Inspection on 19/01/09 for Bradley House

This inspection was carried out on 19th January 2009.

CSCI 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

Bradley House 14/08/09

Bradley House 23/01/08

Bradley House 21/09/06

Bradley House 25/02/06

Bradley House 24/08/05

Bradley House 10/03/05

Bradley House 19/10/04

Bradley House 30/03/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 12/10/2009.

Key inspection report Care homes for older people Name: Address: Bradley House High Street Shirehampton Bristol BS11 0DE     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: Kath Houson     Date: 1 9 0 1 2 0 0 9 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 Older People Page 2 of 27 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 Older People 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) 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 Care Homes for Older People Page 3 of 27 Information about the care home Name of care home: Address: Bradley House High Street Shirehampton Bristol BS11 0DE 01179235641 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: elisabeth.bradleyhouse@btopenworld.com Mrs Elisabeth Laycock care home 10 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: May accommodate up to 10 persons aged 65 years and over requiring personal care. Date of last inspection Brief description of the care home Bradley House is a listed Edwardian building which provides accommodation and personal care for 10 elderly people. The property is arranged over three floors. The home has domestic style facilities such as a large kitchen, a large lounge and an extended conservatory which provides additional space which looks out at the large gargen. There is a large dining area, sufficient toilet facilities and bedrooms for single occupancy. The homes aims and objectives are to provide care and to listen to residents concerns and protect them from abuse. The property can be found in the residential area of Shirehampton, in Bristol. The area has a number of amenities on offer such as shops close by, a church and the local bus route which has access into Clifton and the town centre. Care Homes for Older People Page 4 of 27 Over 65 10 0 Brief description of the care home The home provides twenty four hour staff cover. People can be admitted for emergency admissions. The manager is always on site to address any queries. Fees payable and range from £459-£500 per week for the total care package; this information was collected during the inspection. People who are funded through the Local Authority have a financial assessment. The home is privately owned and managed by Ms Elisabeth Laycock. Care Homes for Older People Page 5 of 27 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 Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: An unannounced visit was made on 19th January 2009. During the visit we: Looked at information about the people who use the service and how well their needs are met. Looked at other records such as policies and procedures; the staff rotas and the medication procedures and practices. Discussed the staff team had the skills and knowledge and training to meet the needs of the people who use the service. Looked around the building to make sure that the home is clean, safe and comfortable Care Homes for Older People Page 6 of 27 to meet peoples needs. We looked at information we have received since the last inspection visit, which included; how the service dealt with any complaints & concerns since the last visit. Any changes to how the home is managed and the manager/providers view of how well they care for people living at the home. We shared the findings of the inspection with the manager/provider. Care Homes for Older People Page 7 of 27 What the care home does well: What has improved since the last inspection? The service has met a number of the requirements from the previous inspection that includes: All care needs identified on admission must form part of a persons care plan. Changing needs especially about healthcare such as pressure sores, medication and recurring health issues must be put in care plans. Complaints records must be kept in such a way that they are confidential to each person. Records must show the timescale for dealing with complaints and the outcome for the person. Two references must be obtained for new employees. The central heating boiler must be regularly serviced and thermostatic water temperature valves checked regularly. Care Homes for Older People Page 8 of 27 Water temperatures in each room must be checked at least monthly and delivered at 43C to make sure people are kept safe from risk of scalding. 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 Older People Page 9 of 27 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 27 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 and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. 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 them 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. Potential users who are interested in the service benefit from sufficient information, which helps people to decide their place of residence. It would be helpful for the home to describe their aims and objectives;which is specfic to the home and the specialst services the home may provide. People can be confident that only peoples whose needs can be met are admitted to the home. Evidence: There had been a new admission since the last inspection and there remains a vacancy available at the home. Each person has a pre-admission assessment completed by the manager prior to admission. This informs the manager of what is needed for each person for instance, mobility care, personal care, and food preference. The home was able to provide an up to date Statement of Purpose (SoP). This contained sufficient information for people to make an informed choice about their Care Homes for Older People Page 11 of 27 Evidence: place of residence. however it would be useful to include the aims and objectives which would help people to decide if the home can meet their needs. People said I came on a visit before I moved into the home; I came on a visit from hospital and had a look round before deciding. I came to visit the home to see what it was like. Another resident said, I already knew of the home as I lived locally but also had visited the home beforehand. It was recommended by my daughter who lives just down the road. The homes Service User Guide also contained information and residents contracts. Care Homes for Older People Page 12 of 27 Health and personal care 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 health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they 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. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them 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. Peoples health and personal care needs are recorded which ensures that the staff have up to date information about individual needs. An effective system for the administration of medication exists which keeps people free from errors. Evidence: Selected care plans were looked at and found to be adequately recorded and regular updates were seen which demonstrates that the home monitors peoples changing needs. A GP said, Individuals healthcare needs are usually met by the service. The staff team said, We have daily diary sheets and weekly monthly care plans updates where the information is recorded. This was seen during the inspection. The care plans were found to be person centred. Some of the care plans were incomplete but the manager said she was updating them. The care plans also included; peoples preferences, in some instances for people with specialist health needs there was a fluid monitoring chart. Peoples healthcare needs were clearly identified and there was evidence of multi-agency team input. For instance, a GP said I have no concerns about this service the residents are looked after well. Care Homes for Older People Page 13 of 27 Evidence: A healthcare professional said individuals health care needs are met with assistance of the District Nurses and continence service. Residents said I always receive medical support when I need and the staff make all the arrangements for the Drs visits, another resident said the staff will arrange all medical visits on request and will sometimes call a Dr if they are concerned about my health; a physio comes in once a week to see me. Assessments of risk are reviewed regularly and updated in peoples care plans. Discussions with the staff show that they are aware of any changes and information regarding peoples needs and how they are met. All residents medication files were seen and no omissions were noted; residents medication sheets were completed well. The home uses the Boots method of colourcoded blister packs. The storage of medication was found to be satisfactory. Peoples privacy and dignity is respected by staff working at the home. The staff were respectful towards people during the inspection and demonstrated a good understanding of their individual needs. Care Homes for Older People Page 14 of 27 Daily life and social activities 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 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. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. 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. Good support is provided which encourage people who use the service to make choices about their lifestyle, routines and social activities. The menu is varied and contains a balanced and nutritional diet, which caters for peoples needs. Evidence: The service has a commitment to enabling people who use the service to maintain their social, independent and communication skills. This was observed and confirmed during a discussion with the activities coordinator. At the time of inspection people were involved in an arts and crafts session. The activities coordinator is a long standing member of staff and organises activities three times per week. In addition there are several outings to concerts, plays, shows, and musicals which are happening in the area. The home also has monthly subscriptions to a number of different publications which provide information about various events, which would be of interest to the residents. These were seen displayed on the homes notice board. The coordinator was able to describe each individuals interest and their favourite pastime or hobby. Some of the artwork was seen around the house. People said there are always things available to do if you want to but you can stay in your room if you want to, I can do jobs around the house if I want to it helps keep you occupied; I play dominoes, go into the garden for a kick about or play cards. A resident said, Care Homes for Older People Page 15 of 27 Evidence: Sometimes I go out with a couple of friends. I enjoy the church service and singing that takes place at the home every few weeks, everything is done that is needed. People said they enjoyed the activities provided and there was a choice of music, making birthday cards, personal shopping, reading, reminiscing down memory lane, numeracy, pub lunches and skittles. People who use the service said its lovely here, other residents said, I feel like I am part of the family, I love it here more comments include, we are very spoilt here. A resident said I have had breakfast in bed everyday. Peoples bedrooms are personalised and people are encouraged to bring in personal items, which reflect their personal tastes and interests. The menu showed a wide and varied diet is provided which offers fresh foods. Peoples likes and dislikes are recorded. People said, The food is always very nice. The food is cooked well and presented in an appetising way. This was observed during the inspection. The residents are given good quality crockery plates, serviettes and glasses to drink from. Endless cups of tea and coffee were given throughout the day in good quality drinking cups and mugs. Food temperatures were seen to be recorded. Good food stocks were available. Care Homes for Older People Page 16 of 27 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. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. 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. A comprehensive complaints procedure exists which encourage people to voice their concerns. People are protected by safeguarding measures, which ensures they are free from abuse and neglect. Evidence: People are provided with information on how to make a complaint. The recording of complaints were seen to be personal and contained in peoples individuals care files. This ensures that peoples confidentiality is maintained. Recording of complaints were seen and they were dealt with in a timely manner resulting in changes being made to suit the residents needs. However, in one residents care plan there was a concern, which did not show the date of an outcome. People said, I would talk to the deputy manager if I had any concerns, other people said, There is a residents meeting once a month. There is staff guidance available for dealing with potential abuse or neglect in the care plans. The staff team understand the procedures for Safeguarding Adults and has regular training to ensure that people are protected from harm and abuse. Care Homes for Older People Page 17 of 27 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, 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. 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. People live in a home that is comfortable, homely, safe and relaxed with an atmosphere, which is pleasant and welcoming and accommodates peoples needs. Evidence: Bradley House is a listed Edwardian house, which provides accommodation over three floors with a lift that goes to the first floor. The property has domestic facilities, which include; a large kitchen, large lounge and extend conservatory, which provides added space for people to sit and admire the large garden. The garden has a raised vegetable patch. The garden is secure and gives people an additional quiet area. There are various trees and shrubs in the garden, which is well maintained. There is a large dining area. All the bedrooms vary in size. The bedrooms can have a private telephone line installed on request. There are bedrooms which are accessible via separate staircases. The bedrooms reflect peoples tastes and preferences and people have been supported to bring personal items with them, which enables them to express their personal and individual tastes. There are sufficient bathrooms, shower and toilet facilities available for residents use. The manager explained that the boiler and the thermostat and all the valves had been adjusted and the water temps are checked. The home is situated on the high street in Shirehampton and close to local shops and Care Homes for Older People Page 18 of 27 Evidence: bus routes. There is access to Clifton Village and Avon Gorge; motorway access to Cribbs Causeway and the M5. There is a bus route into Bristol City Centre and its surrounding areas such as Redland; Bristol Zoo can be found close by. A small community exists in the area of Shirehampton where there are church groups, local shops and supermarkets. People were complimentary about their place of residence and said the home is always clean and fresh, I have always considered being very lucky to be here at home, cleaners come regularly and clean the residents rooms as well as the rest of the house, the home is always nice and clean. During the inspection the home was found to be clean and fresh with no offensive smells. Care Homes for Older People Page 19 of 27 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 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 to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. 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. The staffing levels reflect the needs of the people living in the home with rotas that are flexible to fit around individual lifestyles. Effective communication among the staff ensures that peoples needs are consistently met. The long-standing staff team provides regular care and stability for those people living in the home. Evidence: This service provides 24 hour care which entails of a team of staff during the day shift and 1 sleep in member of staff during the night. The staff team supports each other and people enjoy working at the home. This was evident with the number of long standing staff that means that the staff turn over is low which is positive for people who use the service as this maintains consistency of the staff team. The completed surveys that were sent into the Commission showed that the staff and health professionals were complimentary about the service. For instance; the staff always have the right skills and experience to support individuals needs, residents said, The staff are very helpful. Information obtained from the staff files show people are in safe hands at all times. The staff team are diverse in terms of age group. The staff spoken with understand the needs of the people who use the service and are able to meet those needs. For instance the staffing rotas showed that there are enough staff on duty throughout the day and night. The manager is always on site with the deputy manager. Good Care Homes for Older People Page 20 of 27 Evidence: communication systems exist which ensures information is shared. The staff-training document showed that training was up to date. Staff confirmed that induction training equips them with the skills they need to provide care for people living in the home. Staff spoke knowledgeably about peoples care and showed a good understanding about their roles and responsibilities. The homes recruitment practices protect people living in the home. Appropriate references, Criminal Records Bureau (CRB) and other checks are made before new appointments are confirmed. The staff teams CRBs were signed off during the inspection process. The staff team are so close for example there are strong family connections. The manager said she could vouch for their character. There was a member of staff who only had one reference in her file. The manager said that she knew her since she was a child and has stayed close to the family members. Other staff files had two references, photo identification, a completed application form and training updates. The staff teams have supervision every two months where all matters are discussed. Care Homes for Older People Page 21 of 27 Management and administration 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 led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate 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. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. 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. People benefit from a service that is managed well. Effective communication and use of policies ensures that people living in the service continue to have good quality of life. Evidence: The current manager and provider has been in the care industry for several years and has demonstrated that she has the ability to manage the home well. The manager/provider said she has shown continuous dedication to both staff and residents. This was evident during the inspection. The manager was able to provide all documentation on request, was able to demonstrate how well she manages the staff and the home and includes the night staff on a daily basis. For instance the manager is always on site and although there is senior staff cover the manager states that she is always available. Health professionals were complimentary about the service and a GP said This service maintains a homely atmosphere which is not always possible whilst maintaining high standards in a care home. Other comments include treats individuals as people in their own right and respects them. Care Homes for Older People Page 22 of 27 Evidence: The atmosphere of the home during the inspection was calm and steady, unrushed and operating at a gentle pace, which is in keeping with the people who use the service. There are systems in place to check the quality of the service. The manager has collated the results. The staff and residents would benefit from knowing the findings from the recent quality assurance; this would continue the communication links, which already exists, within the home and inform people and staff of the continuing standards of care.It would be beneficial to the staff team to share the findings. Sound policies and procedures exist which underpin the practices within the home. For instance, regular health and safety checks are carried out according to protocol. This ensures that the home is a safe place to live and work. The manager has been checking the fire drills and evacuation procedures with the Fire Department who had recently conducted an audit and suggested a plan of action to improve the fire safety within the home. For instance a fire evacuation plan has been arranged with the fire department and includes the different zones for the house. A fire safety policy has also been arranged with the fire department. This shows the manager is keen to ensure that the home is a safe place for all the residents, relatives and employees. A maintenance programme also exists and was seen during the inspection this ensures that the home is maintained to a good standard and is a safe place for both people who use the service and the staff team that provide the care. Regular staff and residents meetings take place, which ensure that people have the opportunity to voice their opinions. There is a strong ethos of being open and transparent in all aspects of running the home. The manager promotes and is person centred in her approach. The residents said, I just love being here, we have lunch together and are well looked after, cant fault the home, staff do their best for you, I am happy with the home. The staff team said, the service meets individuals needs by communication and the use of their care plans; speaking to the service users to fulfill their needs in the best possible way. A GP said, feel the service is generally excellent. Another GP said The care service provides an excellent service overall. The staff said its very nice working here, its friendly, the manager is very approachable you can go to her with anything, its a nice place to work. Care Homes for Older People Page 23 of 27 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 Older People Page 24 of 27 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 1 1 The homes statement of purpose could include the homes aims and objectives. This could describe the homes qualities which would help people to decide their place of residence. People would benefit from their care plans being completed; this would ensure that all information is equally accessible. People would benefit from their complaints being resolved in a timely fashion and appropriately recorded; staff are to record the outcomes for all concerns, this is to ensure that equality is maintained throughout. The registered person is to continue to follow the guidelines set when recruiting people and to find creative ways in obtaining references for close family members. This to ensure peoples safety is maintained and that they are free from potential harm. The staff and residents would benefit from knowing the Page 25 of 27 2 7 3 16 4 29 5 33 Care Homes for Older People 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 findings from the recent quality assurance; this would continue the communication links which already exists within the home and inform people and staff of continuing standards of care. Care Homes for Older People Page 26 of 27 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. Copyright © (2009) Care Quality Commission (CQC). 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