Inspection on 19/08/09 for Birwood

This inspection was carried out on 19th August 2009.

CQC has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CQC judgement.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Birwood 05/08/08

Birwood 19/04/07

Birwood 23/02/06

Birwood 11/08/05

Birwood 21/01/05

Birwood 15/04/04

Birwood 04/03/04

Similar services:

Clover House

Parkside

Park Lodge

Mere Hall View

St Bonaventures

Hudson Road

Whitewalls

Home Farm

Extracts from inspection reports are licensed from CQC, this page was updated on 25/11/2009.

Key inspection report CARE HOME ADULTS 18-65 Birwood Wheathills Road Huyton Knowsley Merseyside L36 5UR Lead Inspector Joan Adam Key Unannounced Inspection 19th August 2009 10:00 Birwood DS0000021516.V377372.R01.S.doc Version 5.2 Page 1 This report is a review of the 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. 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 home adults 18-65 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. Birwood DS0000021516.V377372.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Birwood DS0000021516.V377372.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Birwood Address Wheathills Road Huyton Knowsley Merseyside L36 5UR 0151-449-3758 0151 449 3758 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) www.c-i-c.co.uk. Community Integrated Care Manager post vacant Care Home 3 Category(ies) of Learning disability (3) registration, with number of places Birwood DS0000021516.V377372.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home only - Code 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 - Code LD The maximum number of service users who can be accommodated is: 3 Date of last inspection 5th August 2008 Brief Description of the Service: Birwood is a three bed-roomed bungalow that is situated in Wheathills Road, Huyton and is close to local amenities. The service is provided by Community Integrated Care and is registered to provide personal care and support to three younger adults with a learning disability. The property has three bedrooms, a lounge, kitchen / dining area and a small spare room that is used as an office by the staff. Overall, the property is decorated and furnished to a satisfactory standard and provides a homely environment that is domestic in character. There are gardens to the front and rear of the property however the rear garden is unable to be used by the people who live in the home. Care Home Fees range from £1,132.08 per week. Birwood DS0000021516.V377372.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The overall quality rating for this service is one star. This means that the people who use the service experience adequate quality outcomes. We carried out an unannounced visit to the home on 19th August 2009 and a second visit was made to speak with the manager on 20th August 2009 the visit lasted seven hours. The visit was completed by one inspector. The report will say we when referring to what was done and found at the visit, as it is written on behalf of the Care Quality Commission. The visit was just one part of the inspection. Before the visit the manager was asked to complete a questionnaire to provide up to date information about the home.(AQAA) . Other information received about the home was also reviewed. During our visit we looked at various records and the premises. We looked at the care records of the people who live in the home, to see how their needs were being met. We spoke to people who live at the home, the manager and staff on duty. They all gave their views about the home. Feedback was given to the manager on the second day of the visit. What the service does well: The brochure (Service user guide) has been updated so that it is clear and detailed document. This means that people moving into the home and staff have the necessary information to make a decision about whether the persons needs can be met by the home. The health care needs of people who live in the home are recorded so that care needs are fully met. Referrals to the appropriate health care professionals take place when necessary to make sure that people stay as healthy as possible. Meals were varied and reflected peoples references. They are offered a range of choice and variety so that people who are living at the home were able to enjoy a varied diet to keep them well and healthy. The staff team is well established and staff are keen for high standards to be maintained, so that people who live at Birwood receive good quality care. Birwood DS0000021516.V377372.R01.S.doc Version 5.2 Page 6 Staff members were seen to be patient and caring with the people in their care. Staff said, I am offered support when I need it, we meet peoples needs as much as possible and we promote their independence, the manager is supportive” . What has improved since the last inspection? What they could do better: Transport needs to be provided to the home so that people who live there can access the local community and arrangements for a holiday can be made. The manager and staff working at the home are actively trying to address issues with the company. The people who live in the home are in danger of becoming isolated because there are very limited opportunities for them to access community facilities; we would therefore strongly recommend that the organisation looks at how this can be addressed. Birwood DS0000021516.V377372.R01.S.doc Version 5.2 Page 7 The gardens and patio area needs to be made accessible to the people who live at the home so that they can go outside. The ramp at the front of the home needs to be repaired so that it is not dangerous for staff to push wheelchairs. Staff training regarding fire safety needs to improve so that all staff know what to do in the case of a fire. Staff training needs to improve with regard to moving and handling so that all staff are aware of how to move people safely. Training also needs to be improved with regard to safeguarding of people who live in the home so that staff know what to do and how to recognise if abuse was taking place. 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. Birwood DS0000021516.V377372.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection Birwood DS0000021516.V377372.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 2 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People receive enough information about the home for them to make an informed decision about moving in and their needs are assessed before they move in so they know that these can be met at the home. EVIDENCE: A copy of the information that tells people who the service is for, the statement of purpose, was seen in the main office and this had been updated following the last visit we made to the home. The new version of this had been produced with pictures and photographs to help people to understand it more easily. It was suggested that this document be updated each year. There was a document available for staff to use with people before they move into the home, to check on what their needs are. The document covers all personal care and daily living needs and provides information on how many care hours would be needed to provide support for the person. A copy of the needs assessment that social services carry out with the person is also kept in each persons file to provide further information about their needs and show they can be met at the home. There had been no new people moving into the home since the last visit and the people had lived at Birwood for over eighteen years. Birwood DS0000021516.V377372.R01.S.doc Version 5.2 Page 10 Birwood DS0000021516.V377372.