inspection focus area we willclearly identify it under the relevant quality statement.

Fire safety issuesWe do not regulate fire safety. Local fire and rescue services are responsible forchecking services. However, where significant fire safety issues become apparent, wewill alert the relevant fire and rescue services so they may consider what action totake. You can find out more about care services' responsibilities for fire safety atwww.firelawscotland.org



What the service has done to meet any requirements we made atour last inspection

The requirementIndividual care plans must be in place for children who are being supported. Thesemust include risk assessments where necessary.

What the service did to meet the requirementThis is detailed under statement 1.3

The requirement is: Met - Within Timescales

The requirementAll service users' care plans should be reviewed on a 6 monthly basis. The service usershould be fully involved in this review. The Social Care and Social Work ImprovementScotland (Requirements for Care Services) Regulations 2011 Regulation 5 - PersonalPlans. Timescale - Immediately on receipt of this report.



The requirementThe service must ensure that all staff have the qualifications, skills and worknecessary for the work they are to perform. This must include child protection trainingfor staff prior to them working with children.



The requirementThe provider must put in place Individual care plans for all service users, includingchildren who are being supported. These must include comprehensive risk



assessments. This is to comply with, SSI 2011/1210 Regulation 4(1) (a) Welfare ofusers and SSI 2011/1210 Regulation5(1) - Personal Plans Timescale: within one monthof publication of this report



The requirementThe provider must ensure that at all times there are sufficient numbers of staff toprovide the required standard of care and support to people who use the service. SSI2011/210 Regulation 15(a) - Staffing Timescale: within one month of publication ofthis report



The requirementThe provider must review all service users' care planson a minimum 6 monthlybasiswith the service user and carers, where appropriate, fully involved in this reviewprocess. SSI 2011/1210 Regulation 5(2)(b) - Personal Plans Timescale: withinsixmonths of publication of this report



The requirementThe provider must ensure that all staff have the qualifications, skills and worknecessary for the work they are to perform. To address this, the provider must,

• put in place an annual staff training plan based on a robust training needsanalysis

• ensure that staff receive all mandatory, role specific and refresher training



• ensure that staff receive training that enables staff to meet the needs of theresident group, for instance those with diagnosis of dementia or present withchallenging behaviour

• ensure that staff receive regular evaluation of staff training and practice• ensure that staff receive appropriate training in Adult, Support and Protection

and Child Protection

The Social Care and Social Work Improvement Scotland (Requirements for Careservices) Regulations 2011 (SSI 2011/210) Regulation 4(1)(a) - Welfare of usersRegulation 15(a) and (b)(i) and (ii)- Staffing Timescale:within one month ofpublication of this report



The requirementThe provider must ensure that the management structures and practices aresufficiently fit to meet the aims and objectives of the service. To do this, the providermust,

• consider with the management team the reasons why they are feelingdemoralised and over-worked and provide the necessary resources andsupport to ensure appropriate management and leadership of the service.

• ensure the management team have clear roles and responsibilities to enablethem to carry out their duties more efficiently

• provide members of the management team with regular formal supervision oftheir work

• introduce regular minuted management meetings,with plans of action fromissues discussed

• ensure that the service manager has the necessary skills and leadershipqualities to lead the team and ensure the welfare and safety of people usingthe service

SSI 2011/210 Regulation 7(1) and (2) - Fitness of Managers. In making thisrequirement, we have also taken into account, NCS 4 Care at Home - Managementand Staffing Timescale: within one month of publication of this report





The requirementThe provider must ensure that the quality of the service provided is fully assessedwith robust monitoring systems put in place to check standards of practice. Thisshould include key areas such as medication management, incidents and accidents,support plan record keeping and staff training. SSI 2011/210 Regulation 4(1) - Welfareof Service Users Timescale: within one month of publication of this report



What the service has done to meet any recommendations we madeat our last inspectionThis report has focused on the recommendations and requirements made in the lastinspection report. The feedback on the work the service has done to meet the variousrecommendations is included under each statement in the body of the report.

