Inspection of Through Care Team, Housing Support Service by the Care Inspectorate 22 08 24
Renfrewshire Council · 22 August 2024
Back to Education and Children's Services Policy Board — 22 August 2024 and its agenda
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Page 1 of 5 To: Education and Children’s Services Policy Board On: 22 August 2024 ___________________________________________________________________ Report by: Director of Children’s Services ___________________________________________________________________ Heading: Inspection of Through Care Team, Housing Support Service by the Care Inspectorate ___________________________________________________________________ 1. Summary 1.1. Renfrewshire children’s services operates a Throughcare & Aftercare Service for care experienced young people. The housing support element of this service is subject to inspection by the Care Inspectorate on a regular basis. 1.2. The Care Inspectorate utilise a quality frameworks approach to evaluate the quality of care during inspections of registered care services. After an inspection the Care Inspectorate grades the service and promotes an improvement agenda. 1.3. The service inspected operates from 2 locations in Renfrewshire, a community-based support service from St James Street within office hours and a 24-hour, 7 day per week on site support service from Charleston Square. 1.4. The most recent inspection of the service was carried out by the Care Inspectorate in May 2024. The service was assessed as very good in the two areas considered during the inspection (how well do we support people’s well- being and how good is our leadership). A copy of the inspection report is attached at appendix 1. ___________________________________________________________________ 2. Recommendations 2.1. The Education and Children’s Services Policy Board is asked to note: [a] the outcome of the inspection of Through Care Team, Housing Support Service and celebrate the key strengths identified by the Care Inspectorate. ______________________________________________________________
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Page 2 of 5 3. Background 3.1 Social work and social care services are subject to a range of audit and scrutiny activities to ensure that they are undertaking all statutory duties and providing appropriate care and support to vulnerable individuals and groups. A number of social work and social care services are required to register with the Care Inspectorate. These registered services are subject to regular inspection by the Care Inspectorate. Typically, registered support services will be subject to one inspection per year which will be unannounced. 3.2 Inspectors use quality frameworks to evaluate the quality of care during inspections and improvement planning. The frameworks reflect the Health and Social Care Standards and provides transparency about what is expected. 3.3 The Care Inspectorate utilises the following gradings across each of the areas considered during each inspection: • Unsatisfactory – major weaknesses, urgent remedial action is required. • Weak – important weaknesses, priority action required. • Adequate – strengths just outweigh weaknesses. • Good – important strengths, with some areas for improvement. • Very good – major strengths. • Excellent – outstanding or sector leading. 3.4 The Care Inspectorate publishes the inspection reports on its website. In addition to awarding grades in each of the themes inspected, the Care Inspectorate can make a recommendation or put in place a requirement. A recommendation will set out an action that would improve or develop the quality of the service, but failure to meet a recommendation would not result in enforcement by the Care Inspectorate. Requirements are legally enforceable and set out what is required by a care service to comply with the Regulation of Care (Scotland) Act 2001 or with the conditions of registration. 3.5 Throughcare and Charleston Square registered service have a link inspector from the Care Inspectorate and explore an improvement agenda during the inspection and throughout the year. The manager from Charleston Square and the senior manager for our residential services lead this process by identifying where there are strengths in relation to the service and areas for improvement, share this with the link inspector and agree the annual improvement activity. ______________________________________________________________ 4. Recent inspection activity 4.1 Renfrewshire Council Through Care Team provides housing support to vulnerable young people across the Renfrewshire area. Accommodation and support are provided from two locations. Charleston Square is a purpose-built supported housing development in Paisley that has 10 self-contained flats. Charleston Square has support staff based on site 24 hours each day, 7 days per week, 52 weeks of the year. The housing support service operated by the outreach team at St. James Street, has access to a minimum of 10 satellite flats which can be offered to young people who are ready to live independently throughout Renfrewshire.