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,9 People using the 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 personal care needs of people living in the home are met effectively by the staff and support is provided in a way that ensures peoples privacy, dignity and choice. EVIDENCE: We looked at the care plans of the three people who live at the home to check on the care they were receiving. These showed the areas of support that was needed and how this was going to be provided by the staff. The care plans had been updated and improved by the manager since our last visit and included good information about the people living there. A lifestyle plan was present in each person’s file with pictures and the plan had highlighted ways in which they could communicate. Daily record sheets are completed and these were signed by staff to confirm who had written them. These were detailed and painted a picture of how each person spent their day. Birwood DS0000021516.V377372.R01.S.doc Version 5.2 Page 12 People who live in the home are helped to make their own decisions about their daily lives. Individual choices are recorded in the care records so that staff know what peoples preferences are and how they would like the support to be provided. People who live at Birwood are unable to manage their own finances and appropriate records are kept regarding expenditure to show it is completed correctly. Risks are assessed and assessments are produced to make sure that people are safe in what they do. A wide range of assessments are available and these were up to date with reviews held to make sure they are still appropriate Birwood DS0000021516.V377372.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): This is what people staying in this care home experience: 12,13,16,17 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at Birwood were not able to fully access the local community. EVIDENCE: Activities provided for people who live in the home are limited. None of the people living at Birwood attend day services for people with learning disability. People can go out to local shops in taxis with a staff member and it was recorded that each person goes out at least once a week. The manager said that due to the fact that the home does not have it’s own adapted mini-bus it was not possible to take them out together or more regularly which means that people were not getting out and about into the community and this was confirmed by the staff who work in the home. The people living at Birwood had not had a holiday since 2006. The manager is at present in negotiations with CIC, the company who provides care for the people who live at Birwood, Birwood DS0000021516.V377372.R01.S.doc Version 5.2 Page 14 to have their own minibus so that they can be taken to local leisure areas and on holiday. The people who live in the home are in danger of becoming isolated because there are very limited opportunities for them to access community facilities; we would therefore strongly recommend that the organisation looks at how this can be addressed. People who live in the home are offered choices in various ways, such as in the time they get up or go to bed, what they wear or by deciding what they do each day. This gives people some control over their own lives and helps them to stay as independent as possible. The people who live in the home are unable to communicate verbally but staff are aware of non-verbal communication and gestures to enable them to make these choices. A four week menu plan was in place and a record of what each person eats and drinks is kept and these showed a variety of meals including meat, cheese, fish, pasta, eggs and vegetables. Birwood DS0000021516.V377372.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 18,19.20 People using the 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 health care needs of the people who live in the home are met by the staff team in a way that promotes the persons independence, privacy and respect. EVIDENCE: From discussion with the staff and looking at the care files for people who live at the home it was clear that personal support is carried out as each person prefers, so that choice and respect are maintained. Visits from health care professionals were recorded and we saw from the records that visits to the GP, dentist, chiropodist, district nurse, were attended by the people who live in the home. Also annual medication reviews were completed. It was confirmed that healthcare professionals would also visit people at the home if required to make sure that they remain well. Birwood DS0000021516.V377372.R01.S.doc Version 5.2 Page 16 The medicines for two people who live at the home are supplied mainly in a blister pack and this helps to make sure that medicines are given correctly at the right time and as prescribed. Medication administration record sheets were completed when medication was given. All staff had received training in medication awareness so they know who to give medication to and are able to do this safely without making mistakes. Birwood DS0000021516.V377372.R01.S.doc Version 5.2 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People know that their complaints are dealt with. Staff training needs to improve so that people are protected from abuse and harm. EVIDENCE: The complaints procedure was satisfactory and contained details of how to contact the commission. The home had not received any complaints since our last inspection there and we had not received any about this home either. Policies were available regarding the safeguarding of vulnerable adults and included physical intervention, whistle blowing, dealing with bullying, and adult protection and prevention from abuse. However none of the staff working at the home had received up dated training regarding safeguarding adults since 2004. One safeguarding referral had been made by the home in the year before our visit, under the local authoritys safeguarding procedures. Birwood DS0000021516.V377372.