Inspection on 10/03/09 for West Drive

This inspection was carried out on 10th March 2009.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

West Drive 30/08/07

Similar services:

Coopers Mill Ltd

Bramley Avenue (73)

Paradise Lodge

Grangewood

Upaya Ananda

Newton Court (1-2)

Kings Lane (32)

Pemdale

Extracts from inspection reports are licensed from CQC, this page was updated on 09/06/2011.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: West Drive 1 West Drive Arlesey Bedford SG15 6RW The quality rating for this care home is: one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Angela Dalton Date: 1 0 0 3 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. They reflect the things that people have said are important to them: 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 Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) 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 Commission for Social Care Inspection aims to:  Put the people who use social care first  Improve services and stamp out bad practice  Be an expert voice on social care  Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 29 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (20092008) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 29 Information about the care home Name of care home: Address: West Drive 1 West Drive Arlesey Bedford SG15 6RW 01462835490 01462734975 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : www.milburycare.com Milbury Care Services Ltd care home 10 Number of places (if applicable): Under 65 Over 65 10 0 learning disability Additional conditions: The maximum number of service users who can be accommodated is 10. The registered persons 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 are within the following category: Learning disability - code LD. Date of last inspection Care Homes for Adults (18-65 years) Page 4 of 29 A bit about the care home The Commission for Social Care Inspection (CSCI) registered West Drive as a care home for up to eight people with a learning disability in March 2007. The home is a detached property in a large secure garden in the Mid Bedfordshire village of Arlesey. The home is currently on the edge of a new housing development being built on the site of an old hospital. It is close to local shops and other amenities. There is a bungalow next to the main house which has a bedsit layout for two people and houses a third bedroom for sleep in staff. The home benefits from space, as in addition to each of the people using the service having their own large ensuite bedrooms there is a communal lounge, dining room, activity room, and quiet sensory room (with snoezelen equipment) The lounge opens onto decking and onto a large garden. There is an outbuilding for which there are plans to renovate it and make it a second activity room for the service users. There is parking inside the grounds and on the road outside. The home is close to a bus route. Care Homes for Adults (18-65 years) Page 5 of 29 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 Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home Care Homes for Adults (18-65 years) Page 6 of 29 How we did our inspection: This is what the inspector did when they were at the care home One inspector conducted this unannounced site visit on 10th March 2009 between 9.20am and 4.10pm. Three people were case tracked. We followed the care of people who use the service to ensure the care they receive is reflected in the care plan and meets their individual requirements. The case tracking process cross references all the information gathered to confirm that what we are told is happening is actually occurring, and, reflects the Statement of Purpose, which contains the aims and objectives for the service. We spoke to the people who use the service and members of the staff team and the manager. We were present for lunch and observed interaction between staff and people who use the service. We toured the building and examined documentation to check that what was happening in the service was being recorded. The services monthly fees are under review but currently range from 1250.01 pounds to 1923.01 pounds. This does not include toiletries and private chiropody and other personal expenses. Care Homes for Adults (18-65 years) Page 7 of 29 What the care home does well What has got better from the last inspection Despite the recent challenges the requirements made at the previous inspection have been met. The service user guide which mirrors information in the statement of purpose is in a user friendly format. Care plans are written with the involvement of family members and the acting manager is exploring ways of reflecting service user involvement. The individual preferences of people are reflected in their care plan. The Care Homes for Adults (18-65 years) Page 8 of 29 operational manager is researching how person centred plans can be developed for people using the service. Risk assessments held in care plans now only refer to that individual. Each person has an individual activity programme and there is evidence that individual meal choices are reflected in the menus. Medication procedures are followed correctly and an audit trail is available as records reflect the amount and type of medication coming into the home. There is an up to date training plan to reflect what training is available. Staff sign documents to evidence that they are accurately completed. Health and safety checks are carried out at regular intervals. What the care home could do better The service would benefit from a registered manager. This would ensure staff received constant support and an identified person was in post to review the delivery of care on a permanent basis. Health plans would evidence the health care requirements of people were met and any potential problems were identified and managed. The operational manager is researching more appropriate fixtures and fittings to meet the specialist needs of people who use the service. Care Homes for Adults (18-65 years) Page 9 of 29 If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact Angela Dalton 33 Greycoat Street London SW1P 2QF 02079792000 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 set out 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 Adults (18-65 years) Page 10 of 29 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 11 of 29 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, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. 