Care Home: 139 Homefield Road (Homefield College)

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What the care home does well Although no one new has moved into the home, the manager and staff continue to find out about the needs of people who live in the home and check whether the home is able to give them the support they need. There is good written information which tells staff about people`s needs and what kind of support and help they want. Staff give good support to people. There is a good easy-going relationship between staff and people who live in the home. People have the confidence to ask staff for what they want.People who live in the home enjoy a good lifestyle - they are able to do different activities that they enjoy, both in the home and in the community. Friends and relatives are welcome in the home. People are enabled to be independent, and are supported to develop skills, like budgeting and cooking. Staff make sure that they support people to follow up any health concerns that people have. Everyone has a local GP and has health checks that they need to help them stay healthy.The home is clean and comfortable for people who live there. Everyone can have their own things in their bedrooms. Staff get training in different subjects to help them to do their job well. There are policies which tell the staff how to do their job well. Checks are done to make sure equipment is safe. Staff support people to look after their money and to manage how they spend it. What has improved since the last inspection? Some actions were required after the last inspection and these have been carried out: The manager has made sure that information about health and safety in the home is up to date. The provider is making regular visits to the home to check how things are going and making reports about these visits. The manager and staff are getting the views of people who live in the home to find out what they think, and what ideas they have about how things can be improved.Page 9 of 30Care Homes for Adults (18-65 years)Staff are told about how to work safely to prevent infection spreading. They are given protective equipment to help with this. There are policies and procedures, including risk assessments carried out for people who deal with their own medication. People who live in the home are involved with their care plans and sign them. What the care home could do better: The provider must ensure that two written references are obtained for new staff before they start employment in the home. When we pointed this out, the process for collecting references was immediately changed by the service.The provider must ensure that where water temperatures are found to be higher than a safe level, a risk assessment iscarried out and action taken to ensure people who live in the home are kept safe from risks of scalding.It would be good if more of the policies and procedures were written in plainer language, with pictures to aid understanding.It would be good if weight records were kept only in individuals` files, and not in a shared book - to enable privacy and dignity. It would be good if the service updated its information so that people had accurate details about who to contact if they want to make a complaint or report any safeguarding issues. Although the provider takes care to make sure people are safe, it would be better if the home only started employees in exceptional circumstances before full Criminal Records Bureau clearance is obtained. Key inspection report Care homes for adults (18-65 years) Name: Address: 139 Homefield Road (Homefield College) 139 Homefield Road Sileby Loughborough LE12 7TG The quality rating for this care home is: two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Chris Wroe Date: 2 6 0 5 2 0 0 9 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. The first part of the review gives the overall quality rating for the care home:  3 stars – excellent  2 stars – good  1 star – adequate  0 star – poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area Outcome area (for example: Choice of home) These are the outcomes that people staying in care homes should experience. 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 Care Homes for Adults (18-65 years) Page 2 of 30 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 mission of the Care Quality Commission is to make care better for people by:  Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice  Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983  Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services.  Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 30 Information about the care home Name of care home: Address: 139 Homefield Road (Homefield College) 139 Homefield Road Sileby Loughborough LE12 7TG 01509814827 01509815696 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.homefieldcollege.ac.uk Homefield College Limited care home 4 Number of places (if applicable): Under 65 Over 65 4 0 learning disability Additional conditions: No additional conditions of registration apply. Date of last inspection Care Homes for Adults (18-65 years) Page 4 of 30 A bit about the care home 139 Homefield Road is a four bedroom, semi-detached bungalow situated on a residential road in Sileby. The home is one of seven, which are managed by Homefield College. The home is a converted and extended bungalow. Shared accommodation consists of a large lounge (with office accommodation at one end), kitchen (including a dining room), and an enclosed garden. There are four bedrooms. The range of fees charged is £470-£800. Care Homes for Adults (18-65 years) Page 5 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home 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 30 How we did our inspection: This is what the inspector did when they were