Inspection on 19/08/09 for Park House

This inspection was carried out on 19th August 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 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Similar services:

Chesham House

Argyll House

Dorset Lodge

Acacia House

Falcon House

Dial House Nursing Home

Cromwell Avenue (9)

Abbey Lodge

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

Key inspection report CARE HOME ADULTS 18-65 Park House 72 Constable Road Felixstowe Suffolk IP11 7HW Lead Inspector Jenny Elliott Key Unannounced Inspection 19th August 2009 09:45 Park House DS0000073209.V377013.R01.S.doc Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care home adults 18-65 can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Park House DS0000073209.V377013.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 Park House DS0000073209.V377013.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Park House Address 72 Constable Road Felixstowe Suffolk IP11 7HW 01394 284021 01394 277549 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) MPL Care Homes Limited Manager post vacant Care Home 5 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (5) of places Park House DS0000073209.V377013.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: 2. Mental Disorder, excluding learning disability or dementia - Code MD The maximum number of service users who can be accommodated is: 5 19th August 2009 Date of last inspection Brief Description of the Service: Park House is a rehabilitation service for up to 5 people suffering from a mental disorder. It is located in a residential area of Felixstowe, close to shops and other local amenities. The service aims to help people build social and independent life skills, as well as supporting them with their health and personal needs. The service is provided in a recently renovated 5 bedroom house. All areas of the home are domestic in style. Each room has its own en-suite shower and toilet, and there is a shared bathroom also available. In addition there is a communal lounge, kitchen/diner and a seating area in the garden. At the time of this inspection fees ranged from £1,150 to £1,200 per week, depending upon the needs of the individual. This included accommodation, care, food and some outside activities. The home provides some toiletries, but where specific brands are preferred individuals are expected to purchase their own. Park House DS0000073209.V377013.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 1 star. This means the people who use this service experience adequate quality outcomes. Two visits to the home were made to complete this inspection. A second visit was required because some key documents are held electronically and the computer was not working at the first visit. During these visits we looked at records held by the home belonging to the people who live there and relating to the recruitment and training of staff, as well as other records regarding the running of the home. We also looked at all of the rooms in the home and spent time with people who live there. In addition we looked at information that we have received, or requested, since the home was registered on 4th March 2009. This includes the Annual Quality Assurance Assessment (AQAA); this is a self-assessment report completed by the service and provides us with information about how they are meeting the needs of people living in the home. What the service does well: What has improved since the last inspection? What they could do better: Park House DS0000073209.V377013.R01.S.doc Version 5.2 Page 6 The records relating to the administration of medication were not always complete or clear. They must be reviewed and checked to ensure that people are receiving the correct medication and that any errors are quickly identified. 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. Park House DS0000073209.V377013.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Park House DS0000073209.V377013.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,5 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People coming to live at the home can expect to have their needs fully assessed and to take a full part in that assessment. EVIDENCE: At the time of this inspection there were two people living in the home. The records belonging to both people were inspected in detail. These included the pre-admission assessments. The assessments were detailed and covered all areas of care and social support. Each area of assessment clearly stated a persons needs, the action to be taken and why and the views of the service user. The assessments also included information about personal histories and risk assessments. In each section of the functional assessment form the people coming to live in the home were asked for their input. The risk assessments referred to risks associated with mental health as well as physical health and the main part of the assessment included details of behaviours that might indicate deterioration in a person’s mental health. This shows that the service has taken steps to gather as much information as possible from a range of people. This is important because it allows the service to make an Park House DS0000073209.V377013.R01.S.doc Version 5.2 Page 9 informed decision about whether or not it can care for the person, and if so how the care and support should be provided. A summary of the terms and conditions, including expected behaviours, of residency was in each person’s record. The service has a comprehensive statement of purpose and a smaller service user guide that outlines the key aims and objectives of the service. Both of the people living in the home had a copy of the statement of purpose in their room. Park House DS0000073209.V377013.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,9 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live in the home can expect to be listened to by staff and to make decisions about how they live their life. EVIDENCE: The AQAA completed by the home states ‘The emphasis will be on the encouragement of the service user to make an informed choice about what s/he wishes to achieve during their stay at Park House.’ The evidence found during the inspection supported this. It was observed, during the inspection, that the people living there made choices throughout the day about what they did, where they went and what they ate. Where appropriate, staff offered guidance about choices. During the Park House DS0000073209.V377013.R01.S.doc Version 5.2 Page 11 visit one person went, with a member of staff, to the dentist and the shops, another person went for a walk in the local park. One person cleaned their room, again with support from staff. One person had joined a local gym and the manager had provided information for the gym about the support the person would need. The care plan for each person included the development of social, personal and independent living skills. Two weeks entries in the daily log for each person were read. The log was written in a way that promoted the dignity of each person and described the range of activities and outings that each person had undertaken. The activities were relevant to each person and directly related to their personal interests. Each person had a certificate of achievement presented when they had achieved something that had been identified on the care plan. They retained these