Inspection on 05/05/09 for Mossley Manor

This inspection was carried out on 5th May 2009.

CQC has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 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

Mossley Manor 11/02/10

Mossley Manor 28/04/08

Mossley Manor 24/07/07

Mossley Manor 21/06/06

Mossley Manor 31/01/06

Mossley Manor 18/10/05

Mossley Manor 28/04/04

Mossley Manor 20/04/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 15/11/2009.

Key inspection report CARE HOMES FOR OLDER PEOPLE Mossley Manor North Mossley Hill Road Mossley Hill Liverpool Merseyside L18 8BN Lead Inspector Jeanette Fielding Key Unannounced Inspection 5th May 2009 10:30 DS0000025193.V375375.R01.S.do c 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 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. Mossley Manor DS0000025193.V375375.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 Mossley Manor DS0000025193.V375375.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Mossley Manor Address North Mossley Hill Road Mossley Hill Liverpool Merseyside L18 8BN 0151 724 2856 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) Mr Amer Latif Mrs C K Latif Miss Elizabeth Ann Davies Care Home 47 Category(ies) of Old age, not falling within any other category registration, with number (47) of places Mossley Manor DS0000025193.V375375.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 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 The maximum number of service users who can be accommodated is: 47 Date of last inspection 28th April 2008 Brief Description of the Service: The home was originally built in 1878 and over the years has been modernised and converted to its present state. The home is registered for forty seven residents who require personal care and support. The home is situated in Mossley Hill, a quiet suburb of South Liverpool. Shops, cafes, pubs and public transport facilities are nearby. Residents are provided with single rooms; the two double rooms are currently being used for single accommodation. Residents have aids and equipment to help them with their mobility and ramps and a lift allow access to all parts of the house and gardens. There are communal lounges and dining rooms, which are homely and comfortable. Residents can entertain their visitors in these areas or the privacy of their own rooms. A call bell system with an alarm facility operates throughout the home to enable residents to call for assistance. The fee rate for accommodation is £328.00 a week plus £28 per week for ensuite facilities. Mossley Manor DS0000025193.V375375.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means that people who use the service experience good quality outcomes. This unannounced key inspection was undertaken in one day over a period of seven and a half hours. As part of the inspection process, all areas of the home were viewed including many of the service users bedrooms. Assessments and care plans were inspected together with staff records and certification to ensure that health and safety legislation was complied with. Observation of the interaction between staff and people who live at the home provided further evidence of the actual care given. Four service users were case tracked to evaluate their care and obtain their views. Discussion took place with the manager, staff, service users and visitors to the home. The manager completed an Annual Quality Assurance Assessment form prior to the inspection to give additional information regarding the home. What the service does well: The home provides care within a fresh and well maintained environment. The programme of redecoration and refurbishment continues to improve the home. The well trained staff team are given full information about the care and support required by the service users to ensure that their needs and preferences are met. All staff have been trained in the protection of vulnerable adults to protect service users. The home has a strong management structure which is well supported by the owner who visits regularly. What has improved since the last inspection? What they could do better: A high level of fundraising takes place within the home and consideration should be given to using this money to provide additional social activities and stimulation for the service users. The manager does not have full access to the records relating to activities and so these should be held in the office. Mossley Manor DS0000025193.V375375.R01.S.doc Version 5.2 Page 6 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. Mossley Manor DS0000025193.V375375.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection Mossley Manor DS0000025193.V375375.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 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): 1 and 3. People using the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The detailed and informative service user guide provides sufficient information to enable prospective service users to make an informed decision regarding their care provider. EVIDENCE: The owners and manager have recently reviewed and updated the Service User Guide and Statement of Purpose. The documents are extremely detailed and informative and provide current and prospective service users with full details of the services and facilities provided by the home. The documents also include a sample menu and a copy of the contract. These documents enable prospective service users to make an informed decision about their care provider. The Statement of Purpose and Service User Guide are displayed in Mossley Manor DS0000025193.V375375.R01.S.doc Version 5.2 Page 9 the foyer of the home and are accessible to all service users and visitors. Prospective service users, and their relatives, are encouraged to visit the home prior to admission to give them the opportunity to view rooms available and to meet with other service users and the staff team. Prior to their admission, prospective service users are assessed by the manager or one of the senior staff to identify their individual care and social needs to ensure that the home can meet those needs. The pre-admission assessments of recently admitted service users were inspected and were found to contain full information necessary to enable the initial plan of care to be prepared. Individual preferences are identified so that the home is fully prepared for their admission. The home does not offer intermediate care. Mossley Manor DS0000025193.V375375.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 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): 7, 8, 9 and 10. 