Inspection on 05/05/10 for Oak Lodge

This is the latest available inspection report for this service, carried out on 5th May 2010.

CQC found this care home to be providing an Good service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Oak Lodge 15/10/08

Oak Lodge 04/12/06

Oak Lodge 31/01/06

Oak Lodge 04/10/05

Oak Lodge 17/01/05

Oak Lodge 23/08/04

Extracts from inspection reports are licensed from CQC, this page was updated on 29/06/2010.

Key inspection report Care homes for adults (18-65 years) Name: Address: Oak Lodge 213 Eastbourne Road Polegate East Sussex BN26 5DU     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: June Davies     Date: 0 5 0 5 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 26 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 26 Information about the care home Name of care home: Address: Oak Lodge 213 Eastbourne Road Polegate East Sussex BN26 5DU 01323488616 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): The Regard Partnership Ltd Name of registered manager (if applicable) Mr Richard Harris Type of registration: Number of places registered: care home 6 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users to be accommodated is 6. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Learning disability (LD). Date of last inspection Brief description of the care home Oak Lodge is a purpose built bungalow, situated just off the main A22 Polegate/Eastbourne Road. The home shares the same site as Hillview, another service owned by this organisation. Local shops and public transport links are a short walk away. The home is registered to accommodate six younger adults with learning disabilities. Resident accommodation provides six single bedrooms and a communal lounge. The Care Homes for Adults (18-65 years) Page 4 of 26 Over 65 0 6 1 4 0 4 2 0 0 9 Brief description of the care home bathrooms are fitted with the necessary adaptations. The site provides ample car parking. There is a garden and patio areas for service users to enjoy open outside space. A wheelchair friendly ramp leads from a patio area to the lawned area at the rear of Hillview the attached sister home. The Registered Providers of the service are The Regard Partnership. This organisation owns a large number of homes across England and Wales. More detailed information about the services provided at Oak Lodge can be found in the homes Statement of Purpose and Service User Guide - copies of these documents can be obtained directly from The Regard Partnership. Latest CQC inspection reports are available on request from the home. Care Homes for Adults (18-65 years) Page 5 of 26 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This unannounced key inspection was carried out on Wednesday 5th May 2010 over a period of 4 hours. During the inspection the inspector spoke with the appointed manager, deputy manager, two members of staff and two residents. Documentation in relation to the key standards were viewed. The inspector also observed some parts of the internal environment of the home and the external gardens. Care Homes for Adults (18-65 years) Page 6 of 26 What the care home does well: What has improved since the last inspection? Since the last key inspection the manager has ensured that care plans reflect the preferences, choices and life styles of the service users. In Oak Lodge there is a weekly menu planning meeting, and this is where the following weeks menu is chosen by the service users, with support by the staff, so that a varied and nutrious menu is provided of the service users own choosing and taking into account special eating requirements and specialised diets. Where medication is covertly administered, there is a written agreement with the General Practitioner and pharmacist so that the strength of the medication is not compromised. In all cases service users monies are managed by the relative or by the funding local authority. A receipt is obtained for any monies that service users may spend, and an account sheet is kept for each service user. The home has undergone structural repairs since the last key inspection as well as interior refurbishment and decoration in colours that are user friendly. All equipment used in the care home is in good working order and has up to date maintenance certificates. On the day of this inspection the home was clean and tidy and in good decorative repair. All furnishings were in good condition. Externally a new ramp has been built that makes the lawned area at the back of Hillview (the sister home) accessible to wheelchair users. Fencing has been placed around pathways that have a drop down kerb, so that wheelchairs are safe and service users are not at risk of wheeling their wheelchairs off the kerb. At the time of this inspection there were sufficient staff on duty to meet with service users assessed health, personal and social needs, although the manager is in the process of recruiting more staff so that service users activities can be more flexible. Care Homes for Adults (18-65 years) Page 7 of 26 Further support is also planned for night duties, so that there will be three waking night staff on duty. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 26 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 26 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective service users are given information about the home in a format that they can understand or can be easily explained to them. The manager ensures that comprehensive pre-admission assessments are carried out prior to a service user moving into the home, to ensure that the staff have the skills and knowledge and the environment can meet all the needs of the service user. Evidence: Oak Lodge has a statement of pupose and service user guide that is up to date and provided in large print, picture format. The manager also plans to update the audio tape for service users who prefer to use a sound version of these documents. Pre-admission assessments are comprehensive and include all aspects of the service users, health, personal and social care needs. These pre-admission assessments also cover the wishes and preferences of the service user, in regard to daily living needs and keeping safe. Care Homes for Adults (18-65 years) Page 10 of 26 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Each service user has their own individual care plan in place, that reflects their preferences, choices, likes and dislikes. Support workers encourage service users to make everyday decisions in relation to activities and daily living routines within the home. All service users have their own individual risk assessments in place that have been written to take into account their abilities and to ensure staff have clear information as to how the level of risk can be reduced. Evidence: A care plan was viewed for one of the newest service users in Oak Lodge. The care plan was