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Page 3 of 5 4.2 Renfrewshire Throughcare team & Housing Support Service was last inspected in August 2020, managers maintained a relationship and dialogue regarding the development of the service with the link Care Inspector since this time. 4.3 The Care Inspectorate made two requirements and three areas for improvement in relation the Throughcare team & Housing Support Service in August 2020. An action plan was developed and closely monitored by both internal and external managers following that inspection to the most recent. 4.5 The two requirements and three areas for improvement were reviewed as part of the most recent inspection with both requirements and areas of improvement being fully met since the last inspection. 4.6 Throughcare team & Housing Support Service was inspected in May 2024 with the final report being published in August 2024. The service has been evaluated as Very Good overall in both areas explored in the scope of this inspection (how well do we support people’s well-being and how good is our leadership). 4.7 The Care Inspectorate found that significant improvements and developments had been made within the Throughcare team & Housing Support Service since the last inspection. Areas of strength identified within the service were: • Young people experience warm and compassionate care and support. • The service understood diversity and encouraged young people to express themselves and voice their opinions. • Evidence of the effective management of risk & need, recognising all of the young people's needs including the needs of the most vulnerable. • Very positive outcomes for some young people, particularly in relation to their ability to manage risk. Some young people had turned their lives around and were excellent advocates for themselves and others. • The service had a progressive approach to risk management, and this was something we were pleased to observe 4.8 The Care Inspectorate did not make any requirements or identify any area of improvement at this time. The Service however, continues to be committed to an improvement agenda and continues in the journey of reflection, review, consultation, analysis and change. 4.9 The inspection considered how well we support people’s wellbeing and graded this as very good. The report details findings of significant strength in aspects of the care provided and how these have supported positive outcomes for young people. The inspector witnessed young people experience warm and compassionate care & support through positive relationships with access to a range of care and support when wanted or required. They noted a seismic shift in in both the approach and availability of support.
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Page 4 of 5 4.10 The report details that the service understood risk, diversity, rights of young people & advocacy and encouraged young people to express themselves and voice their opinions. The Inspection evidenced the voice of young people leading to action of management and staff with openness to adjusting support in response to individual need. 4.11 The Care Inspector highlighted that the support to young people was flexible and worked around their lives. For young people working or at college they had access to people in the evenings and staff sought to enable young people through the support they gave. 4.12 The development of the outreach Service managed by the manager and staff team at Charleston Square was established initially during the covid pandemic & developed significantly since then. This was recognised by the inspection, highlighting a sense of belonging, they found that that there was a wider community of young people who continued to be supported by Charleston Square and developed a community of support whilst living in their own homes. 4.13 Leadership within the Service was scrutinised as part of this inspection and graded as very good. The inspection found significant strength in the care provided and how these supported positive outcomes. Staff and managers were found to be committed to improvement and everyone spoke to was passionate about outcomes for young people, challenging systems & focussing on change for the better. 4.14 The inspection highlighted that within the service leaders had taken bold decisions about service design based on strong values of leaders and focus on the needs of young people with positive impact. 4:15 The inspection reports noted clear aims and objectives of the service and a positive culture of staff spending time exploring discussing outcomes for young people and reviewing the quality of approach and intervention. Managers were seen as reflective and critically analytical, recognising difficult decision making regarding the use of the resource but open and available to young people, listening to their views and explaining decisions. 4:16 This inspection found that the key driver to change in the service was positive outcomes for young people and a strong approach to corporate parenting was evident within the service. ___________________________________________________________________ Implications of this report 1. Financial None. 2. HR and Organisational Development None. 3. Community/Council Planning None.