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. Care plans are sufficiently detailed to provide staff with the necessary information to enable them to meet the care and social needs of the service users. EVIDENCE: The manager prepares individual care files for all service users. Each file contains care needs assessments and care plans to inform staff of the specific care required and of how to provide that care. A random sample of four care files were inspected and all showed that the needs of the service users had been identified. Risk assessments had been prepared and risk management plans put in place to reduce or remove any risk to the service users without restricting their preferred lifestyle. Each file also includes a life history of the service user. Family members are encouraged to contribute information about Mossley Manor DS0000025193.V375375.R01.S.doc Version 5.2 Page 11 the service user to give staff greater understanding of the individual. Photographs are in place on all files for identification purposes. The care needs of service users are reviewed on a daily basis in the daily records and formally on a monthly basis to ensure that the care files are accurate to enable the staff to provide the required level of care and support. The daily records completed by the staff are informative and provide evidence of the actual care given. Support is provided to the manager and staff by Mossley Hill Hospital staff, Community Psychiatric Nurses and the Community Matron who can all be called on for information at any time. Discussion regarding care files took place with the manager who is proposing to upgrade the information held on files through the provision of new documentation. This upgrade will take place over the next few months and will be reviewed by the manager and staff to ensure effectiveness and efficiency. Medications are administered to all service users, with the exception of one, by the staff. One service user has chosen to administer their own medications and their ability to do so has been assessed to ensure that the service user is safe. The service users’ ability to continue to administer their own medication is reviewed each month and the medications are ordered by the home. Medication Administration Record (MAR) sheets were found to be well maintained and up to date. Staff sign the MAR’s when the medication has been administered in accordance with the home’s policy and procedure. All storage areas were found to be clean and organises. Appropriate arrangements are in place for ordering medications and for the disposal of unwanted or refused medications. The manager completes a monthly audit of the medications and maintains a record of her findings. Appropriate action is taken in the event of any discrepancies. Senior care staff, who administer the medications, have completed training in medications and evidence of this is held on their files. Service users are accommodated in single bedrooms and staff were observed to knock on doors prior to entering. Service users spoken to confirmed that their privacy and dignity were respected at all times. Mossley Manor DS0000025193.V375375.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above 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): 12, 13, 14 and 15. 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. Dietary needs of service users are well catered for with a balanced and varied selection of food available that meets their tastes and choices. EVIDENCE: The home employs an activities co-ordinator for a minimum of 16 hours each week over three days. A range of activities are offered to service users including bingo, board games, cards, skittles and musical entertainers. An activities profile is held on each service users care files. A high number of photographs of activities are displayed around the home, however, many of these took place over a year ago. No trips out have been taken so far this year and the activities co-ordinator said that the cost of purchasing transport is high. Service users who responded to the survey by CQC said that they felt that activities were usually or sometimes activities taking place that they could participate in. One service user said that none of the activities were suited to them as they spent most of their time in their bedroom, so just watched Mossley Manor DS0000025193.V375375.R01.S.doc Version 5.2 Page 13 television. Service users spend time on a one to one basis with the activities co-ordinator and the records held refer mainly to chatting. The records of the activities that take place within the home are held by the activities coordinator. These should be held in the office to give full access to the manager and care staff who can add details of activities that take place when the activities co-ordinator is not on duty. Discussion with the activities co-ordinator identified that a number of fund raising events had taken place, with the money raised being donated to various charities. Consideration should be given to ensuring that funds raised by service users and relatives is for the benefit of the service users at the home, to fund transport costs, entertainers and the purchase of additional activities supplies. Service users should be consulted about fundraising and given a realistic choice of what the money is spent on. The home provides a pleasant library and reading area on the first floor. A large number and range of books are available. Relatives are welcome at the home at any time and two visitors to the home were spoken to. Both confirmed that their relatives were well cared for and said that the staff were kind and caring. One said that the relative was very happy in the home and that they were given everything they needed. Meals are served in the dining room, the lounge or the service users own bedroom as they wish, but all are encouraged to use the dining room to promote social interaction during mealtimes. A choice of meals is offered at all mealtimes and the menus show that a varied and well balanced diet is offered. Service users said that the meals were good and if there was something that they wanted that was not on the menu, the chef would try to provide this. A new chef has recently been employed by the home. Menus are reviewed and changed according to season and service users preferences. Service users confirmed that they can go to bed and get up at a time of their choosing and that staff assist them wherever necessary. Mossley Manor DS0000025193.V375375.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 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. All staff have undertaken training on the Protection of Vulnerable Adults to ensure that service users are protected. EVIDENCE: The home has a detailed complaints policy and the procedure is displayed in the foyer of the home and also detailed in the Service User Guide. A low number of complaints have been made and the records show that these have been addressed in a timely manner to the satisfaction of the complainants. Records are held of the complaints, the investigation taken place and the outcome, together with copies of correspondence. All staff have been given training on the Protection of Vulnerable Adults and staff spoken to were able to demonstrate that they were aware of the different types of abuse and of the action they would taken in the event of abuse being suspected or reported to them. Mossley Manor DS0000025193.V375375.R01.S.doc Version 5.2 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 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): 19, 20 and 26. 