Inspection on 22/09/09 for Ingleby Care Home

This inspection was carried out on 22nd September 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Ingleby Care Home 26/03/09

Ingleby Care Home 25/03/08

Ingleby Care Home 18/05/07

Ingleby Care Home 17/05/06

Ingleby Care Home 19/09/05

Ingleby Care Home 16/05/05

Ingleby Care Home 22/09/04

Ingleby Care Home 15/06/04

Ingleby Care Home 27/02/04

Similar services:

Turret Villa Retirement Home

Moor House

Mendip House

Beaconsfield Court Care Home

Little Sisters Of The Poor

Manor House

Middleton Hall Ltd

Middlesbrough Intermediate Care Centre

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

Key inspection report Care homes for older people Name: Address: Ingleby Care Home Lamb Lane Ingleby Barwick Stockton-on-Tees TS17 0UP     The quality rating for this care home is:   one star adequate 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: Jacqueline Herring     Date: 2 2 0 9 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 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 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 26 Information about the care home Name of care home: Address: Ingleby Care Home Lamb Lane Ingleby Barwick Stockton-on-Tees TS17 0UP 01642750909 01642750966 noemail Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: T L Care Ltd care home 56 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 56 The registered person may provide the following category 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: Old Age, not falling within any other category, Code OP - maximum number of places 56 Date of last inspection Brief description of the care home Ingleby Care Home is a 56 bedded purpose built care home, which provide personal care to older people. All 56 rooms are single rooms with ensuite facilities and there is the required number of bathing facilities and communal space. Ingleby is owned by TL Care who also operate a further four homes in the Teesside area. Ingleby Care Home is close to the centre of Ingleby Barwick, being in easy reach of the local church, supermarket and parade of shops. The fees for Ingleby Care Home still need to be confirmed. 3 0 0 3 2 0 0 9 0 Over 65 56 Care Homes for Older People Page 4 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: one star adequate 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: The quality rating for this service is one stars. This means the people who use this service experience adequate quality outcomes. This Key Inspection was to check that the home meets the standards that the Commission for Social Care Inspection say are the most important for the people who use the services, and that it does what the Care Standards regulations say it must. This inspection was conducted by one inspector and a pharmacy inspector in one inspection day. This Key Inspection was carried out within six months of the previous one due to the issues identified at that time and the requirements made. It was to ensure that the required improvements had taken place. During the inspection, a number of records were looked at, including records of people Care Homes for Older People Page 5 of 26 who use the service, along with staff recruitment and training records. The medication systems was also looked at and discussed at length. Discussions also took place with people living at Ingleby Care Home as well as a number of staff and the manager. An Annual Quality Assurance Assessment (AQAA), the services self-assessment of how well they think they are meeting standards had also been completed prior to the last Key Inspection. Information was also used from it for this inspection. We have reviewed our practice when making requirement to improve national consistency. Some regulations from previous inspection reports may have been deleted or carried forward into this report as recommendations, but only when it is considered that people who use the services are not being put at risk or harm. In future if a requirement is repeated it is likely that enforcement action will be taken. Discussion took place with the providers of the service and it is acknowledged that much work has been completing to improve the service following the last key inspection. Care Homes for Older People Page 6 of 26 What the care home does well: What has improved since the last inspection? What they could do better: Discussion took place with the providers of the service, who brought up to date policies and procedures with them. It is clear that much work has been completed in regard to these, however some additional information is still needed. Other areas in need of improvement are the need for the newly appointed manager to become registered with CQC. The required regulation 26 visits need to take place on a monthly basis and a copy of the report available within the home. The way in which medication is managed within the home also needs some further developement. Some further development of the care records and evaluation of care needs to take place. Staffing levels should remain under review to ensure that there are sufficient staff on duty to meet peoples needs. Care Homes for Older People Page 7 of 26 The menu should also remain under review and consideration should be given to providing a choice. Improvements to the environments also needs to continue. 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 8 of 26 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 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 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. Peoples needs are assessed before moving to the home, which ensures their needs can be met. Evidence: The AQAA received for the previous key inspection contained the following information about the admission procedure, Provide a pre-admission assessment prior to admission. This is compiled for our long term and short term residents. A thorough system is in place regarding admissions to the care home. The care records of two people living at Ingleby were looked at, one was for a person who had been admitted since the last inspection. It was confirmed that people have their needs assessed prior to being admitted to Ingleby Care Home. A copy of the care managers care plan and copies of reviews were also contained within the care records looked at. Care Homes for Older People Page 10 of 26 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People receiving the service are happy with the way in which care is delivered by staff. Care records are in place for all people living at the home and provide information about individuals needs. The way in which medication is managed is in need of some further improvements, which will ensure strengthen the systems further. Evidence: The care records of two people living at Ingleby Care Home were looked at. Improvement to the care needs assessment and associated records was evident. The records looked at were up to date and generally identified peoples care needs and detailed how these care needs are to be met. The care records looked at contained a lot of documentation, some of which was quite repetitive. The manager did say that they were continuing to review the care documentation with a view to reducing the repetition and making them more accessible and effective records. It was also identified that care is needed with the monthly evaluation of care as these Care Homes for Older People Page 11 of 26 