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Page 5 of 5 4. Legal None. 5. Property/Assets None. 6. Information Technology None. 7. Equality and Human Rights The Recommendations contained within this report have been assessed in relation to their impact on equalities and human rights. No negative impacts on equality groups or potential for infringement of individuals’ human rights have been identified arising from the recommendations contained in the report. 8. Health and Safety None. 9. Procurement None. 10. Risk None. 11. Privacy Impact None. 12. Cosla Policy Position None. 13. Climate Risk None. 14. Children’s Rights There are no implications for children’s rights in this report. List of Background Papers (a) None ___________________________________________________________________ Children’s Services KS /JT 15 August 2024 Author: John Trainer. Head of Children and Justice Social Work/Chief Social Work Officer, 0300 300 0277, john.trainer@renfrewshire.gov.uk
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RRenfrenfrewshirewshire Council Thre Council Through Carough Care Te Teameam Housing Support Service 10 St. James Street Paisley PA3 2HT Telephone: 01414873010 Type of inspection: Unannounced Completed on: 28 May 2024 Service provided by: Service provider number: Renfrewshire Council SP2003003388 Service no: CS2005101044 Appendi Appendix 1
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About the service Renfrewshire Council Through Care Team provides housing support to vulnerable young people in the Renfrewshire area. Accommodation and support are provided in two locations. Charleston Square is a purpose-built supported housing development in Paisley that has 10 self-contained flats. Charleston Square has support spaces and a large garden that offers space for relaxation. The housing support service operated by the outreach team at St. James Street, has access to 10 satellite flats which can be offered to young people who are ready to live independently. About the inspection This was an unannounced inspection which took place on 13 May 2024, 14 May 2024, 16 May 2024, 20 May 2024 and 21 May 2024. The inspection was carried out by one inspector from the Care Inspectorate. To prepare for the inspection we reviewed information about this service. This included previous inspection findings, registration information, information submitted by the service and intelligence gathered since the last inspection. In making our evaluations of the service we: • spoke with young people using the service • spoke with staff and management • observed practice and daily life • reviewed documents • spoke with visiting professionals. Inspection rInspection reporteport Inspection report for Renfrewshire Council Through Care Team page 2 of 11
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Key messages • We saw young people experiencing warm and compassionate care and support. • The service understood diversity and encouraged young people to express themselves and voice their opinions. • There had been times when the young people had not felt safe and we reviewed these incidents. Whilst the response from managers was not as quick as some staff and young people desired, we understood the need to counterbalance all of the young people's needs including the needs of the most vulnerable. • There were very positive outcomes for some young people, particularly in relation to their ability to manage risk. Some young people had turned their lives around and were excellent advocates for themselves and others. • The service had a progressive approach to risk management, and this was something we were pleased to observe. From this inspection we evaluated this service as: In evaluating quality, we use a six point scale where 1 is unsatisfactory and 6 is excellent How well do we support people's wellbeing? 5 - Very Good How good is our leadership? 5 - Very Good Further details on the particular areas inspected are provided at the end of this report. Inspection rInspection reporteport Inspection report for Renfrewshire Council Through Care Team page 3 of 11
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How well do we support people's wellbeing? 5 - Very Good We found significant strengths in aspects of the care provided and how these supported positive outcomes for young people, therefore we evaluated this key question as very good. We saw young people experiencing warm and compassionate care and support. There were positive relationships between young people and staff and if young people wanted the support, it was there for them. In the time since we last inspected this service, we observed a seismic shift in the approach to supporting young people and the availability of support to young people. The young people we spoke with felt respected and understood. They didn't always agree with the view of staff or want the intervention of staff but if they declined support there was always an opportunity to pick this up again. We were impressed with the outreach support from Charleston Square and the approach from the throughcare team to support young people for as long as they needed it. It meant that young people continued to have the support of their corporate parent well into their twenties. The service understood diversity and encouraged young people to express themselves and voice their opinions. When things were not working for young people, they spoke up and had access to managers. The approach from managers was to find ways to help young people. During our inspection we saw examples of the voice of young people leading to action and staff being open to adjusting their support to what young people needed. There was a sense of belonging within the service. We were heartened by the community impact and how young people in their own houses engaged with each