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. Improvements continue to be made to the home to provide service users with a comfortable and homely environment in which to live. EVIDENCE: The planned programme of redecoration and refurbishment continues within the home. New carpets have been purchased for corridors and bedrooms and will be fitted within the next few weeks. The rolls of carpet were seen in the home and the manager explained that they were waiting on the carpet fitter. The manager confirmed that service users were given a choice of colour of the carpet for their bedroom or of cushion flooring. Some of the floorboards were Mossley Manor DS0000025193.V375375.R01.S.doc Version 5.2 Page 16 noted to be extremely noisy when walked on and consideration should be given to addressing this prior to fitting the new carpets. Some minor maintenance issues were identified during the inspection and the manager arranged for these to be addressed immediately. Service users are encouraged to personalise their bedrooms with small items of furniture, ornaments, pictures and photographs and bedrooms seen were homely and comfortable. All bedrooms are decorated and furnished to a good standard. Locks are fitted to bedroom doors for service users to use to protect their privacy. Service users have full access to the two spacious lounges and dining rooms and may choose where they spend their day. Plans are in place for the replacement of some of the armchairs. The home has a hairdressing salon on the ground floor and a qualified hairdresser visits the home each week. New garden furniture has been provided to provide comfortable seating for service users. The garden is enclosed and provides a pleasant area for service users to spend time in the warmer months. The home also has a small roof garden and flowers have been planted in tubs by a service user and their relative to provide a pleasant area. The home is clean and fresh throughout and is maintained to a good standard. Mossley Manor DS0000025193.V375375.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are 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): 27, 28, 29 and 30. 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. Service users are supported by a well trained and enthusiastic staff team to ensure that their individual needs and preferences are met. EVIDENCE: Discussion with the manager and staff, and inspection of the staff rota confirmed that the home employs and deploys staff in sufficient numbers to meet the needs of the service users. A selection of staff files were inspected, both new staff and those who have worked at the home for some time. All files showed that the home’s recruitment procedure had been followed. All prospective staff are required to complete an application form prior to being called for interview. Two references are taken and checks are made through the Criminal Records and Protection of Vulnerable Adults bureaux. One file showed that a photograph is required to be included. Training continues to be given to staff and a new induction training programme has been introduced. New staff are required to complete a workbook which Mossley Manor DS0000025193.V375375.R01.S.doc Version 5.2 Page 18 provides evidence of training given and assessment of competency. This is in line with the Skills for Care training programme. All staff, with the exception of two new staff, hold NVQ qualifications. Arrangements are being made for the new staff to commence this training. Regular training updates are provided and staff are currently undertaking training on infection control. Each staff member has an individual training file which contains certificates and evidence of the training undertaken. Staff spoken to during the inspection confirmed that they attended training sessions and were enthusiastic about improving their knowledge and understanding of the needs of the service users. Supervision is given to all staff on a regular basis to identify training needs and to give staff the opportunity to speak with the manager confidentially on a one to one basis. Students work in the home to obtain work experience and all checks are made on them to ensure that service users are protected. Service users spoke highly of the staff and comments include ‘The staff are really kind and do everything they can to make me happy’, ‘The girls are caring and I love to sit and chat with them’. One relative said ‘The manager and staff are really nice. They will go that extra mile every time’. Mossley Manor DS0000025193.V375375.R01.S.doc Version 5.2 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. 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 and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 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): 31, 33, 35 and 38. 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 manager has a good understanding of the areas in which the home needs to improve and planning is in place to identify how this is to be managed for the benefit of the service users. EVIDENCE: Since the last inspection, the manager of the home has been registered with CQC as required. The manager continues to develop her knowledge and understanding through continued training and evidence of this is held in the home. Staff spoke highly of the manager and said that her open door policy Mossley Manor DS0000025193.V375375.R01.S.doc Version 5.2 Page 20 made them feel comfortable about approaching her at any time. One member of staff said that she was very supportive. The manager speaks with service users and relatives on a one to one basis to obtain their views of the home to further improve the quality of service provision. The records held in the home, observation of staff interactions with service users and from comments from service users and staff, show that the home is run in the best interests of the service users. No monies are held in the home on behalf of service users however, the owner oversees the financial affairs for one service user. These records were not available at this inspection but have been inspected at previous inspections. It will be necessary for records to be made available for inspection at the next inspection. The home is decorated, furnished and maintained to a good standard. Health and safety issues are addressed as soon as they are identified to ensure the protection of staff and service users. A maintenance book is held in the home and record of all repairs necessary are recorded together with confirmation of completion. Equipment used in the home is inspected regularly by appropriate companies and evidence of this is held. All safety certificates inspected were well maintained and up to date. Regular tests are made on the fire detection equipment and records held. Fire drills are undertaken on a regular basis to ensure that all staff are aware of the action to be taken. Training on fire protection is given to all staff. The owner of the home visits on a regular basis and completes a report of the findings of the visit as required. Mossley Manor DS0000025193.V375375.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People 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 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Mossley Manor DS0000025193.V375375.R01.S.doc Version 5.2 Page 22 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP12 OP12 Good Practice Recommendations Consideration should be given to reviewing the outcomes of fund raising to enable a higher level of funding for service users social activities to be made available. The records relating to the activities that service users participate in should be held in the office to ensure that they are accessible to the manager and care staff. Mossley Manor DS0000025193.V375375.R01.S.doc Version 5.2 Page 23 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. 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