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 the person 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. The necessary information is in place to enable people who use the service to make an informed choice about moving in. Evidence: The service has not had any new admissions since the previous inspection in August 2007. The statement of purpose had been reviewed in January 2009 to reflect that information is current. Each service user has a copy of the service users guide. This outlines what faciliities the service offers and what is available in the local area. It is in a user friendly format and contains pictures and large print text to ensure it is easily understood. The service currently has one vacancy. The acting manager and operational manager both confirmed that any new admission to the home would be carried out with careful consideration to the needs of current service users. Members of the management team would conduct the assessment and ensure a phased moving in process rather than an emergency admission. Each person had a contract which outlined the terms and conditions of the home and what services could be expected whilst living at West Drive. This has replaced the temporary version that is initially issued following moving into West Drive. The registration certificate reflected current details about the service providing up to date information to people who use the service. Care Homes for Adults (18-65 years) Page 12 of 29 Care Homes for Adults (18-65 years) Page 13 of 29 Individual needs and choices 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 needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. 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. Inividuals are encouraged to make their own decisions and choices. Evidence: We looked at 3 care plans. Information is recorded at the end of each shift to ensure that staff have a clear picture of individuals needs and what activities have taken place. It also enables staff to identify any current or potential issues that may require attention. Staff have a good awarenesss and insight into working with people with Autism and understand the importance of routine and consistency. Care plans were divided into specific areas. There was information to enable staff to meet daily living skills such as personal care and nutrition. Individual likes and dislikes were recorded for leisure activities and food. There was information to reflect how complex needs, including behaviour, are managed and monitored. Staff confirmed that they had adequate information to work alongside people and meet their behavioural needs. There were records to assist staff to identify behavioural triggers and enable them to use techniques and distrations to prevent escalation. Monthly reviews have recently been introduced to ensure any required changes are made and recorded. The operational manager is exploring how Person Centred Planning can be introduced into the service to ensure peoples hopes, dreams and aspirations are recorded and incorporated into their daily care. This would further support the long and short term Care Homes for Adults (18-65 years) Page 14 of 29 Evidence: goals that have been identified. Risk assessments reflected how individuals were assisted in managing risks, such as crossing the road. There are plans to review some risk assessments and practices, such as locking toiletries away and locking toilet doors in line with the Deprivation of Liberty aspects of the Mental Capacity Act. Each person who uses the service receives family support but independent support could be sought from Advocacy Alliance if necessary. Important family information was recorded such as birthdays to ensure that staff could assist in sending a card or gift. Some families had signed care plans to reflect involvement. The acting manager is exploring ways to reflect how people have been involved in devising their care plan or if it has been explained to them. We observed staff communication with people in a way which they could understand, using Makaton signs where appropriate. This supported information recorded in care plans. Care Homes for Adults (18-65 years) Page 15 of 29 Lifestyle 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 can take part in activities that are appropriate to their age and culture and 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 and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. 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 who use the service are able to make choices about their lifestyle and how they spend their leisure time. Evidence: The service has 2 vehicles; a people carrier and an estate. The people carrier was in for repair on the inspection. Some people went out for a drive and cafe visit to Dunstable Downs whilst others went for a walk around the local fields during our visit. Staff aim to ensure people go out each day as remaining at home can quite often be counter productive and may result in people becoming agitated. Each person has a leisure and activity timetable. Some people attend college and staff are in the process of planning holidays but nothing definite has yet been arranged. People participate in the running of their home and assist with cooking and cleaning where possible. They are supported to do their laundry and each person has 2 half days assigned. There is a computer for service users but this does not have internet access. One service user regularly uses the computer in the office to gain access to the internet. A request has been submitted to the company for internet access for people who use