other as part of a smaller community. We also found that that there was a wider community of young people who continued to be supported by Charleston Square and came back for dinner time and special events. The rights of young people were clearly understood and staff amplified these if young people were unable to do so themselves. We found a passionate staff group who were hugely committed to young people, who stuck by them and attempted to improve their outcomes. Advocacy was a central foundation of the approach by staff. If young people were not getting something that they needed, people across the organisation worked together to find solutions. This meant that young people benefitted from an organisational focus on improving outcomes. There had been times where the young people had not felt safe and we reviewed these incidents. Whilst the response from managers was sometimes not as quick as staff and young people desired, we understood the need to counterbalance all of the young people's needs including the needs of the most vulnerable. We found that risk assessments were regularly analysed through a lens of the impact on the greater good and when necessary, actions were taken focused on protection. This meant that there was regular reflection, analysis and consideration in the midst of difficulties. This oversight and critical review assured us that there was always an ongoing review of the safety of everyone. Young people had access to tailored support. The aims and objectives of the service had progressed significantly since our last inspection to reflect the support more clearly but also to have a more direct impact upon young people. If young people didn't want the support, it was not enforced upon them but there were always staff available if young people needed help. Inspection rInspection reporteport Inspection report for Renfrewshire Council Through Care Team page 4 of 11
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The staff were proactive in accessing young people in their own homes, which was an improvement since the previous inspection. The willingness to go to young people as opposed to waiting for them to seek staff out was a significant progression in helping people. The group setting had shifted from historically feeling like group care to being individualised flats with access to communal areas and individually tailored support by staff. Young people were enabled to develop their skills and interests. We found some very positive developments for young people based on the supports being provided and the opportunities given. If young people had an interest and it could be used to build functioning, skill or promote education and employment then the staff were creative and encouraging in making this happen. Staff used their resources wisely and found ways to create opportunities for young people despite significant pressure on resources at times. There were times where young people were frustrated by the actions of their neighbours and found any damage to the communal environments disruptive. Any damage was repaired, and the staff and managers were present to support young people when this occurred. Most importantly there was clear thresholds for the young adults and when risk reached a certain level action was taken. However, we also understood the need to balance the needs of everyone and to understand everyone's welfare and safety through a trauma informed lens. This was something that we found the staff and managers did well. The support to young people was flexible and worked around their lives. For young people working or at college they had access to people in the evenings. The staff sought to enable young people through the support they gave. Whilst nothing could be enforced the staff worked hard to build relationships from which they could begin to encourage positive decision making and help young people unlock their potential. We found that everyone was committed to keeping people safe. There were examples of where the staff had prevented young people from being seriously harmed through their own actions. Staff and managers had a very good understanding of trauma, and this lens allowed them to empathise with young people and adjust their care to meet individual needs. At times young people were at risk of being exploited in the community but the reactions of staff addressed these concerns, ensured the police were quickly involved and meant young people were kept safe. When young people were at risk of being bullied or unhappy with the behaviour of others the staff and managers listened and acted. The focus was on protecting everyone but also ensure everyone got the help they needed. There were incredible outcomes for some young people, particularly in relation to their ability to manage risk. Some young people had turned their lives around and were excellent advocates for themselves and others. They were both empowered and supported by staff. Other young people had not made the progress that everyone would have wished but we found relationships between staff and young people were retained and this was a powerful contributor to future positive outcomes. The service had a progressive approach to risk management, and this was something we were pleased to observe. Young people were supported as individuals and as adults. This meant that they were treated as such. This enabled some young adults to test out life in its fulness but from a slightly safer space. We believe this nurtured independence and got young people more ready for the future. There was very good professional links to agencies across health. Young people were given opportunities to link with services and staff were knowledgeable about what could help each individual. The support young people received was led by them, whilst staff signposted and nurtured young people to make the best possible decisions ensuring they retained appropriate choice. The service as a whole understood that young Inspection rInspection reporteport Inspection report for Renfrewshire Council Through Care Team page 5 of 11
