Care Home: Belsfield House

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What the care home does well We found the home provides an excellent environment in which people can live. They have an excellent standard of rooms, facilities and services available to them. In addition there is specialised equipment and aids and adaptations for people with mobility or specialist needs, including a hydrotherapy pool, a range of bathing facilities, beds and lifting equipment so that their specialist needs can be met. People we spoke to said, "its really lovely and there is so much space", "I have been able to bring pieces of furniture with me". Surveys told us people are very happy with the homes environment. We found there is a good skills mix of staff working in the home, which means people receive care from a staff team who have the necessary skills to meet the individual needs of people living there. Comments included, "the staff are so nice they are always around if you need them, they cant do enough". Staff we spoke to had a good range of knowledge about the specialist needs of people living in the home, including their cultural and social needs so that people are not disadvantaged. Comments included, "we have a range of people living here who have different needs, and we have had training in all these areas of need so we can give the best care". We looked at the activity planning the home has in place and found this is being developed. A member of staff spoken to has recently attended training so that they are aware of various ranges of activities for people with different needs, so they can provide activities designed to meet them. By making sure care planning records are kept up to date, staff were aware of the current needs of people living there. Comments included, "we are made aware of any changes in the records, and the manager always tells us if something needs changing". Staff told us they think the recording systems are good and they use them daily to input information. What has improved since the last inspection? This is the first inspection of the service since registration. What the care home could do better: We saw there were some files which had not had an assessment under then Mental Capacity Act 2005, which would identify if a person was being deprived of his or her rights in any one area, which would then be managed and reviewed. This is an area the home needs to develop. We saw there are records for this to be carried out and therefore they should be used to manage any form of deprivation of liberty Safeguards (DOLS). Most care staff have a first aid qualification but for those who have not it is advised they receive training so that they are competent if emergency first aid is required. Key inspection report Care homes for older people Name: Address: Belsfield House 4 Carlin Gate Blackpool Lancs FY2 9QX     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: Jacqueline Riley     Date: 2 7 1 0 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 26 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 26 Information about the care home Name of care home: Address: Belsfield House 4 Carlin Gate Blackpool Lancs FY2 9QX . Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Ryecourt Limited Name of registered manager (if applicable) Mrs Jean Wilson Type of registration: Number of places registered: care home 40 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category physical disability Additional conditions: The registered person may provide the following category of service only: Care home with nursing - Code N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Dementia Code DE; Mental Disorder, excluding learning disability or dementia - Code MD; Physical Disability - Code PD; Old age, not falling within any other category - Code OP (maximum of 6 places) The maximum number of service users who can be accommodated is: 40 Date of last inspection 40 40 0 40 Over 65 0 0 6 0 Care Homes for Older People Page 4 of 26 Brief description of the care home Belsfield house is purpose built providing residential and nursing care for up to Forty people. It is situated in a residential area, close to the beach and local transort networks including buses and trams. The home has four floors and is divided into units. The home has underfloor heating and can be controlled in each room for personal preference. Each floor where accomodation is sited there are communal lounges and dining areas. All rooms are individually furnished and inlcude en suite facilities. 60 of the rooms have either a wet room or step in shower. Rooms are single and spacious. Beds are of a high specification with pressure relieving mattresses in all bedrooms. All rooms have nurse call systems. The home has inlcuded various audio connections as well as WI Fi network so that people choosing to use IT systems are enabled to do so. The home has access to all floors by stairs or passenger lift. There is also a seperate lift system for delivering food to each floor direct from the kitchen. The basement houses the kitchen and laundry area as well as medication room, and additional office space. There is also a smoking room and quiet room for people to use. On this floor there is a hydrotherapy pool, which has a changing and shower area. There is a paved area at the side and rear of the home with seating which people can use. The home has a Statement of Purpose and Service User Guide, which includes information about the service, care and qualifications and experience of the owner and staff and what people can expect if they choose to live at the home. Information received on the day of inspecting the service (27/10/09) told us the fees range from £375.00 to £550.00 per week. Additional costs may be incurred but are included in peoples indivdual contracts. Care Homes for Older People Page 5 of 26 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: A key inspection of the home was undertaken