informative and included information gained during pre-admission assessment as well as information obtained since the service users stay in the home. There was good evidence in the care plan that the service user had been involved in drawing up their plan of care which included health, personal, mental and social care Care Homes for Adults (18-65 years) Page 11 of 26 Evidence: needs giving clear guidelines to staff as to how the service user wished to be supported. While the detail in the care plan was good and a good working tool for support staff, it would not be easy for the service user to understand. There was evidence in the care plan that a review had taken place and that the service user had been party to this review. On a daily basis support workers consult with service users and listen to their wishes and preferences in relation to the service users daily routines, likes and dislikes. Staff are aware of the individual communication needs of each service user, and interact with service users according to these communication needs. Service users care plans demonstrate how they are able to make individual choices in all aspects of the lives. The majority of service users in Oak Lodge have chosen not manage their own finances but have elected relatives or the funding Local Authority to do this for them. Each service user has their own risk assessments in their care plan. These risk assessments are individual and relate to the physical, mental, choice of activity and daily living routine of each service user. Risk assessments are clearly written and give staff sufficient information so that the level of risk can be reduced. Care Homes for Adults (18-65 years) Page 12 of 26 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users are encouraged to participate in local clubs and community activities as well as engaging in new activities if they wish to. There is good evidence that service users have regular contact with the local community. Staff at Oak Lodge actively encourage and support service user to maintain contact with their relatives and friends, either by supporting service users to visit relatives and friends or encouraging visits to the home. Meals in the home are good, with residents making weekly decisions about the food they wish to eat and being supported by staff to eat a healthy and nutritious diet. Care Homes for Adults (18-65 years) Page 13 of 26 Evidence: Support staff encourage service users to develop new skills in daily living. The activities sheets show that service users are supported to follow activities of their choice within the home including housekeeping tasks, attending church or attending in-house church services as and when they wish to. All service users have access to events in the local community, eating and drinking out at local cafes or pubs, visiting local places of interest, attending clubs of their choice, shopping etc. Support staff understand the importance to service users needs for keeping in touch with family and friends. Relatives are openly encouraged to visit the home and have a meal with their service user or a group of service users. Service users are also supported by staff on home visits to relatives. There is good documented evidence that service users are able to participate in annual holidays of their choice providing that all their care needs can be met. This year it is planned that some service users will be going to Bognor Regis, while others are visiting Somerset. All service users have free access to a safe and secure patio and garden area. Daily routines in the home are set around the service users choices, preferences and daily activities. The home has a pet cat that many of the service users like having around. The menus and choice of food in the home is planned around the choices, likes and dislikes of the service users, and weekly menu planning meeting are held to encourage service users to develop their own weekly menu. Choice of food is either given verbally or in picture format. From viewing a weekly menu there is evidence that service users are offered a healthy, nutritious and varied diet. Liquidised meals are presented in an appetising and appealing manner. Specialised diets can be catered for as and when required. Care Homes for Adults (18-65 years) Page 14 of 26 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users are able to choose their own daily living routines and have flexibility over their lives. Good evidence is available to show that service users have access to a full range of health care professionals as and when required. Medication is well managed in the home and medication procedures do not place residents at risk. Evidence: Evidence in care plans, talking to management and support staff evidenced that service users are able to make choices in regard to their daily living routines, getting up and going to bed. Personal care is delivered according to service own wishes and preferences and in privacy. Care plans show that service users have access to a variety of health care professionals, and are supported by staff to attend health care appointments. All health care visits are recorded in each individual service users care plan. Any concern in regard to a service users health is reported directly to the service users own General Practitioner. Care Homes for Adults (18-65 years) Page 15 of 26 Evidence: Medication in the home is managed in accordance with Regard Partnerships policies and procedures. Only staff trained in the administration of medication are allowed to administer medication. The deputy manager carries out monitoring on the senior staff team for the administration of medication, and in turn senior staff monitor the support workers. These monitoring checks are recorded. All unused medication is returned to the pharmacy on a regular basis. No medication is given covertly unless written permissions are sought from the service users General Practitioner and supplying pharmacist. Care Homes for Adults (18-65 years) Page 16 of 26 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users can be confident that any complaints will be recorded, investigated and dealth with appropriately. Good recruitment practices and staff training ensure residents are not placed at risk of abuse. Evidence: The complaints policy and procedure is developed in different formats to meet the needs of Service Users. There have been no complaints in relation to Oak Lodge since the last key inspection. The home does have a complaints file, and there is evidence from the sister home (Hillview situated on the same site) that when complaints do occur they are dealt with in accordance to the complaints policy and procedure. All staff are made aware at induction of how to deal with complaints. All staff have received training in the Safeguarding of Vulnerable Adults. This was evidenced via the training matrix and from