Care Home: Ashby House

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What the care home does well Information about the home is available to prospective residents to help them decide if the home is right for them. Their wishes for care and diverse support needs are assessed before they move to the home to ensure they can be met. There is good liaison with local healthcare services and peoples` individual health and personal care needs are met in a way which protects their autonomy and dignity. One resident said `the place has a happy feel`, another `staff wait on us hand and foot`. There is a programme of activities which residents can choose to join if they wish. The gardens are accessible and a small vegetable patch has been developed for those who like gardening. The activities coordinator also spends time on a one to one basis with people who do not wish to be involved in group activities. Meals are of a high standard and there is a choice of menu at each meal. Residents spoken to said they liked the food. The dining rooms are attractive and provide a sociable atmosphere for residents who like to eat in company. Those who do not are able to eat in their rooms if they wish. The chef is able to provide individualised menus and can provide diets to meet peoples` health needs and cultural and faith wishes. The home is accessible to people with disabilities and is set in tidy gardens. Residents can walk in the gardens safely. People are encouraged to personalise their rooms and many had chosen to do so. The dementia care unit known as `memory lane` is furnished to stimulate peoples` memories of past times and to provide conversation and sensory input for those who have memory difficulties. One resident said `the home has a friendly feel and the decor is bright and interesting`. People receive care from kind, well trained staff who can meet their diverse health and care needs in a timely way. There is an active training programme and staff have training in caring for people with dementia. Recruitment procedures are thorough and checks are made to protect residents from unsuitable staff. Residents said `staff are kind` and, in response to the surveys, most said `they listen to what I say`. The home is well managed in the interests of residents. There is a quality assurance programme in place and representatives of the company visit the home regularly. Residents and staff said the manager was approachable and one resident said `I feel safe here`. The safety of residents is monitored and staff have had training in safe working practices to reduce the risk of injury to residents or themselves arising from care. What has improved since the last inspection? There has been an ongoing programme of redecoration and refurbishment. The dementia care unit, `Memory Lane` has been decorated with items to remind people of past times and provide conversation and sensory stimulus for people who have memory problems. The staffing team has stabilised and there is a full management team in place. More staff have had training in dementia care. Hygiene has been improved and there were no offensive odours in the home. What the care home could do better: Not everyone has a copy of the terms and conditions of their stay which may lead to a lack of clarity for residents and their families. This should be addressed and every one should have a copy of their terms and conditions irrespective of their funding source. Some residents share hoist slings and alcohol hand sanitizer for staff is not routinely available in the home. This is not in line the latest guidance from the Department of Health. The home should review the infection control procedures to ensure that they are in line with the latest Department of Health`s (DH) guidance. Further information about infection control is available on our website www.cqc.org.uk and the DH website www.dh.gov.uk. Key inspection report Care homes for older people Name: Address: Ashby House 100 Chadwick Drive Milton Keynes Bucks MK6 5LS     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 Sidwell     Date: 2 3 0 7 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 27 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 27 Information about the care home Name of care home: Address: Ashby House 100 Chadwick Drive Milton Keynes Bucks MK6 5LS 01908696676 01908609809 ashby@barchester.net www.barchester.com Barchester Healthcare Homes Ltd Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Keren Welch Type of registration: Number of places registered: care home 64 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 64. The registered person may provide the following category of service only: Care home with nursing - (N) tos ervice users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Dementia (DE) Old age- not falling within any other category (OP) Date of last inspection Brief description of the care home Ashby House is owned by Barchester Healthcare Homes Limited and provides care and accommodation for 64 older people. The home is on one level divided into two separate living units, Bradwell and Oakgrove. Each unit has its own lounge and dining room and most bedrooms have en-suite facilities. Bradwell provides care for frail older and physically disabled people and Oakgrove provides care for older people who have a Care Homes for Older People Page 4 of 27 Over 65 0 64 64 0 Brief description of the care home varied degree of dementia related conditions. The home is situated in a residential area of Milton Keynes close to local amenities and public transport is accessible from the home. Care Homes for Older People Page 5 of 27 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 Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The