which included an announced visit to the service on 27th October 2009 and lasted approximately five hours. It was the first inspection of the service since registration with the Care Quality Commission in June 2009. We spoke to the a director of the service, registered manager, six staff members, two visitors and a number of people using the service. The care records and other records relating to the care people receive were looked at. We also looked around the home with the manager and spent some time talking to people who live there. We received a number of surveys from people telling us about their experience using the service. All comments were positive and some will be used in this report. Every year the person in charge or manager is asked to provide us with written information about the quality of the service they provide, and to make an annual Care Homes for Older People Page 6 of 26 assessment of the quality of their service. This document is called an Annual Quality Assessment (AQAA). We use this information, in part, to focus our inspection activity. Care Homes for Older People Page 7 of 26 What the care home does well: What has improved since the last inspection? 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. Care Homes for Older People Page 8 of 26 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 26 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 26 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 are admission and assessment procedures in place to ensure the care needs of people are being met. Evidence: We saw the home has in place good written information about the services it provides to people who choose to live there. This information is made available to people who enquire about the service so they can make an informed decision about living there. Comments included, we had all the information we needed to assist our relative in making a choice about moving here. Surveys we received told us people were given information about the home before making a decision to use the service. We looked at three records of people living at the home. We saw they had in place assessment details from other professionals including, social workers, Psychologists and Psychiatrists so that the home has the information they need to create a personal care plan. Staff we spoke to said they find the details they receive to be very useful so Care Homes for Older People Page 11 of 26 Evidence: they know the specific presenting needs of the person and can use this information to determine the level of care the person needs. Comments we received about assessment planning included, we were involved in planning the care for my relative, they kept us informed all the time. Care Homes for Older People Page 12 of 26 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. Promotion of health is taken seriously, peoples welfare is monitored and health needs are met. Evidence: We looked at the care planning records for three people using the service. We found they were accurate and up to date. There was good information about individual healthcare needs as well as how those needs are going to be met. The way the records are designed means staff can follow the information easily. Comments from staff included, we are involved in putting information onto records, and find this helps all staff to follow the needs of a resident. Other staff told us they find the records easy to follow which helps them maintain and provide the support people need. The records we looked at showed there are individual risk assessment in place, highlighting the identified risk, how it will be managed and reviewed and who is responsible. We saw risk is identified in a number of areas including moving and handling, nutrition, falls risk, and environmental risk. All records were seen to have Care Homes for Older People Page 13 of 26 Evidence: regular reviews so risk is being monitored and any changes are clearly recorded. We saw there is a good link between the home and other healthcare professionals, including doctors, district nurses, social workers, psychologists and psychiatrists. The records we looked at showed there is a good record of when people attend appointments and what the outcome is so that the staff team can monitor visits and help staff to keep updated on any changes which may occur or any treatment which may be necessary. Staff told us they have good relationships with healthcare professionals, comments included, we work well together. The way the home manages its medication procedures is good. We saw the home has dedicated storage facilities for all medication used by the home. Records we looked at showed medication is administered by trained staff and that the records were up to date. The three records we looked at showed prescribed medication corresponded with the administration sheets so people were receiving medication as prescribed. By making observations throughout the time spent at the home we confirmed staff respect peoples privacy and dignity by way of talking to people sensitively, and the way they went about assisting people. Staff spoken to said they recognise the need to respect peoples rights to privacy and dignity and this was included in their induction training programme. We looked at how the home has included assessment under the Mental Capacity Act 2005, which requires an assessment of Deprivation of Liberty Safeguarding (DOLS) for each person. The aim of this assessment is to identify if a person is being deprived of their liberty in any part of their life as part of their care planning. If this is identified an application for this to be monitored and reviewed must be made. In respect of the three files we looked at one had an assessment carried out prior to being admitted, the other two had not yet had assessments. We spoke to the manager who has recently undergone training in this area and is working through the records to ensure all people