Evidence: continue to need to have more detail and need to demonstrate if the care given is being effective or not. Some of the evaluations looked at made comments such as, Continue with care plan. It was observed that a number of people were not using footrest on their wheelchairs. This was discussed with the manager who said that it was their individual preferences. There is however the need to ensure that this has been properly risk assessed, people understand the potential risk and that appropriate strategies are in place. The new medicines policy were shown to contain some inaccuracies and guidance on ordering and receiving medicines was not available. There was a homely remedies policy but this not not include reference to all homely remedies in use in the home. Clear medication procedures based on current professional guidance help staff to work consistently and reduce the risk of medication errors. Individual medication care plans were available but these were not always up to date. There was good information in the care plans of people with specific conditions for example a diabetic person and a person taking anticoagulation medication. There were very few administration gaps on the MAR charts meaning that people living in the home can expect to received their prescribed medication correctly. There is no record of staff authorised to administer medicines making it difficult to identify who was involved in any administration errors. Each MAR chart divider contained a photograph and allergies were recorded, the MAR folder also contained information on medicines prescribed when required. MAR chart entries for nutritional supplements and cream were inconsistent and in some cases the supplements and creams in use were not those listed on the MAR charts. Medicines are stored in standard lockable medicines trolleys. The room is warm and room temperature is not accurately recorded. The date of opening of medicines with a limited use once opened is not recorded. This means that medicines may be used beyond the date recommended by the manufacturer. The cupboards used to store controlled drugs appeared to meet regulations and all stock balanced. There is also the need to ensure that for those people who wish to self medicate that they have an appropriate lockable facility within their rooms, keeping their medication safe and secure. Care Homes for Older People Page 12 of 26 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. People are treated with respect and there are opportunities for social and recreational activities. Meals are provided to a reasonably good standard, although Evidence: The care records contained information about peoples social and lifestyle interests and preferences. Extremely positive comments were received about the person responsible for organising activities for people living at the home. During the inspection at Ingleby Care Home, the activities co-ordinator was observed working with people on a one to one basis. One lady was being assisted to write a letter, while another was helping devise a quiz to be used. A relative spoken to said, The activities girl is excellent, they work very hard. A person living at the home said, The activities lady is splendid, she has made a big difference in this home. The activities include bingo, play your cards right, family fortunes, coffee mornings, Care Homes for Older People Page 13 of 26 Evidence: trip to local shops and time spent with people on a one to one basis. All of these activities are recorded on a monthly sheet and details who is involved. Discussion took place with the manager about individual entries within peoples own care records, which would then form part of the evaluation and review process. The menu was looked at and whilst there was no actual choice, it was confirmed that alternatives were available for people. people living at the home said they were satisfied with the meals and thought that they had improved. One person said, The kitchen staff have become more organised and overall do a good job. Another person said that there was no actual choice but if you did not like what they brought then you could have something else. A relative said that the meals are very nice and that they have stayed and had meals. Care Homes for Older People Page 14 of 26 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. Systems are in place if people want to raise concerns or complaints. Adult protection procedures are in place, which helps to protect people that use the service from abuse. Evidence: The AQAA received for the previous Key Inspection detailed information in regard to complaints, it was stated that the service, Address complaints immediately. It also detailed that the complaints procedure and contact details are on display in the home. It also details that all staff are updated with regard to No Secrets training. No complaints have been received since the last inspection of the service. The training matrix detailed that staff had received training in respect of protection of vulnerable adults. There was one compliment recorded and the following comment was made, There is a distinct improvement in the ambience and general appearance of the home since the new managers appointment. Care Homes for Older People Page 15 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, 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 clean, reasonably homely and maintained environment, which meets their needs. Evidence: Significant improvements had been made to the environment of Ingleby Care Home at the last Key Inspection. There is the need to continue with these improvements. It was confirmed by the manager that plans are underway to refurbish different areas of the home and that new carpets would be laid in the corridors. Since the last inspection, improvements have been made to the dining rooms, with small kitchen areas having been installed. A survey completed by someone living at the home said that they thought the environment could be improved as it was a little outdated and that the furniture in the bedrooms was now looking a little tired and could do with updating. It was confirmed in discussion with the manager and through observations that some of the furniture has been replaced in a number of bedrooms and this will continue throughout all of the rooms. This new furniture provides a lockable facility for peoples valuables. The upstairs unit is currently not occupied and the manager discussed the possible Care Homes for Older People Page 16 of 26 Evidence: change of category of registration for that particular unit. An application for this change of registration will be needed should this go ahead. Care Homes for Older People Page 17 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 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. People needs are met by staff who have the knowledge and experience to do so. Whilst staffing levels are generally sufficient, this needs to kept under review to ensure that peoples dependency needs are fully met. Evidence: Two sets of staff files were looked at. Both contained the required information to show good recruitment practices are in place. This included completed application forms, with no gaps and Criminal Bureau checks that has been completed prior to the person commencing employment. Care is however needed in regard to the reference system as the reference does not ask the referee to