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 24,30 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well maintained so that people who live at Birwood live in clean, comfortable and safe surroundings. The garden is not suitable for use with people who have limited mobility. EVIDENCE: We had a look around the home during our visit and saw all the shared areas and the bedrooms. All the bedrooms are single and the standard of decor is very good. The bedrooms had been made homely by using pictures, furniture, photographs and by having TVs, DVDs and other equipment that the people who live in the home have purchased since moving in. All the people who live at the home had new bedroom furniture in place. The home was clean and had no unpleasant odours. Birwood DS0000021516.V377372.R01.S.doc Version 5.2 Page 19 However, the gardens at the rear of the home have not been suitably adapted for use by people in wheelchairs which means that the people who live in the home are unable to utilise this space. The patio area which is made of crazy paving is overgrown and is mossy which means it is slippy and unsafe. The budget given to the manager for the maintenance of the gardens would appear to be inadequate as it does not cover the cost of the grass to be cut. Reference was made to this at the last visit. The front garden area has been improved by the manager by putting pots of plants and small shrubs in front of the home. A set of garden furniture has been purchased and staff said that they sit out here with the people who live at the home when the weather is good. The ramp leading from the front door is in need of repair and is unsafe and the non-slip covering is coming off which makes it difficult for the staff when wheeling wheelchairs on it. The manager is waiting for a contract company to repair this but in spite of numerous telephone calls a date has not yet been given to him for the work to commence. Birwood DS0000021516.V377372.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 32,34,35 People using the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Records were not kept of new staff employed at the home to provide evidence that staff were recruited safely. Staff training needs to improve so that people are kept safe. EVIDENCE: The staff rota showed the staff on duty over the week. The staffing levels appeared to be sufficient to meet peoples needs. There had been no new staff employed at the home for a number of years. The newest staff member was the manager and his personal file was not in the home so that we could not check if he had been recruited properly. This was a requirement at the last visit. We saw that all of the staff working in the home have achieved a national vocational qualification in care which shows that they have had formal training to carry out their roles. Information looked at with regard to mandatory staff training showed that none of the staff had received up to date training on moving and handling so Birwood DS0000021516.V377372.R01.S.doc Version 5.2 Page 21 that they may not know what to do to move people safely. Staff employed have not received training with regard to safeguarding adults since 2004 so that they know what to do to protect people. None of the staff working at the home have received training in fire safety so that they will know what to do in case of a fire. Fire drills including a full evacuation of people who live at the home had been carried out on a monthly basis. Birwood DS0000021516.V377372.R01.S.doc Version 5.2 Page 22 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 37,39,42 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Some areas of management must improve so that the home is well run. EVIDENCE: The manager of Birwood has been in post since March 2008.He has applied to be registered with CQC. He is an experienced manager and staff spoken with said he is very supportive. He has attained NVQ level 4 in management. Staff meetings are held every two months and full discussions take place. There is an established quality assurance process used by the company and this is completed by the service manager, who visits the home every month. A Birwood DS0000021516.V377372.R01.S.doc Version 5.2 Page 23 full audit of the home took place in July and some areas highlighted in this report were recorded such as lack of training. Satisfaction surveys are due to be sent out to relatives of the people who live in the home to gain their views. The AQAA told us that all relevant safe checks are carried out on items such as lifts and hoists within the home. The accident book was kept up to date and records seen were stored appropriately. The fire safety equipment test log book was up to date and completed appropriately. Staff training regarding fire safety needs to improve so that all staff know what to do in the case of a fire. Staff training needs to improve with regard to moving and handling so that all staff are aware of how to move people safely. Training also needs to be improved with regard to safeguarding of people who live in the home so that staff know what to do and how to recognise if abuse was taking place. Birwood DS0000021516.V377372.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 x 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 1 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 2 13 1 14 X 15 X 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 2 X 3 X X 2 x Version 5.2 Page 25 Birwood DS0000021516.V377372.R01.S.doc YES Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA34 Regulation 17 (3) Schedule 4. Requirement Timescale for action 15/09/09 2 YA35 17 (2) Schedule 4 The Registered Person must ensure that the records detailed in Schedule 2 of the Care Home Regulations 2001 are at all times available for inspection in Birwood, to provide evidence that the Acting Manager has been correctly recruited. Unmet requirement 05/09/08 An up-to-date record of all 25/09/09 training undertaken, including induction training must be maintained in Birwood, to provide information on the range of training completed by the staff team. Unmet requirement 05/10/08 All staff must receive up to date moving and handling training so people living in the home are not placed at risk of possible injury All staff must receive up to date training regarding safeguarding of adults so they know how to recognise abuse. All staff must receive up to date DS0000021516.V377372.R01.S.doc 3 YA35 18 30/09/09 4 YA35 18 30/09/09 5 Birwood YA35 23 30/09/09 Page 26 Version 5.2 6 YA24 23 7 YA42 23 training regarding fire safety so that they know what to do in the case of fire. The gardens and patio area must 30/09/09 be made accessible to the people who live in the home so that they can go outside. The maintenance of the front 30/09/09 ramp must be carried out to ensure the safety of the people living in the home and the staff working there. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 5. Refer to Standard YA13 Good Practice Recommendations The people who live in the home are in danger of becoming isolated because there are very limited opportunities for them to access community facilities; we would therefore strongly recommend that the organisation looks at how this can be addressed. Birwood DS0000021516.V377372.R01.S.doc Version 5.2 Page 27 Care Quality Commission North West Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: 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. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Birwood DS0000021516.V377372.R01.S.doc Version 5.2 Page 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!