in their rooms, and seemed proud of them when they showed them to me. At the second visit to the home, the individual progress review for one service user was seen. This is used to plan for a meeting with the service user, relevant professionals and staff to review the progress a person has made and to plan for the future. The service user is asked who they wish to attend the meeting. The first part of the form summarises the strengths and on-going needs of each section of the care plan, this is expanded later on in the form. In the latter section there is specific targets and action identified by the service to ensure continued development appropriate to each individual. This is important because it ensures that all of the people important to the wellbeing of people living at the home are involved and clear about the service that will be provided. Both of the people living in the home manage their own finances. Comprehensive risk assessments formed part of the assessment process. They outlined action to be taken to minimise risks rather than avoiding activities that may contain risk. A comment from one relative, in the homes comment book said ‘Thank you for helping [service user] to get better and to get his confidence back’ and from a visiting professional ‘ The residents have choice in all aspects of their care and are encouraged to go out and try new things.’ One of the people living at the home was asking who might be visiting on the day of the inspection and said they liked having visitors. The AQAA from the home stated that ‘wherever possible, service users are consulted about the day-to-day life of the home and its management’. A service user meeting had been held in August. Staff had taken time to explain to people living there how to make a complaint. People living in the home had said they would like roast lamb for Sunday lunch, diet sheets showed that this had been provided. Park House DS0000073209.V377013.R01.S.doc Version 5.2 Page 12 Park House DS0000073209.V377013.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): This is what people staying in this care home experience: 12,13,14,15,16,17 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at the home can expect to lead meaningful lives and develop their social and life skills. EVIDENCE: People living in the home were taking part in meaningful activities. The daily logs, and observation during the inspection, showed that they played a significant role in the day to day running of the home. This included making decisions about and shopping for food, keeping their own rooms clean and tidy, clearing up after themselves’ in the house and, with support, doing their laundry. Park House DS0000073209.V377013.R01.S.doc Version 5.2 Page 14 The daily logs also showed that one person used the local library and the other a local church, as well as the local park and gym. One person said they enjoyed the trips to the local pub, where they played pool. Although there were no friends or relatives visiting on the day of the inspection, the visitors’ book and other records showed that each person had regular visitors. The relative of one person said ‘[service user] looks so relaxed and seems an awful lot happier that I have seen [them] for a long time.’ In addition to providing support with daily tasks, staff were observed sitting with people who lived at the home and accompanying them on visits outside of the home. When service users wished, they took themselves to their rooms or one of the shared areas of the home. Lunch was observed during the visit to the home. Both of the people living in the home chose what they wanted. One of the service users sat in the garden with staff to eat their lunch and the other person chose to eat on their own. There was evidence in the records belonging to people who live at the home, that medical advice had been sought to help one person manage their weight and that the advice given was being followed by the person, with support from staff. Park House DS0000073209.V377013.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at the home can expect their health needs to be promoted. They cannot be confident that the records relating to the administration of medication will be kept in good order. EVIDENCE: The care plans belonging to the people who live at the home, suggest that personal care is provided in the way that they want. Staff described how they helped one person with their personal care in a manner that supported their privacy, dignity and independence. Records also showed that staff had supported people when attending appointments with medical professionals. On the day of the inspection, one person was accompanied to the dentist. On their return they said that the Dentist had said they had good teeth, and discussed with the member of staff Park House DS0000073209.V377013.R01.S.doc Version 5.2 Page 16 who had accompanied them what they needed to do to ensure this continued to be the case. As has already been stated, one person was being helped, through regular exercise, support with food choices and increased activities to reduce the use of take away foods, to manage their weight. The medication administration records (known as MAR sheets) and controlled drugs register were inspected. The records were not as clear as they should be. There were some unfilled lines in the controlled drugs record and on some occasions the second signature was missing Some MAR sheets had been stopped half way through the record and new sheets started. In some instances this made it difficult to ascertain what drugs had been administered. At the second visit to the home, the records were inspected again. The manager and a senior member of staff had counted the medication stored, but had not compared this with what had been received and administered. A new prescription for antibiotics had been received by one service user in between the two visits to the home. The pharmacist had not provided a MAR sheet for this medication and the home had drawn up its own, but not until 3 days after the service user had begun taking the medication. Most, but not all, of the administered medication had been recorded in the person’s daily log. An audit of two different medications was undertaken during the two visits to the home. The total in stock tallied with the medication prescribed, but not necessarily the medication signed as having been administered. It is important that clear records are available with regard to the administration, ordering and record keeping of drugs, this helps to ensure that people receive the correct medication and that if there are problems a clear audit trail to identify how much of any one drug has been taken is easily available. An immediate requirement notice was left with the service, requiring them to audit all of the drugs currently used by people living at the home. This is to ensure that the correct medication has been administered, and to identify problems with the current system. The service was required to send a report of this audit to the Commission by 3rd September 2009. A copy of the audit of all drugs currently used by people living at the home, and the review of procedures was received by the Commission on the 26th August. The review included information about what the home was going to do to ensure that records relating to the administration of medication would be managed in a way that protected the people who live at the home. Park House DS0000073209.V377013.R01.S.doc Version 5.2 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at the home can expect to be listened to and to be protected by well trained and recruited staff. EVIDENCE: As has been previously stated, the service had explained to people living there how to make a complaint if there was something they were not happy with, and each person had a copy of the complaints policy in their room. The service has only been opened a short time and in that time has not received any complaints. The commission has not received any complaints or concerns about the service. Staff have undertaken training in respect of safeguarding vulnerable adults and the services safeguarding policy was checked as part of the registration process. Park House DS0000073209.V377013.