the service and an outcome is awaited. Some people were watching a DVD with staff and Care Homes for Adults (18-65 years) Page 16 of 29 Evidence: others were drawing. The service has a snoezelen (sensory) room on the ground floor which can be used for relaxation. There is an activity room located in the garden with a pool table and karaoke machine. However, the room is not effectively heated and tends to be used more in the warmer weather. The large garden can be accessed and there is eqipment to use such as a trampoline and ball pool. The garden also provides an opportunity for people who use the service to let off steam. A new televison and DVD player are awaiting a cabinet to be fitted to as previous items have been dismantled. We observed lunch and staff ensure that they eat with service users to promote it as a social occasion. Individual likes and dislikes are recorded on care plans. There is a white board to display daily menu options but the current system using velcro to dispay choices is not working well as service users remove the display. An alternative display system is being researched by the acting manager. Service users go shopping locally for food and likes and disilikes are sought at house meetings or one to one work with staff. Where there are issues with meals and nutrition specialist input is sought. Care Homes for Adults (18-65 years) Page 17 of 29 Personal and healthcare support 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 receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people 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. If people are approaching the end of their life, the care home will respect their choices and help them to 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. Records do not reflect how individual health needs are met or how potential problems or complications are avoided. Evidence: Service users have access to health and social care professionals and this was reflected in care plans and reviews. We looked at how health needs were recorded and monitored in three care plans. People do not have separate health plans but there is some reference to health needs. However, we could not find guidance to reflect how needs are monitored managed or met - specifically in the case of one persons care plan to mange continence and epilepsy. They had not had a seizure for several years but there was no information to reflect what type of seizures they had experienced to assist staff to recognise if it had returned. There were no guidelines to reflect how staff assisted a person to manage their continence needs. Staff were observed to be discreet and appropriate in their support but it was not clear how consistency was achieved or how any problems were monitored. Records did not guide staff about the type of pads that were required or how frequently they needed to be changed. There was some advice in the district nursing notes about increasing fruit and fluid but no reflection how this was implemented or monitored. The district nurses advice and input was not reflected in a care plan. Advice for laxatives to cease for one week had been recorded in the medication administration records but there was no supporting information to guide staff what to do after a week or the reason why medication had Care Homes for Adults (18-65 years) Page 18 of 29 Evidence: stopped. We asked the operational manager and acting manager if this information was recorded elsewhere but it was not and could no be found in the care plan. We checked 2 peoples medication and the amounts were accurate and clearly recorded. Records of medication coming into the home were recorded to ensure an audit trail was available. There were no records of storage temperatures being kept but this was rectified during the inspection to ensure medication is stored correctly. All staff receive medication training. Care Homes for Adults (18-65 years) Page 19 of 29 Concerns, 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. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. 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. Staff have a clear understanding of the safeguarding procedure. Evidence: People who use the service and staff have experienced a difficult few months because of the situation involving a previous service user. The funding authority took the lead regarding safeguarding and staff followed the procedure appropriately. The acting manager will ensure that there is a copy of the local authoritys procedure available in the service. All staff complete safeguarding training. We were assured by a senior support worker that all behavioural incidents between service users were reported to the safeguarding team. We checked two financial records and found them to be in good order. There had been no complaints recorded since the previous inspection. Each service user has a copy of the complaints procedure in an easy read format. Care Homes for Adults (18-65 years) Page 20 of 29 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, comfortable, 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. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service provides a clean and comfortable environment to live in, which encourages independence. Evidence: The house was clean, tidy and odour free on the day we visited. There has been carpet fitted on the hall stairs and landing to aid in soundproofing the wooden floor and to reduce the loss of DVDs and CDs down the floorboard gaps. The hallway, stairwell and living room have been redecorated since the previous inspection. The activity room is scheduled for redecoration and colour charts are in place for people to choose from. The staff have access to cordless phones so that help can be summoned quickly if needed. There is a skip due for removal in the front garden whilst the vacant room has been cleared and redecoration has been carried out. Bedrooms are personalised but not all furniture is suitable to meet the needs of people who use the service. One person is currently using the shower facilities