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people should have choice and advocated this strongly. For young people with significant health needs the staff were knowledgeable and responsive. They equipped themselves with the right learning to be able to support people alongside the external professionals. Much like in a family environment, staff were on hand to support young people to remember about appointments or to take them there. The need to develop independence was balanced with the need to always provide nurture. We were heartened by the approach to listening to young people. The consistent message we got back about the staff and managers was that they listened. If they had failed to do so initially staff revisited this and addressed issues. This had the biggest direct impact. The service had adjusted its approach to be more available to listen to young people, particularly in the midst of crisis or distress. Staff empathised and tried to understand young people, and this led to the development of strong relationships. There was young people whose outcomes remained a concern for everyone. We have encouraged the service to revisit these outcomes, to analyse the approach taken and to consider how they could have delivered the care and support differently. This would benefit from everyone involved in the care and support process being part of this discussion. We were very pleased to see the positive impact food was having at Charleston Square. The domestic staff had a wider positive impact on daily life by creating tasty meals and baking for the young people who lived there. It meant that the communal space was a nurturing one and young people in particular who were struggling had the offer of a nutritious meal once a day. This approach to nurture reflected a wider shift in culture with a longer-term focus on developing independence but in a compassionate and empathic way. How good is our leadership? 5 - Very Good We found significant strengths in aspects of the care provided and how these supported positive outcomes for young people, therefore we evaluated this key question as very good. Across the throughcare service we found staff and managers committed to improvement. Everyone we spoke with was passionate about outcomes for young people, about challenging system issues and focusing on change for the better. Within such a large system as this service we did not find that everyone agreed on the use of resources, or the decisions made at times. However, we were heartened by the advocacy available to young people and the willingness for people to have difficult conversations focused on improvement. It assured us that people were being heard and that there was a continual cycle of improvement. Within the service the leaders had taken bold decisions about service design and we were pleased to see the impact of this. These decisions were based on the strong values of leaders and the focus on the needs of young people. The aims and objectives clearly set out the functions that we observed in staff. Staff challenged decisions if they believed they were wrong and there was a positive culture of spending time discussing outcomes and reviewing the quality of approach. Whilst managers had oversight of audits, the staff had strong opinions and views about improvement. We saw people owning their professional values and prioritising the voice of young people. When outcomes for young people were poor the staff team were reflective about this. Staff had ideas about how things could be done differently. Managers were reflective and critically analytical. Whilst they had to make decisions at times that didn't please young people we saw a willingness to explain decisions to young people and to spend time hearing their views. Inspection rInspection reporteport Inspection report for Renfrewshire Council Through Care Team page 6 of 11
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The service had received complaints in the last year. Some of these had been addressed out with inspection but others were considered as part of the inspection. Safety was important to young people and staff and they told us about that. We found managers had listened to the views of people and responded. Some staff had not felt equipped to manage risk and the service had been adjusted to respond to this. We found managers to be very present and available to both staff and young people. The managers flexed their hours to ensure they were around at different times of the day and to oversee the quality of care. We found the managers had a clear understanding of what needed to improve and what was not working well. We questioned whether joint working across the teams could improve, but that this needed to be led by managers and modelled to staff. The senior managers for the service agreed to have an oversight of this to support an improvement. We found that outcomes for young people was the key driver for change. Managers at all levels had a really good knowledge and understanding of the young people. This meant that alongside staff, everyone talked to being a corporate parent and wishing the best possible outcomes for their young people. Requirements Requirement 1 The aims and objectives for Charleston Square must reflect the work currently being undertaken by the service. Furthermore, the aims must also fully reflect the high-level needs of the young people staff will be expected to support and how young people should expect to be cared for. This will develop the way in which staff and managers work together and support structured and consistent service delivery. This is to ensure that care and support is consistent with the Health and Social Care Standards (HSCS) which state that: 'My care and support meets my needs and is right for me.' (HSCS 1.19); and 'I am in the right place to experience the care and support I need and want.' (HSCS 1.20) This requirement was made on 18 August 2020. Action taken on previous requirement This requirement was met some time ago. We found aims and objectives that were clearly defined and were having a positive impact on outcomes for young people. Met - within timescales What the service has done to meet any requirements we made at or since the last inspection Inspection rInspection reporteport Inspection report for Renfrewshire Council Through Care Team page 7 of 11