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 24,30 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at the home benefit from a clean, fresh, homely environment. EVIDENCE: This service was first registered this year. The standard of accommodation has been maintained as at the time of registration. The home was clean, odour free and well decorated and furnished. Both of the people living in the home showed me their rooms. They were both well furnished and reflected the interest of the person who was living there. The home has a garden with patio area that was well used by people living there on the day of the inspection. The kitchen and laundry facilities were domestic in nature, and the whole building had a modern but homely feel. Park House DS0000073209.V377013.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 32,34,35 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at the home can expect to be cared for by staff who are suitable to work in the home and are trained to meet their needs. EVIDENCE: The recruitment records for staff were all held on the computer. At the first visit there was a problem with the computer and therefore it was necessary to return on a second day. The manager had ensured that back up records were available to view on a separate screen, and this meets the requirements of regulation that such documents are available for inspection. The records of one member of staff were inspected. They included an application form, CV, notes from the interview, documents to confirm ID, photograph, Criminal Record Bureau Check and references. The way that information had been collected about the persons working history, meant that there was no record of gaps in employment or reasons for leaving Park House DS0000073209.V377013.R01.S.doc Version 5.2 Page 20 employment. This is important because it helps to reduce the risk of relevant information being missed. The home has a comprehensive training programme, and staff are expected to demonstrate their understanding of training by completing post training questionnaires and achieving a score of at least 80 . There was evidence to show that where this was not achieved, time was spent with the manager reviewing the learning before retaking the test. This helps to demonstrate that the service has a commitment to training impacting on the quality of care provided. Training included areas of knowledge specific to the needs of people with mental health problems, for example, mental health awareness, Aggression and challenging behaviour and the Mental Capacity Act. Park House DS0000073209.V377013.R01.S.doc Version 5.2 Page 21 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 37,39,42 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at the home can expect it to be run in their best interests. EVIDENCE: At the time of this inspection there was no registered manager in post. A manager had been registered when the service was registered at the beginning of the year, but that person had since left. The Commission was advised of this at the time. The person acting as manager was the person registered by the Commission as the responsible individual for the company that owns the home. Another person connected with the company was Park House DS0000073209.V377013.R01.S.doc Version 5.2 Page 22 carrying out what are known as Regulation 26 visits to the home. These are monthly visits that enable the provider to check that the service is being run properly. The reports from these visits were inspected. They were detailed and contained some constructive comments to help the service improve. The reports were made available to staff, and staff signed them to show that they had read them. The acting manager advised that the position of registered manager would be reviewed as the number of people living at the home increased and the staff team became more established. The home had a quality assurance policy in place, it was not possible to inspect how well it would measure the quality of the service provided as it was a new home and the process had not yet been completed. There was evidence, including the visitors comment book, service user and staff meetings and meeting with other professionals, that the service did listen to and take account of the views of stakeholders. This is an important aspect of quality assurance and one of the aims of the service. At the time of this inspection the service was not looking after money for either of the people living in the home. Records relating to the building including gas and electricity checks had been seen at registration and were not inspected at this visit. Record documenting that the fire alarm system was being checked on a regular basis were not found at the first visit, but were available for inspection at the second. These showed that two call points had been checked each week since people began living at the home. As stated earlier in the report, the records relating to the receipt and administration of medication were not complete and the home was required to carry out an audit of these. This was done promptly and a review of practice led to the development of an action plan including regular audits in the future. Park House DS0000073209.V377013.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 N/A 4 N/A 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 N/A 26 N/A 27 N/A 28 N/A 29 N/A 30 3 STAFFING Standard No Score 31 N/A 32 3 33 N/A 34 2 35 3 36 N/A CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 N/A 3 N/A LIFESTYLES Standard No Score 11 N/A 12 3 13 3 14 N/A 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 1 N/A 3 N/A 3 N/A N/A 3 N/A Version 5.2 Page 24 Park House DS0000073209.V377013.R01.S.doc No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA20 Regulation 13 Requirement The service must audit and review systems in place for the receipt, administration and recording of medication. This is to ensure that people who live at the home receive their medication as prescribed. Timescale for action 03/09/09 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 YA34 Refer to Standard Good Practice Recommendations The service should ensure that the reason for any gaps in a persons’ employment history, and the reasons for leaving employment, are recorded. This is to ensure that all information relevant to a person’s employment at the home is available. Park House DS0000073209.V377013.R01.S.doc Version 5.2 Page 25 Care Quality Commission East 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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