The annual returnEvery year all care services must complete an 'annual return' form to make sure theinformation we hold is up to date. We also use annual returns to decide how we willinspect the service.Annual Return Received: Yes - Electronic

Comments on Self AssessmentEvery year all care services must complete a 'self assessment' form telling us howtheir service is performing. We check to make sure this assessment is accurate.

The Care inspectorate received a fully completed self-assessment document from theprovider prior to the last inspection, we only require the provider to submit this once ayear therefore as this is a second inspection the service was under no expectation tosend us a self assessment prior to this inspection.

The service should consider prior to submitting their next self-assessment how theycan involve service users and staff in the process. The self assessment should alsofeature what the outcomes have been for people using their service under eachstatement.



Taking the views of people using the care service into accountWe visited 6 people who use this service, they were all positive about the quality ofthe service they received. Their comments are included in the body of the report.

Taking carers' views into accountWe were able to speak with two relatives during this inspection, they were positiveabout the service. Their comments are included in the report.



3 The inspectionWe looked at how the service performs against the following quality themes andstatements. Here are the details of what we found.

Quality Theme 1: Quality of Care and SupportGrade awarded for this theme: 3 - Adequate

Statement 1We ensure that service users and carers participate in assessing and improving thequality of the care and support provided by the service.

Service strengthsThe service was adequate at involving people who use the service in the assessmentand development of the service which they receive. We arrived at this conclusion afterconsidering the following information:

- Personal care plans- Records of meetings with the people who use the service- The returned questionnaires that the service sent out to service users

and the service's analysis of them.- Interviews with service users- Service user information pack- Participation strategy

There was one recommendation made under this statement at the last inspection.This was that the management should ensure that common issues are identified fromparticipation methods and action plans are put in place to address these and theplans should be shared with service users. The service did this by sending outquestionnaires to service users which it then analysed and created an action planfrom the points raised. The service identified that not all service users had the newservice user guide and they plan to rectify this over the next few weeks.

During the inspection we spoke with people who use the service, what they told us inrelation to this statement included:

- "We get questionnaires from them every 2-3 months."



- "I've got the new service booklet which talks about the complaints procedure."- "If I say 'could you do this..' I know they will do it."

Areas for improvementThe service has developed a new style of care plan to be introduced to people whouse the service. This has still not been rolled out across the service.

The management team need to ensure that all service users receive the new serviceuser guide.

The serviced compiled the questionnaires that they received back from service usersand created an action plan to address the points raised, as mentioned above; theyhave still to share this plan with the people who use the service. It is very importantthat services provide feedback to people who have taken the time to returnquestionnaires; it values their efforts and makes it more likely that they will want toparticipate in the development of the service in the future.

Grade awarded for this statement: 3 - Adequate

Number of requirements: 0

Number of recommendations: 0



Statement 3We ensure that service users' health and wellbeing needs are met.

Service strengthsThe service was adequate at ensuring service user's health and wellbeing needs weremet. We arrived at this conclusion after considering the following information:

- Care plans- Medication policy- Risk assessments- Interviews with service users- Interviews with relatives- Medication policy- Incidents and Accident folders

We could see that the health and wellbeing of those using the service was givenappropriate priority. Staff have training on; moving and assistance and personal care,management told us that additional training would be sourced if a service user'ssupport needs required it.

The provider had put in place individual care plans for service users including thechildren it supported. These included basic health care needs. This meets therequirement made against this statement in the last inspection report.

The provider has held several rounds of recruitment since the last inspection whichhas resulted in them having more staff at their disposal to provide care to serviceusers. We sampled staff rotas and recruitment files to evidence that this had takenplace. This meets the requirement made against this statement in the last inspectionreport.