home last had an unannounced key inspection on the 25th September 2007. Random short unannounced inspections were undertaken on the 13th August 2007 and the 5th December 2008. This inspection was conducted over three days and included a review of the information we hold about the service and an unannounced visit to the home on the 25th June 2009 of eight hours. The key standards for older peoples services were assessed. Information received about the home since the last inspection was taken into account in the planning of the visit. The manager completed an annual quality assurance assessment (AQAA) in which she described the way in which the home ensures that the views of people who use the service are included in what they do, the way they ensure equality and diversity is respected, what they do well, the evidence to show it and their plans for improvement. This was completed in full and returned on time. Questionnaires were sent to the home for distribution to residents, staff and visiting Care Homes for Older People Page 6 of 27 professionals. Ten residents or their families, thirteen members of staff and three healthcare professionals returned these. Residents and families were spoken to on the day of the unannounced visit. Discussions took place with the interim manager, deputy manager, the administrator, nursing, care and ancillary staff. Initial feedback was given at the end of the visit. Care practice was observed and the care of four residents was followed through in detail. The environment and accessibility of the home for people with disabilities was checked. The homes approach to equality and diversity was considered throughout. Care Homes for Older People Page 7 of 27 What the care home does well: What has improved since the last inspection? There has been an ongoing programme of redecoration and refurbishment. The dementia care unit, Memory Lane has been decorated with items to remind people of past times and provide conversation and sensory stimulus for people who have memory problems. The staffing team has stabilised and there is a full management team in place. More staff have had training in dementia care. Hygiene has been improved and there were no offensive odours in the home. Care Homes for Older People Page 8 of 27 What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 27 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is information available and the opportunity to visit the home to help people decide whether they wish to move to the home. Peoples health and social care needs are assessed before they move to the home, to ensure they can be met. Not everyone has a copy of the terms and conditions of their stay, which may lead to a lack of clarity for residents and their families. Evidence: There is information available to prospective residents in the form of a statement of purpose, which describes the services provided by the home and a home brochure. Prospective residents and their families are welcome to visit the home and stay for a trial period before deciding whether the home is for them. The care files of three people who have moved to the home since the last inspection were checked. Their needs had been assessed by a registered nurse before they moved to the home to identify with them their needs and wishes for care. The assessment documentation prompts staff to take note of peoples faith and cultural wishes as well as their health Care Homes for Older People Page 11 of 27 Evidence: and social care needs. The manager and administrator said that privately funded residents had contracts although those who were supported by their Primary Care Trust or Local Authority did not have a copy of the terms and conditions of their stay at the home. This should be addressed. Residents should have a contract or terms and conditions of their stay irrespective of their funding source. The home does not offer intermediate care for those requiring intensive rehabilitation. Care Homes for Older People Page 12 of 27 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents diverse personal, health and medication needs are met in a manner which protects their dignity, promoting their wellbeing. Evidence: The care of four residents was followed through. All had comprehensive care plans which had been updated regularly with them and with their families. Residents diverse healthcare needs were recognised and recorded. Their risk of developing pressure damage had been assessed and appropriate action taken to prevent this. Residents risk of malnutrition was assessed and they are weighed regularly. All had maintained their weight since admission. One resident had lost weight in hospital. He saw the dietician, a care plan was developed and he was now gaining weight. Falls risk assessments are undertaken and appropriate care plans are in place. There was evidence in all the files to show that residents see a general practitioner and other members of the local primary healthcare team regularly and are supported to visit hospital outpatient departments when necessary. A physiotherapist visit the home twice a week to work with residents and to advise staff. Care Homes for Older People Page 13 of 27 Evidence: Residents are supported to maintain their personal hygiene and to wear clothing of their choice. The atmosphere was noted to be relaxed and staff were speaking to residents politely and gently. They were not seen to hurry and residents were given time to express themselves. Staff said all care is given in residents rooms. Staff were seen to help residents back to their rooms to see the visiting chiropodist. People told us that they were happy in the home and when asked, in the surveys, what the home does well said wait on us hand and foot, answer the