at the care home We visited the home on 26th May 2009, and went to the main college office to look at records on 10th June 2009. Our visit to the home and to look at records lasted a total of 5 hours. The main way we do our inspections is using a method we call case tracking. This means looking at the care given to people in different ways. The ways this was done are: - talking to the people who live in the home - talking to staff and the manager - watching how people are given support - looking at written records. We talked to three people who live in the home during our visit and spent some time with people and with staff. We watched to find out how comfortable people were in their home. We spoke to one member of staff during our visit to the home, who told us about working in the home and gave us their views. We checked all the standards that the Care Quality Commission has decided are key standards during this inspection. The information in this report just about what we checked in this inspection. We have kept details about individual people out of the report, to make sure these things are kept confidential. Care Homes for Adults (18-65 years) Page 7 of 30 What the care home does well Although no one new has moved into the home, the manager and staff continue to find out about the needs of people who live in the home and check whether the home is able to give them the support they need. There is good written information which tells staff about peoples needs and what kind of support and help they want. Staff give good support to people. There is a good easy-going relationship between staff and people who live in the home. People have the confidence to ask staff for what they want. People who live in the home enjoy a good lifestyle - they are able to do different activities that they enjoy, both in the home and in the community. Friends and relatives are welcome in the home. People are enabled to be independent, and are supported to develop skills, like budgeting and cooking. Staff make sure that they support people to follow up any health concerns that people have. Everyone has a local GP and has health checks that they need to help them stay healthy. Care Homes for Adults (18-65 years) Page 8 of 30 The home is clean and comfortable for people who live there. Everyone can have their own things in their bedrooms. Staff get training in different subjects to help them to do their job well. There are policies which tell the staff how to do their job well. Checks are done to make sure equipment is safe. Staff support people to look after their money and to manage how they spend it. What has got better from the last inspection Some actions were required after the last inspection and these have been carried out: The manager has made sure that information about health and safety in the home is up to date. The provider is making regular visits to the home to check how things are going and making reports about these visits. The manager and staff are getting the views of people who live in the home to find out what they think, and what ideas they have about how things can be improved. Page 9 of 30 Care Homes for Adults (18-65 years) Staff are told about how to work safely to prevent infection spreading. They are given protective equipment to help with this. There are policies and procedures, including risk assessments carried out for people who deal with their own medication. People who live in the home are involved with their care plans and sign them. What the care home could do better The provider must ensure that two written references are obtained for new staff before they start employment in the home. When we pointed this out, the process for collecting references was immediately changed by the service. The provider must ensure that where water temperatures are found to be higher than a safe level, a risk assessment is Care Homes for Adults (18-65 years) Page 10 of 30 carried out and action taken to ensure people who live in the home are kept safe from risks of scalding. It would be good if more of the policies and procedures were written in plainer language, with pictures to aid understanding. It would be good if weight records were kept only in individuals files, and not in a shared book - to enable privacy and dignity. It would be good if the service updated its information so that people had accurate details about who to contact if they want to make a complaint or report any safeguarding issues. Although the provider takes care to make sure people are safe, it would be better if the home only started employees in exceptional circumstances before full Criminal Records Bureau clearance is obtained. Care Homes for Adults (18-65 years) Page 11 of 30 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 Chris Wroe CPC1 Capital Park Fulbourn Cambridge Cambridgeshire CB21 5XE 01223771300 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 12 of 30 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 13 of 30 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. People who live in this home benefit from ongoing assessment of their needs and a supportive living environment. Evidence: No one new has moved into the home since we did our last inspection. We found that the staff still met the needs of people living in the home. Staff have ongoing training to help them to meet peoples needs. Written information is given to people who come to live in the home, to tell them about the home and about what they can expect. It would be good if some of the policies were written in plain English with pictures, to aid communication. Care Homes for Adults (18-65 years) Page 14 of 30 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. People who live in this home benefit from having their needs met and having choice over their daily lives. Evidence: People we spoke to, who live in the home, told us that they feel well cared for by staff. We saw that staff have good, easy-going and respectful interaction with people who live in the home. People told us about their daily lives - and we saw that they have some choice and control over how they live their lives. People made choices about what they wanted to do, about the food they eat and about their daily routines. We saw that there are care plans for each person, which give details about the kind of support they need. People talked with us about their care needs, and about what was important to them - they were involved with their care plans. Care plans have personal and individual information in them. There are also risk assessments for people, which tell about how people can be safely supported to do the things they want to do. Care Homes for Adults (18-65 years) Page 15 of 30 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 excellent 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 this home are enabled to have a very good lifestyle. Evidence: We found out about the many different things that people who live in the home are involved in. We look at written records which gave us information. We also talked with people and they told us about the different activities they enjoy. People study different subjects at college. Some people also work - for example in a cafe. People have different leisure interests. Staff support and enable people to take part in different activities, and also to have independence. Staff support people to increase their independence, by learning new skills and by helping them to achieve goals. People who live in this home have family and friends involved in their lives. They are enabled to visit people, or to have people come to visit them. One person enjoys receiving letters and photographs from their family. People are supported to go to church if they would like to. Care Homes for Adults (18-65 years) Page 16 of 30 Evidence: Staff give support to people to cook their own meals, plan menus, do housework and make choices in their lives. While we visited, people who live in the home planned and prepared their own meals, and enjoyed some homemade cake that had been made earlier in the day by one person with a member of staff. Care Homes for Adults (18-65 years) Page 17 of 30 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 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 this home benefit from good attention to their personal and healthcare needs. Evidence: People told us about the ways in which they are supported to take care of their personal and health needs. We saw during our inspection that people are enabled to care for themselves independently if they are able to, and given support if they need it. We found from looking at written records that staff support people to have the health check-ups they need, such as dental checks and optician visits. People are supported to see their GP if they need to. Each person has an individual health plan. Staff keep different records about peoples health. People are enabled to write their own health records if they are able to and wish to. We found that weight records are kept in a notebook before being transferred to individual records - one person said they did not like this as it was private. This is something the home could consider changing. We looked at the way that medication is given out and stored in the home. There are written policies which tell how medication should be looked after and how to give it safely. Where someone has chosen to look after their own medication, there are checks in place to make sure this is done safely. Medication is stored locked away, and the home Care Homes for Adults (18-65 years) Page 18 of 30 Evidence: has recently got a new medication cabinet. Care Homes for Adults (18-65 years) Page 19 of 30 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. People who live in this home are mainly enabled to raise any concerns and are kept safe from harm. Evidence: People we spoke to who live in the home told us they know how to raise any concerns and complaints. There is a complaints procedure in the home, which tells people how to make a complaint and how it will be looked into. But the procedure is out of date, with the wrong information on it about who people can contact if they want to complain to someone outside the home. People who live in the home were confident about talking to staff if they have any problems. Staff have had training to help them to understand how to protect people from harm. People we spoke to told us they feel safe in their home. There are policies to tell staff about what they need to do to safeguard people - again some of the information in these was incorrect and needs to be updated. Staff support people to look after their money and keep records of money that is spent. One person writes their own records and is moving towards living more independently. Care Homes for Adults (18-65 years) Page 20 of 30 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. People who live in this home benefit from having a clean, comfortable and homely environment. Evidence: We looked around the home, and found that it is clean, comfortable and homely. People who live in the home are able to move freely around and use the rooms they want to. The lounge also has the office space in it, with a desk and computer - people who live in the home can use this space themselves too and have access to the computer. Each person has their own bedroom, and can have their own personal things in it. There are two bathrooms. The washing machine is located in the kitchen, as in a general household. People who live in the home told us about what they have learnt about how to make sure infection does not spread