living there have an assessment carried out in the near future. Records for this assessment are in place on each file but have yet to be completed. Care Homes for Older People Page 14 of 26 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. Social activities and meals provide daily variation and interest for people living in the home. Evidence: We spoke to a number of staff during the inspection of the home and found some of them have attended training in providing an activity programme for people living there. The staff told us training was designed to take into account various needs of people including dementia and acquired brain injury. Staff said this has motivated them and they are currently planning various activities to meet the needs of people living in the home. Comments included, I find it really interesting, and am planning lots of things to do on top of what we already do. Records we looked at showed their are individual records to record what people do, they include a range of activities such as manicure, board games,listening to music, going out with staff and family. People we spoke to told us they liked to do a variety of things and said they were looking forward to the party to be held to celebrate Halloween. Staff have access to a key worker record, giving them information about the person Care Homes for Older People Page 15 of 26 Evidence: including, religious preferences, former occupations, whether they had served in the armed forces, clothes styles and sizes, what sort of jewelery and make up people like as well as other personal information they may wish to share, so staff have a good idea about what to focus on when assisting people and working out activity planning. Staff told us this had been really useful and people seemed to like to talk about themselves and provide information about themselves which helps them. We spoke to the chef, who told us they have lots of experience preparing meals for people in residential and nursing care. We saw lunch being prepared which was seen to be fresh and nutritious. People we spoke to told us they like the meals and found the choice good. Comments included, I like all the meals here, staff are really helpful with my relative when they need to encourage them to eat. We saw there was plenty of evidence of fresh foods and fruit and veg, as well as evidence of home baking with pies and cakes being prepared by the chef. The chef told us he has good insight into specialist diets and knows how to manage them, when informed by the manager of any person who requires a specialist diet. Care Homes for Older People Page 16 of 26 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. Complaints are taken seriously ensuring people feel listened to. Staff have access to safeguarding procedures to protect people. Evidence: We looked at the homes complaints procedure. It is made available to people using the service. Surveys we received and people we spoke to told us they know about the complaints procedure and how to go about making a complaint. Comments we received told us, I have been made aware of the procedures and would know what to do if I am unhappy about something. There have been three complaints received by the Commission since June 2009. One investigated by Social Services and was unsubstantiated, one investigated by the Commission at this inspection and found to be unsubstantiated and another investigated by the manager of the home. In all instances the management team worked closely with the investigating teams. We spoke to the manager and staff about how people are protected, they told us there has been training for staff and those who have not yet received training will attend the next course available. Staff we spoke to told us they knew about safeguarding issues and what to do should abuse be suspected. The home has in place policies and procedures for protecting people and this is used as part of the induction training for staff. Care Homes for Older People Page 17 of 26 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in an environment which provides excellent standards and equipment for the benefit of those who use the service. Evidence: This is a new purpose built home, which provides an excellent environment for people to live in. We looked a round the home and found it to be furnished and decorated throughout to a high standard. All rooms are spacious and well furnished, with either wet rooms or step in showers in over sixty per cent of rooms. All rooms have spacious en-suite facilities for peoples comfort. Comments included, I couldnt wish for a nicer room, its got everything I need. The home has four floors with each floor providing an environment for people in specific categories including dementia, mental disorder and physical disability. Each floor has a designated lounge area as well as communal dining space. There is a range of seating on each floor as well as mobility aids including hoists, and other lifting equipment. Each persons room has been designed to a high specification, in some instances people have brought pieces of furniture from home. Comments included, I have furniture from home which, because of the size of the room I could bring with me. All rooms have beds in place which include specialist beds for people with a range of Care Homes for Older People Page 18 of 26 Evidence: medical needs. Heating is underfloor so there is no need for radiators and people can control their room temperature so they have choice in how it is heated for their personal preference. In addition some people have computers and can access the Internet due to WI FI connections. The home has its own maintenance team who are qualified to maintain all areas of the home and this is recorded. There is a paved area with seating at the rear and side of the home which can be used by people if they choose. There is the availability of connection to satellite television due to the home making provision