call bell quickly and good food. There are medication policies and procedures in place and the staff spoken to were aware of these. The storage facilities were satisfactory. Controlled medication was stored and recorded correctly. Records are kept of medication delivered and disposed of by the home. Residents individual medication administration records were completed in full and appropriate steps were taken to ensure that supplies were received regularly. Procedures were in place to deal with variable dose medication. None of the residents managed their own medication at the moment although there are policies and procedures in place to support this if residents wish. The staff spoken to said that medication was never given covertly. If a resident did not want to take their medication, this would be recorded. If the medication was essential and the resident lacked capacity, the doctor and family would be told and a way forward agreed. Care Homes for Older People Page 14 of 27 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can choose how they spend their day and are supported to take part in activities if they wish. The standard of food is good meeting residents social, cultural and nutritional needs. Evidence: Residents spoken to said that they had a choice as to when they got up, went to bed and how they spent their day. An activities coordinator organises a range of activities, including musical entertainments, quizzes, crosswords and walks in the garden. A vegetable patch has been dug for those residents who like gardening. On the day of the unannounced visit to the home a professional entertainer was leading a reminiscence session. Residents were engaged and clearly enjoying themselves. A church service had been held in the morning. One resident commented that she particularly liked the musical entertainment. There is a varied menu and all food is home cooked. There is a choice of menus at each meal. The chef was knowledgeable about residents likes and dislikes. There are attractive dining rooms. Dining tables were decorated with flowers and well laid with tablecloths, cutlery and drinks and glasses. Residents have a choice as to whether they eat alone or with others. The chef said he would be able to prepare special Care Homes for Older People Page 15 of 27 Evidence: menus to meet peoples cultural and faith needs if necessary as well as special diets which may be needed to meet peoples health needs. Everyone who returned the questionnaires said that they always or usually enjoyed the food. One said that the chef likes to chat to us and when asked what the home does well another said the food. Care Homes for Older People Page 16 of 27 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at the home are protected from harm and their concerns are listened to and addressed. Evidence: There is a copy of the complaints procedure displayed in the home and it is described in the Service Users Guide. Most people who returned the surveys said that they knew who to speak to informally if they had a concern and that they knew how to make a formal complaint. Two family members spoken to on the day of the unannounced visit said that they knew how to make a complaint although had not had to do so. One said they are very caring and listen to us and I have not felt the need to raise anything formally. The manager said in the AQAA that there have been four complaints since the last inspection all of which were investigated and action has been taken. The home has a copy of the local multi agency safeguarding policies and procedures and staff have a received training in safeguarding vulnerable people. There are whistle blowing policies and procedures in place and the staff spoken to say that would have no hesitation in reporting any concerns. One family member said that she feels that her husband who has dementia feels safe here and that he smiles when he sees the carers and appears to recognise them. She had no concerns leaving him. Another family spoken to said that they were made welcome at any time and were always contacted if staff had any concerns. We have been told of two concerns,since the last Care Homes for Older People Page 17 of 27 Evidence: inspection, which were reported appropriately to the local authority, which is the lead agency in these matters. Care Homes for Older People Page 18 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides a clean, safe and homely environment for residents. Measures to minimise the risk to residents of acquired infection are in place although they should be improved if they are to meet the latest guidance from the Department of Health. Evidence: The home is on one floor and is accessible to people with disabilities. There is an ongoing programme of maintenance and redecoration. It is set in well maintained gardens and a small vegetable patch has been developed this year for residents who like gardening. All rooms are single and most have ensuite facilities. Residents are supported to personalise their rooms with small items of furniture and personal mementos. Many had chosen to do so. The dementia care unit, known as Memory Lane has a life skills kitchenette where residents can help staff prepare tea. The activities coordinator uses it to make cakes with residents. Care staff use it to ensure that drinks and finger foods are available for residents to help maintain a high calorie intake for people with dementia who may be prone to losing weight. The home was clean and tidy on the day of the unannounced visit and there were no offensive odours. There are infection control policies and procedures in place. The laundry is well organised and the washing machines have programmes to deal with soiled linen and clothing. Staff