from one person to another. Staff also had good understanding about infection control, and there are policies in the home about this to help staff to work safely. The manager and staff make checks on fire safety equipment to ensure it is safe, and carry out fire safety practices. Care Homes for Adults (18-65 years) Page 21 of 30 Care Homes for Adults (18-65 years) Page 22 of 30 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 live in this home benefit from having supportive well trained staff. Evidence: Staff work during the day to support people to live their daily lives and take part in different activities. At night a member of staff sleeps at the home to be available if anyone needs them - one person told us they can wake staff if they need them. Care staff do a full range of tasks in the home, such as cooking and cleaning - but this is done with people who live in the home to try to encourage and support them to be independent. The provider takes steps to make sure that staff are safe to work with people. Records are clear and well kept. The provider makes sure that proper checks are carried out on all new members of staff, such as collecting references and getting POVA1st and Criminal Records Bureau (CRB) clearance. CRB checks are renewed for people who have worked for a long time. References are collected - sometimes these have come after people have started working in the home. Even though staff have a probationary period, during which time they are supervised, references must be collected before people start working in the home. When we pointed this out, the process for collecting references was immediately changed by the service. Care Homes for Adults (18-65 years) Page 23 of 30 Evidence: Records are kept of training. Members of staff have ongoing training in different areas to help them to do their job well and to meet the needs of people who live in the home. One member of staff told us that they have achieved their National Vocational Qualification (NVQ) Level 2 in care, and that they were looking forward to doing Level 3. Care Homes for Adults (18-65 years) Page 24 of 30 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 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 this home mainly benefit from good management systems. Evidence: The registered manager remains in post in the home. One member of staff told us that they felt well supported in their work. The provider makes sure that they visit the home every month to check how things are going and prepare a report. People who live in the home are asked for their views about how the home is run - there are questionnaires for them to fill in. People are confident to speak up about how they feel about things. Staff carry out safety checks of different equipment, to make sure it is fit for use. We did note that while regular checks of water temperatures at baths and sinks are carried out, there has been no action taken where temperatures were found to be high and could create a potential risk. Although staff told us there is no immediate risk to people, this must be changed, to make sure that people are kept safe from any risk of scalding. Both staff and people who live in the home were very aware about how to keep safe Care Homes for Adults (18-65 years) Page 25 of 30 Evidence: when using chemicals, doing cleaning and other tasks in the home. We saw that the home has an old registration certificate displayed, from a previous registering organisation. This needs to be updated. Care Homes for Adults (18-65 years) Page 26 of 30 Are there any outstanding requirements from the last inspection? Yes No X 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 27 of 30 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 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 34 19 The provider must ensure that two written references are obtained before people begin to work in the home. This has been completed. This is to ensure that the provider can verify employees and people who live in the home are protected from potential risk. 30/06/2009 2 42 13 The provider must ensure 19/06/2009 that a risk assessment is prepared relating to the risk of scalding water which has been noted from testing water outlets, and that action is taken to address the risks identified. This is to ensure that people are protected from any risks to their safety. Care Homes for Adults (18-65 years) Page 28 of 30 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 2 It is recommended that the service gives consideration to putting some policies and information for people who live in the home into plain English, with pictures, to aid communication. It is recommended that the manager looks at whether there are alternative ways to recording peoples weights that mean they are not written into one book - to enable privacy and dignity for people. It is recommended that the complaints procedure is changed to include up to date and accurate information about whom people may complain to if they are not satisfied with the homes investigation. It is recommended that the procedures relating to protection from abuse are changed to include up to date and accurate information about the Care Quality Commission. It is recommended that the provider does not begin people in supervised employment as a matter of course once the POVA1st check has been obtained, but waits for full CRB clearance where possible. Only in exceptional cirumsatances should employment commence before the full CRB clearance is obtained, with appropriate supervision of staff. 2 19 3 22 4 23 5 34 Care Homes for Adults (18-65 years) Page 29 of 30 Helpline: Telephone: 03000 616161 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. 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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