The service has a new computer system which alerts the management one monthbefore service users are due a care review, this is to allow managers to send outinvitations for the review. People we spoke with all mentioned that they have hadregular review meetings. This meets the requirement made against this statement inthe last inspection report. The system also alerts management a week before serviceusers birthdays so that they can send them a birthday card.

The provider has reviewed the medication policy since the last inspection which isnow in line with best practice guidance. Staff have been trained on the new policy.This meets the recommendation made against this statement in the last inspectionreport.

The management identified that the Dumbarton and Helensburgh area was too big ageographical area to be covered by the one team, which it was previously. This lead to



time pressures on staff because of the travel time between the people they weresupporting. Therefore a decision was made to create separate teams for both areas toreduce the travel time. This has been successful according to management. Wetargeted this area to visit 6 service users, all of whom said that time keeping andconsistency of the carers providing their support had improved since the lastinspection. This meets the recommendation made against this statement in the lastinspection report.

Since the last inspection report the service has sent service users weekly staffrotas to alert them in advance which staff to expect. The service users we spoke withconfirmed they received a rota and if there were ever any changes to this someonewould phone to tell them. This meets the recommendation made against thisstatement in the last inspection report.

The service users that we spoke to during the inspection told us in relation to thisstatement;

- "They (the council) have tried to cut my hours but a worker from M&J comes to themeetings and explains that this is not possible."

- "There is one girl who comes in regularly, if I get a new worker it's always a regularworker who will bring them in and tell them what to do."

- "We get better consistency and continuity now."

- "I'm happy I've got a core team of workers now, this has made a big difference."

- "I get my rota in advance and I'm told if there are any changes."

- "If they think there is a problem they will say."

Areas for improvementThe risk assessments that we saw within care plans were completed in a formatwhich encouraged staff to tick boxes rather than detail what the actual risks were forboth service users and staff. We also believe that the risk assessments would beimproved if they were shortened and focused on the actual support that they arebeing asked to provide. (See recommendation one under this statement.)






Recommendations

1. The management team should review the risk assessments that they carry out withservice users to ensure that they are person centred and focused on thesupport staff are being asked to provide.

This is a recommendation against the National Care Standards, Housing SupportServices - Standard 4, Housing Support Planning.



Quality Theme 3: Quality of StaffingGrade awarded for this theme: 3 - Adequate

Statement 1We ensure that service users and carers participate in assessing and improving thequality of staffing in the service.

Service strengthsThe service was adequate at involving people who use the service in assessing andimproving the quality of staffing within the service. We considered the followinginformation in grading this statement:

- Staff training- Interviews with service users- Interviews with staff

All the people who use the service that we spoke with were very positive about thequality of staffing within the service. The same is true for the relatives that we spokewith. Comments made from service users included:

- "I like the consistency I get."- "Recently I've been getting a rota with the same girls on it every day."- "They are occasionally late but you get a phone call."

Areas for improvementAt the last inspection we made a recommendation under this statement that theservice develops suitable ways to involve carers in the selection and recruitment ofstaff. The management team told us that they hadn't pursued this as they thoughtthat service users would not be interested in being involved in this. Thisrecommendation will be re-iterated in this report as we believe that the managementteam need to consider all the ways that service users maybe involved in staffrecruitment. Other similar sized services have managed to involve service users instaff recruitment either; directly in interview panels or recruitment fares, or indirectlyby suggesting questions to be put forward at interviews or by helping to create jobdescriptions. People can be asked these questions at reviews so it is about utilisingthe contact that the service already has with service users it does notnecessarily require more resources. (see recommendation one under this statement.)



The management team should also consider how service users views about staffcould be captured in staff annual appraisals. This is important as a good appraisalneeds to consider the views of the people who are receiving the support from staff.




Recommendations

1. Suitable ways should be developed and introduced to involve service users andcarers in the selection and recruitment of staff.

This is a recommendation made against the national care standards, Care at home,Standard 11, Expressing your views.