date the reference when signed and it is not date stamped on return. It would also be helpful to keep a copy letter on file to show who the reference has been sent to, as on one of the files it was not clear who had completed the previous employment reference. The manager confirmed that any new staff would now complete the Skills for Care induction programme if they were not qualified to NVQ Level 2. People spoken to had mixed views about the staffing levels within Ingleby at the moment. One person believed there were not sufficient staff on duty and that there were too many staff being brought in from other homes to cover for staff shortages. This person concern was that they did not know the needs of the people living at the Care Homes for Older People Page 18 of 26 Evidence: home. Another person said, They are short staffed, they havent got enough time to spend with you, they are rushing all the time. Surveys completed by people living at Ingleby has also been completed and contained the following comments. I would like to see a more balanced regular staff of carers instead of strangers from other homes although I accept that staff coverage is important. More staff, so I could be taken for a walk/wheelchair outside. The staffing levels on duty on the day on inspection for nineteen people living at the home, was one supervisor and two care assistants. There is the need to keep this under review and in line with peoples dependency needs. A training matrix was made available and showed that mandatory training was rolled out on a regular basis and that staff were kept up to date with this training. A relative spoken to said that the staff were very approachable and that she was listened to by them. They also said in regard to staffing levels, Dont think you ever can have enough but I have no worries that needs arent being met. They did however say that it would improve things further if there was some more flexibility of staff so that they were able to spend more time with the residents. Care Homes for Older People Page 19 of 26 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Ingleby now has a new manager who is providing the leadership needed. Management systems have improved although some additional work is needed to policies and procedures, which will ensure the home is operating safely and in the interests of the people living there. Evidence: There has been no registered manager at Ingleby Care Home for some time. Although there has been a manager in post for the last year, they did not register with CQC and has now left. A new manager has been appointed who has commenced permanent employment in this role and who is in the process of registering with CQC. Positive comments were received from people living at the home. One person said, All is falling into place, improvements are being made and I think that they are on their way. I have confidence in the new manager, very much so. Surveys also contained comments about the management. One contained the following comment, Organisation has improved considerable since new management has taken over. Care Homes for Older People Page 20 of 26 Evidence: Visits that are required to take place by the provider on a monthly basis, these visits known as regulation 26 visits have not been taking place as the required intervals. These are an essential aspect of ensuring satisfaction and maintenance of quality within he home and organisation. As part of the quality assurance system, meetings are held with people living at the home and their relatives. There has been two meetings since the last inspection, which have been minuted. Accident records were looked at and there was analysis in place. It was agreed with the new manager that the level of detail in the analysis needed to be expanded upon to show the measures that had been taken. The providers were present for some of the inspection. They had brought along the updated policies and procedures. Whilst it is acknowledged that a lot of work has been completed in reviewing and updating them, there is still the need for some additional amendment and in some instances, more information. This was fully discussed with the manager who agreed. Water temperatures are now being checked and recorded on a weekly basis as is the fire alarm system. Work has also commenced on reveiwing the fire evacuation procedure and fire drills. It was also confirmed that regular fire training has taken place. Care Homes for Older People Page 21 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 Older People Page 22 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 1 9 13 Medication must be stored securely and safely. A system must be in place to check expiry dates of medicines and to add the date of opening when necessary. This makes sure medication is safe to administer. 19/10/2009 2 9 13 Medication must only be 12/10/2009 administered to the person it was prescribed for. This will reduce the risk of mistakes. 3 9 13 Where people choose to self 19/10/2009 medicate they must have secure facilities in which to store their medication within the bedrooms. This will keep their medication safe and secure. Care Homes for Older People Page 23 of 26 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 4 33 26 Regulation 26 visits must be conducted on a monthly basis and a copy of the report must be available within the service. This will ensure that the service is being monitored and it is being managed in the best interests of people living at the home. 02/11/2009 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 7 The care records should continue to be reviewed and more detail should be included within the monthly evaluations of care. Where people choose not to use the footrests on their wheelchairs there should be a risk assessment and risk management strategy in place, which the person has agreed with and shows they fully understand the risks. The temperature of the medication room should be regularly and accurately monitored. This makes sure that medicines are being stored at the temperature recommended by the manufacturer. The medicine policy should be updated in line with current guidance so that staff understand how to handle and administer medicines safely. The menu should continue to be reviewed and further consideration given to introducing an actual choice rather than just alternatives. The work that has commenced on refurbishment and redecoration should continue. This should include redecoration of a number of areas, new carpets in the corridors and the continued replacement of furniture in the Page 24 of 26 2 8 3 9 4 9 5 15 6 19 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 bedrooms. 7 8 27 29 Staffing levels should remain under review, ensuring that peoples needs are fully met. The system for obtaining references for people should be strengthened further. The actual reference forms needs to have a date for when the person completed the reference. It would be helpful do date stamp the reference on return and to keep a copy of the letter requesting the reference. The new manager should complete the process for registrations with CQC. The work that has commenced on reviewing and updating the policies and procedures should continue. 9 10 31 38 Care Homes for Older People 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. Copyright © (2009) Care Quality Commission (CQC). 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