in the staff sleep in room as they have removed the bathroom tiles and broken items of furniture in their bedroom. The acting manager and operational manager plan to research furniture that is more substantial and better suited to meet peoples specialist needs. There is evidence of this with the plans to fit a more substantial television cabinet. The maintenace department visited during the inspection to review the work needed to repair the ensuite bathroom. Since the previous inspection the garden has been tidied and garden furniture is used during the warmer weather. In addiion to the main house there is also a bungalow which is home to 2 people and Care Homes for Adults (18-65 years) Page 21 of 29 Evidence: has a sleep in room. This was in good order. As stated earlier, the acting manager will review the locked door policies to ensure that the Mental Capacity Act is observed. Care Homes for Adults (18-65 years) Page 22 of 29 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, qualified 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. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. 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 who use the service receive support from competent and trained staff. Evidence: We examined 3 recruitment records and the pro forma that is used reflected that all required checks to protect service users had been conducted. The pro forma is in place as an agreement has been made between Voyage and the Commission for Social Care Inspection that the Professional Relationship Manager for CSCI can check records at the head office. The acting manager has successfully recruited several staff which has led to an improvement in morale. 4 full time staff are awaiting start dates and a part time vacancy of 27 hours needs to be filled. 6 staff work on an early and late shifts with an additional member covering the middle shift. 2 staff work waking nights with a member of staff sleeping in at the bungalow. Vacant hours are covered by staff or agency. There is a policy to ensure that agency staff do not observe personal care during the first week of work to ensure that service users dignity is observed. All staff are completing the Learning Disability Qualification and 10 out of 25 staff have an NVQ qualifiction: 1 at level 4, 2 at level 3, 7 at level 2. The acting manager has completed a training matrix to reflect that staff have completed all necessary mandatory training. All staff have access to electronic teaching sessions known as the L box, which provides them will a rolling training programme. They have also completed specialist training to assist in meeting specialist needs such as Non Violent Crisis Intervention training. Care Homes for Adults (18-65 years) Page 23 of 29 Conduct and management of the 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 have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because 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. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. 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. The service has an effective quality assurance system in place and the acting manager ensures that the focus is upon people who use the service. However, the sevice would benefit from the consistent approach of a permanent manager. Evidence: The service is currently without a manager and despite concerted efforts by the operational manager two recent recruitment drives have been unsuccessful. The company has now registered with a recruitment agency. In the meantime the service is being supported by anothe home manger who vists 3 times each week. Staff stated that they felt supported and that the home had settled since their involvement. They have worked for voyage for 6 years and have implemented many improvements since becoming involved with West Drive. Staff now receive regular supervision and this is cascaded from the management team. The operational manager has conducted an operational review as part of their monthly visit and overview of the running of the home. This has identified the areas of the service which require attention. This has also added to the quality assurance process. People who use the service are asked to contribute their views and families are asked to complete questionnaires. The findings form part of the quality assurance report which family members are informed about. Familiy members can also meet the Operational Manager at the Annual Service Review as part of the companys Letting us Care Homes for Adults (18-65 years) Page 24 of 29 Evidence: know what you think policy. Regualr health and safety checks are conducted. A fire plan is in place and fire drills are conducted at night and during the day to ensure all staff employed are familiar with the procedure. The acting manager is investigating the sporadic problem of water being too hot in one bedroom and is implementing a risk assessment to manage the situation. Care Homes for Adults (18-65 years) Page 25 of 29 Are there any outstanding requirements from the last inspection? Yes  No  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 Adults (18-65 years) Page 26 of 29 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 Description Timescale for action 1 37 8 A manager must be registered with the Commission for Social Care Inspection. 30/06/2009 The service would benefit from the constent approach a permanent manager could offer. 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 Description Timescale for action 1 19 12 Records must reflect how individual health needs are monitored, managed and reviewed. 31/05/2009 This will ensure that individual health needs are addressed appropriately and any complications or problems are dealth with at an early stage. Care Homes for Adults (18-65 years) Page 27 of 29 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 Care Homes for Adults (18-65 years) Page 28 of 29 Helpline: Telephone: 03000 616161 or Textphone : or 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. 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