Statement 3We have a professional, trained and motivated workforce which operates to NationalCare Standards, legislation and best practice.

Service strengthsWe found the service's performance in the areas covered by this statement wasadequate. We concluded this after considering the following:

- Interviews with management/staff/service users and relatives- Staff induction procedure- Samples of staff supervision and appraisal minutes- Staff meeting minutes

At the last inspection we made a requirement that the service ensure staff have thequalifications, skills necessary for the work they are to perform. Since then the servicehas created an annual training plan for staff, extended the induction for new staff to5 days to help better prepare new staff for the work they will be undertaking and theyhave also created a training room within their office space to allow better facilities forthe training manager to train staff. (This meets the requirement made against thisstatement in the last inspection report.)

We interviewed the training manager who stated that she was able to focus herattentions on recruitment and staff training which is an improvement from the lastinspection where there were other tasks competing for her attention.

Around 85% of staff have undergone adult support and protection training, theservice should look at how all staff can be put through this training as well as childprotection; while most staff may not be supporting children they may well come intocontact with children who are in visiting their relatives when staff turn up to providetheir care.

Since the last inspection the service has increased the amount of staff andsupervision meetings which take place. This meets the recommendation made underthis statement at the last inspection.

Service users that we spoke to told us in relation to this statement:

- "The girls are awfully good, very obliging."- "You can tell the ones who are well-trained. They always pay close attention to

hygiene and treat me with respect."- "The girls do as much as they can with the time they have."- "All the staff are good."- "The staff are pleasant and cheerful."



One of the relative we spoke with described the staff as " friendly with good banter."

Areas for improvementThe service should ensure that it continues to hold regular supervision and appraisalmeetings with staff.

The management team should ensure that it involves staff in the completion of theirself assessment which they complete prior to their inspection.






Quality Theme 4: Quality of Management and LeadershipGrade awarded for this theme: 3 - Adequate

Statement 1We ensure that service users and carers participate in assessing and improving thequality of the management and leadership of the service.

Service strengthsThe service was adequate at ensuring that service users and carers participated inassessing and improving the quality of management and leadership of the service. Weconsidered the following information in grading this statement:

- Discussions with service users- Interviews with management and staff- Returned questionnaires- Provider's complaints brochure- Complaints information

The service has reviewed and updated their service user guide document to includetheir own complaints procedure along with the care inspectorate contact details. Theservice has used service user surveys to check whether people have an awareness oftheir complaints process. This meets the recommendation made under this statementin the last inspection report.

We made a recommendation that the management team follow-up complaintsappropriately by ensuring that people who complain are satisfied of the outcome orare made aware of their right to appeal if they choose. The complaints file that wesampled evidenced that the manager had followed up complaint investigations withthe people who had made the complaints. Written replies were made to those whomade complaints within the timescales laid down by the providers policy. This meetsthe recommendation made under this statement in the last inspection report.

Service users that we spoke with told us in relation to this statement:

- "It's always the same manager I deal with. She comes to the meetings with socialwork and she has been out 2 or 3 times to check that the girls are doing everythingright."



- "I've no problem phoning the office they are well-managed."

Relatives that we spoke with said in relation to this statement;

- "We get good communication with the office, they have never let us down."

Areas for improvementWhile the service had updated its service user handbook to include the provider'scomplaints policy several of the service users we visited did not have the newhandbook within their houses. The management team should ensure that this isdistributed to all service users .






Statement 4We use quality assurance systems and processes which involve service users, carers,staff and stakeholders to assess the quality of service we provide

Service strengthsThe service was adequate in relation to this statement. We considered the followinginformation in grading this statement:

- Quality assurance systems- Minutes of management meetings- Complaints information- Training information- Feedback from two different local authorities contract compliance officers

We held individual discussions with the management team as at the last inspection itwas highlighted that morale was low amongst them partly because theybelieved their roles and responsibilities were not clearly defined. All of the managersthat we spoke with sounded more positive than they had done at the last inspectionand it was clear that following the last inspection a lot of work had been put intoreorganising the different roles and responsibilities managers had.