talking to staff. Staff recruitment is stringent to ensure that prospective new staff are appropriately vetted prior to being employed in the home. See staffing outcome area 34. There have been no Safeguarding Vulnerable Adult referrals made to the local authority since the last key inspection. Care Homes for Adults (18-65 years) Page 17 of 26 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users live in a warm, comfortable home, with good access to safe and secure outside areas. Infection control procedures in the home are good helping to ensure that residents are not placed at risk of cross infection. Evidence: On the day of this key inspection Oak Lodge was seen to provide its service users with a clean, well maintained, comfortable home. Since the last key inspection structural repairs have been carried out as well as refurbishment. All cracks to internal walls have been repaired to a high standard. Most of the home has been redecorated and decoration colours are service user friendly. Bedrooms seen by the inspector all reflected the individual service users interests and personalities. Specialised equipment is provided throughout the home to assist support workers with service users who have mobility needs. Service users have access to all the garden area of the home via a newly constructed ramp and hand rails, a flat turf lawn has been laid. There is just one small area of garden where drain covers stand above grass level and one area of grass that has an undulating surface and could be a danger to service users. Discussion with the Care Homes for Adults (18-65 years) Page 18 of 26 Evidence: manager confirmed that he will get this area sorted so there is no risk to service users. In one patio area a fence has been fitted so that wheelchairs cannot drop down the kerb. Adherence to infection control procedures in the home is good. On the day of the inspection the home was free from offensive odours. Staff receive infection control training, and disposable clothing is used by staff for personal care and cleaning up spillages. All communal hand washing facilities are provided with liquid soap and paper hand towels. Care Homes for Adults (18-65 years) Page 19 of 26 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. At the present time there are sufficient staff on duty to meet residents assessed needs. The Regard Partnership carries out stringent employment checks to help ensure that service users are not placed at risk of abuse. While many staff have obtained qualifications in Social Care and undertaken mandatory training further improvements need to be made in this area, to ensure that all staff have the knowledge and skills to meet service user needs. Evidence: On the day of this key inspection the staff rotas showed that at the present time there are sufficient staff on duty to meet the assessed, personal, health and social care needs of the service users. The manager is in the process of recruiting further support workers so that service users have more flexibility in relation to accessing the community and for internal activities. Staff spoken to on the day of this inspection said that recruitment of further staff would be of benefit to the residents. The inspector viewed two staff personnel files and found that the Regard Partnership who own Oak Lodge and its neighbouring sister home Hillview operate stringent Care Homes for Adults (18-65 years) Page 20 of 26 Evidence: recruitment procedures. All staff have appropriate checks carried out prior to starting employment with the partnership. There was evidence within the staff personnel files that new staff undertake initial induction as well Skills for Care induction. The inspector found from viewing the staff training matrix that 41 of support workers in Oak Lodge had obtained their NVQ Level 2 or above qualification. Further work needs to be done to encourage more support workers to obtain this qualification. From viewing the support worker training matrix the inspector found that support workers had received the following mandatory training 70 Food Hygiene, 60 First Aid, 80 Medication, 80 Health and Safety training, 99 fire safety 60 safeguarding vulnerable adults, and 80 of support workers had received moving and handling training. All staff should receive this mandatory training within the first six months of their employment and the manager must make every effort to ensure that each member of staff in Oak Lodge receives this training. There is evidence on the staff training matrix that staff are provided with work related training to increase their skills and knowledge. Care Homes for Adults (18-65 years) Page 21 of 26 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The appointed manager has the knowledge and skills to manage Oak Lodge. The quality assurance system needs further development to ensure that the home as a whole offers a high standard of care overall. Health and safety procedures in Oak Lodge are good helping to ensure that service users live in a safe environment. Evidence: At the present time the appointed manager is in the process of applying to Care Quality Commission for registration. He has the skills and qualifications to manage Oak Lodge and Hillview and has obtained NVQ levels 2, 3 and 4 in Social Care, has a Registered Managers Award and other qualifications and training that give him the skills and knowledge to manage the home. The manager spends time working with service users and staff in Oak Lodge this gives him a good knowledge of the service users, and his staff team. Care Homes for Adults (18-65 years) Page 22 of 26 Evidence: The Regard Partnership has developed its quality assurance system and obtains the views of service users, relatives and external stakeholders. Regular regulation 26 visits are carried out, with a written report being made on the findings and actions required. At the present time medication in the home is monitored and recorded by the deputy manager. Further work needs to be done by the manager to develop a monitoring of systems used in the home so they can be incorporated into the overall annual quality assurance summary report. The AQAA told us that all equipment used in the home has up to date maintenance certificates. The inspector evidenced that fire call points, fire fighting equipment, fire doors and signage are checked on a regular basis. Staff carry out regular health and safety checks on the home. All accidents and incidents are recorded in the homes accident book any concerns regarding these would be reported by the manager to relevant external bodies. Care Homes for Adults (18-65 years) Page 23 of 26 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 24 of 26 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Adults (18-65 years) Page 25 of 26 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. 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