for sky plus television, this again gives people more choice in their audio preference. The basement of the home has a hydrotherapy pool, as well as a large changing area and shower. They are currently waiting for staff to have a recognised life saving qualification before using the facility so people are safe. There is a full range of bathing facilities as well as those in individual rooms. There are specialist baths for people with limited mobility or physical disability. By looking around the home we found it to be clean and free from offensive odours. There are policies and procedures in place for staff regarding infraction control. Most of the staff spoken to have received training in Infection control. We spoke to the domestic employee who had a good knowledge of infection control procedures. The home has specific laundry facilities which is currently used by staff but as the occupancy level increases will have a dedicated member of staff responsible for this area. Care Homes for Older People Page 19 of 26 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. Procedures for recruiting staff are god ensuring the safety and protection of people. Training and deployment of staff is good so they are meeting the needs of people using the service. Evidence: We looked at duty rotas and discussed staffing levels with the manager. We found there is a good skills mix of staff on all shifts. Numbers of staff were seen to be satisfactory to meet the needs of the people living there. The manager told us staffing levels are always being reviewed due to the changes in occupancy levels and the needs of people using the service. There have been concerns raised about staffing levels at night, however by looking at rotas, and talking to people we found they are sufficient to meet the needs of people living there. The manager did say there are occasions when staff do not arrive for their shift without notice and in these instances she finds additional staff or attends herself. Staff we spoke to said they felt they worked well as part of a team, and they have worked on all shifts including nights and felt the staffing levels were sufficient. We looked at the homes training records and saw staff have access to various levels of training including national care qualifications of which over 50 of staff have already achieved. Staff we spoke to and records we looked at showed staff have access to mandatory training including, moving and handling, health and safety and first aid. Care Homes for Older People Page 20 of 26 Evidence: Some staff need to undertake first aid training so that they have the necessary skills in this area. Staff we spoke to told us they have received training in specialist areas including dementia, challenging behavior and restraint, which they said they have found very useful, as some people living there require the necessary skills of staff to manage them due to their conditions. We looked at three staff files. They showed us staff are recruited safely using procedures which take into account full information about them including application records and references, criminal Record Bureau (CRB). Protection of Vulnerable Adults (POVA) checks to make sure they are safe to work with people who may be vulnerable. Care Homes for Older People Page 21 of 26 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 managed well with systems and policies in place for the safety and protection of people who live there. Evidence: We saw the home is run in the best interests of people using the service including staff. We spoke to a number of people using the service including visitors and they made a number of comments including, the manager is very supportive and makes time to listen, she is always around and provides us with good systems to work with, If I need to talk about something I know the manager will listen. We spoke to the manager who said she had worked hard with the staff team to put in systems which are working well and are for the benefit of people who live there and use the service. The manager demonstrated a good level of knowledge and skills for the day to day management of the home. The systems in place are supporting the staff to provide a high level of care to people using the service. Care Homes for Older People Page 22 of 26 Evidence: We talked to the manager about how they gain the views of people using the service. We saw there are systems being put in place to use in the near future, including questionnaires. The manager told us they talk to people and give people the opportunity to tell them about the services they receive. The manager is organising staff meetings and resident meetings as the occupancy level expands as does the staff team. Staff we spoke to said they feel they can talk to the management team about things and feel they are listened to. Comments included, I think we are listened to and can make suggestions about the service. We found staff were able to follow clear instructions in the records for health and welfare. Staff said they felt they were well constructed and easy to follow. We found there is a clear line of management responsibility in the home, and staff communicated with the manager throughout the inspection of the service. Since registration in June 2009, all essential equipment is tested to ensure its operating safely. Care Homes for Older People Page 23 of 26 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 24 of 26 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 1 7 The care home should continue to develop Deprivation of Liberty Safeguards assessment in order to meet clinical guidelines associated with the Mental Capcity Act 2005. The home should continue to provide first aid training for care staff so they have the skills to deal with emergency first aid. 2 30 Care Homes for Older People Page 25 of 26 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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