We found that each manager had a specific area that they oversaw and the trainingmanager was able to now concentrate on recruitment and training. The registeredmanager has also provided the other managers with regular supervision meetings.(This meets the first requirement made under this statement at the last inspection)

We also made a requirement around ensuring that the service is fully accessed withrobust monitoring systems in place to check standards of practice. We found evidencethat the service has improved in this area. Service users confirmed that managerscalled them or visited them to check that the support workers were doing what theywere meant to be doing. We viewed spot check lists which showed that managershad visited service users and asked questions around the quality of the serviceprovided.

The provider has purchased a new electronic monitoring system which alertsmanagement when staff enter and leave a service users home. This is done throughthe phone line. Several of the service users that we spoke with said that staff clockedin and out of their homes. The computer system also will alert management whentraining is due, and when reviews are due. (We assessed the second requirementmade under this statement at the last inspection to have been met.)

We spoke with two local authority contract compliance officers from 2 differentcouncil who both confirmed that they had been involved in meetings with themanagement team following the last inspection. Both were satisfied that the service



appeared to be better organised than it had been and that feedback from their owncare managers and internal complaints procedures indicated that satisfaction levelshad risen since the last inspection was completed. (The first recommendation madeunder this statement at the last inspection was deemed to be met.)

The provider has reviewed all of their policies since the last inspection liking them tobest practice guidance. We viewed the medication and induction policy to confirmthis. (This meets the second recommendation made under this statement at the lastinspection.)

Areas for improvementWhile supervision had improved for the rest of the management team the registeredmanager has not been able to have formal supervision since the last inspection as theowner who provided this in the past is currently living abroad. We acknowledge thatthe manager said he had phone conversations with the owner but best practicewould be that the manager should still have someone who they can meet with in aformal capacity who is qualified to provide their supervision. (See recommendationone under this statement.)




Recommendations

1. The provider should ensure that the registered manager is offered the support offormal supervision on a regular basis.

This is a recommendation under the National Care Standards, Housing SupportServices, Standard 3, Management and Leadership.



4 Other information

ComplaintsNo complaints have been upheld, or partially upheld, since the last inspection.

EnforcementsWe have taken no enforcement action against this care service since the lastinspection.

Additional InformationN/A

Action PlanFailure to submit an appropriate action plan within the required timescale, includingany agreed extension, where requirements and recommendations have been made,will result in the Care Inspectorate re-grading a Quality Statement within the Qualityof Management and Leadership Theme (or for childminders, Quality of StaffingTheme) as unsatisfactory (1). This will result in the Quality Theme being re-graded asunsatisfactory (1).



5 Summary of grades

Quality of Care and Support - 3 - Adequate

Statement 1 3 - Adequate


Quality of Staffing - 3 - Adequate



Quality of Management and Leadership - 3 - Adequate



6 Inspection and grading history

Date Type Gradings

19 Aug 2013 Announced (ShortNotice)

Care and support 2 - WeakStaffing 2 - WeakManagement and Leadership 2 - Weak

3 Aug 2012 Unannounced Care and support 4 - GoodStaffing 4 - GoodManagement and Leadership 4 - Good

All inspections and grades before 1 April 2011 are those reported by the formerregulator of care services, the Care Commission.



To find out more about our inspections and inspection reportsRead our leaflet 'How we inspect'. You can download it from our website or ask us tosend you a copy by telephoning us on 0845 600 9527.

This inspection report is published by the Care Inspectorate. You can get more copiesof this report and others by downloading it from our website:www.careinspectorate.com or by telephoning 0845 600 9527.

Translations and alternative formatsThis inspection report is available in other languages and formats on request.

Telephone: 0845 600 9527Email: [email protected]: www.careinspectorate.com



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