were observed to be wearing protective clothing correctly. There is liquid soap and paper towels in residents ensuites for the use of Care Homes for Older People Page 19 of 27 Evidence: staff and visiting professionals. The manager said that it was the companys policy not to use alcohol hand sanitizer as it was felt this may discourage staff from washing their hands. She said it was used however when they had a recent outbreak of infection. Residents also share hoist slings although the manager said that they had their own hoist sling if they where known to have an infection. Neither of these practices are in line with the latest guidance from the department of health The home should review the infection control procedures to ensure that they are in line with the latest Department of Healths (DH) guidance. Further information about infection control is available on our website www.cqc.org.uk and the DH website www.dh.gov.uk Care Homes for Older People Page 20 of 27 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People receive care from kind, well trained staff who can meet their diverse health and care needs in a timely way. Recruitment procedures are thorough protecting residents from unsuitable carers. Evidence: There is a consistent staff team. There are two Registered Nurses (RN) on duty in the mornings supported by five or six carers, one RN and four carers in the afternoons and one RN and two carers at night, in each unit. People told us that they usually received the care and support they need , that staff listen and act on what they say and that staff are available when they need them. They made positive comments about the staff team saying they interact with residents and families and they are very kind. Two residents however said they had to wait a little longer at night for the call bell to be answered. There is an ongoing training programme. Computerised training records were in good order and showed that staff training in safe working practices, was up to date. Staff receive training in specialist topics such as caring for people who have dementia, clinical skills training for registered nurses, first aid and training as to how to prevent and deal with choking incidents which may be experienced by people who have difficulty swallowing. There are twenty carers, some of whom are qualified nurses in their own country and deemed to hold the equivalent of the National Vocational Qualifications in Care at Level 3. Two other carers hold the National Vocational Qualifications in Care at Level 2. There is a programme in place for Care Homes for Older People Page 21 of 27 Evidence: other carers to achieve this qualification. Staff said that they valued the training offered by the home. The recruitment files of three members of staff who had started at the home. All had the required documents. There was evidence of the staff members identity and work permits were in place where necessary. Criminal Records Bureau disclosures and references had been sought before the staff member started work. The application form showed the staff members work history and interview records were kept. There was evidence that staff had had an induction programme. Staff told us that they were given the opportunity to attend training and all said that they received support from senior staff. Care Homes for Older People Page 22 of 27 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well managed in the interest of the residents. Evidence: The registered manager holds a nursing qualification and the National Vocational Qualifications in Management and Care at level 4. She is supported by a deputy manager and heads of care in each unit, who are registered nurses. The registered manager was absent from the home at the time of the inspection and an interim manager was managing the home to ensure continuity for residents and staff. There is a quality assurance programme in place. There are regular resident, family and staff meetings. The interim manager said that she had an open door policy and this was confirmed by the relatives and residents spoken to on the day of the unannounced visit. She is planning a relatives evening shortly which is a social event but also an opportunity for relatives to speak with her and members of the management team. The company has a regular audit programme in place and monthly returns of untoward events are made enabling trends to be identified. Care Homes for Older People Page 23 of 27 Evidence: The home does not manage residents financial affairs. All expenditure is invoiced to families for payment. There are health and safety policies and procedures in place and regular meetings are held. Maintenance records were up to date and there was evidence that essential safety checks of services and equipment are undertaken. Water temperatures are tested regularly to reduce the risk to residents of scalding. The fire risk assessment had been updated and fire safety checks were made. The last Fire Safety Officers visit was on 8th November 2007 when all matters were considered satisfactory. The last Environmental Health Officers visit was in June 2009 when the home achieved 5 stars, the top rating. The training records showed and staff confirmed that they had had training in safe working practices, including moving and handling, fire safety and infection control. Care Homes for Older People Page 24 of 27 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 25 of 27 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 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 Older People Page 26 of 27 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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. 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