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Requirement 2 The service managers would benefit from undertaking a learning needs analysis for all staff in order to ensure that they understand the skill set and experience needed to provide high-quality care and support. This should lead to staff being provided with training aimed at meeting their learning and development needs. This is to ensure that care and support is consistent with the Health and Social Care Standards (HSCS) which state that: 'I have confidence in people because they are trained, competent and skilled, are able to reflect on their practice and follow their professional and organisational codes.' (HSCS 3.14) This requirement was made on 18 August 2020. Action taken on previous requirement We found an active staffing and learning needs analysis and a staff team that had been recruited based on values, experience and skills. This meant that the majority of staff were equipped to meet the needs of young people. Met - within timescales Areas for improvement Previous area for improvement 1 The support young people receive should reflect their individual needs and help them transition at a pace that is right for them. They should receive the same care and support regardless of who is tasked with looking after them. Charleston Square will benefit from having a clear model of care to guide staff and managers to work in the same way and to ensure the young people receive individually planned and consistent support that is right for them. This is to ensure that care and support is consistent with the Health and Social Care Standards (HSCS) which state that: 'I am treated as an individual by people who respect my needs, choices and wishes, and anyone making a decision about my future care and support knows me.' (HSCS 3.13); and 'If I am supported and cared for a by a team or more than one organisation, this is well coordinated so that I experience consistency and continuity.' (HSCS 4.17) This area for improvement was made on 18 August 2020. What the service has done to meet any areas for improvement we made at or since the last inspection Inspection rInspection reporteport Inspection report for Renfrewshire Council Through Care Team page 8 of 11
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Action taken since then This area for improvement has been met for some time. We found a clear model of care that focused on nurture and the majority of staff were working in this way. Previous area for improvement 2 Service managers should ensure that there is a regular audit and analysis of serious incidents. Furthermore, where serious incidents occur, there should be a clear debriefing process for all involved that supports improvements in service delivery. This is to ensure that care and support is consistent with the Health and Social Care Standards (HSCS) which state that: 'I am protected from harm, neglect, bullying and exploitation by people who have a clear understanding of their responsibilities.' (HSCS 3.20) This area for improvement was made on 18 August 2020. Action taken since then We reviewed the audit processes for incidents and our sample showed that they were being reviewed regularly and staff were being given informal and formal debrief support. Furthermore, serious outcomes were reviewed as part of formulation and reflection meetings. Previous area for improvement 3 Service managers should engage with staff to review the effectiveness of supervision and to develop structures that ensure they feel supported. This is to ensure that care and support is consistent with the Health and Social Care Standards (HSCS) which state that: 'I have confidence in people because they are trained, competent and skilled, are able to reflect on their practice and follow their professional and organisational codes.' (HSCS 3.14). This area for improvement was made on 18 August 2020. Action taken since then We found that supervision was occurring regularly and the majority of staff were benefitting from the process. Complaints There have been no complaints upheld since the last inspection. Details of any older upheld complaints are published at www.careinspectorate.com. Inspection rInspection reporteport Inspection report for Renfrewshire Council Through Care Team page 9 of 11
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Detailed evaluations How well do we support people's wellbeing? 5 - Very Good 1.1 People experience compassion, dignity and respect 5 - Very Good 1.2 People get the most out of life 5 - Very Good 1.3 People's health and wellbeing benefits from their care and support 5 - Very Good How good is our leadership? 5 - Very Good 2.2 Quality assurance and improvement is led well 5 - Very Good Inspection rInspection reporteport Inspection report for Renfrewshire Council Through Care Team page 10 of 11
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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. Inspection rInspection reporteport Inspection report for Renfrewshire Council Through Care Team page 11 of 11