Care Home: Burton Road (703)

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What the care home does well The care home finds out what people need and write this down. Staff read these reports so that they can help people to keep healthy and as active as possible.People were helped to have interesting lives. Staff gave them individual attention and they were treated with respect.The home`s policies and procedures kept people safe. Policies are rules about how to do things. Procedures tell people how to follow the rules.People were living in a comfortable, homely and safe environment.The care home finds out information about new staff before they start work there. This helps to keep people safe. Staff have training so they understand how to meet people`s needs.The care home was well managed. People were safe and their rights were recognised. What has improved since the last inspection? We had approved a new manager at the home.Rooms in the home had been redecorated. What the care home could do better: The Manager must follow safe procedures if someone has been abused. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Burton Road (703) 703 Burton Road Midway Swadlincote Derbyshire DE11 0DL two star good service The quality rating for this care home is: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Anthony Barker Date: 0 3 0 6 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area Outcome area (for example: Choice of home) These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to:  Put the people who use social care first  Improve services and stamp out bad practice  Be an expert voice on social care  Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Internet address www.cqc.org.uk Information about the care home Name of care home: Address: Burton Road (703) 703 Burton Road Midway Swadlincote Derbyshire DE11 0DL (01283)216301 01283216301 703burtonroad@robinia.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): The Robinia Group PLC Name of registered manager (if applicable) Dawn Warren Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 Over 65 5 0 care home 5 learning disability Additional conditions: The registered person may provide the following category/ies of service only: Care Home only - Code PC To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Learning Disability - Code LD The maximum number of service users who can be accomodated is: 5 Date of last inspection 1 4 0 5 2 0 0 7 A bit about the care home 703 Burton Road is owned by the Robinia Care Group and is managed as small family-type accommodation. It is situated on the main road between Burton-on-Trent and Swadlincote and enjoys access to both areas. The premises have been furbished to reflect the style of a family home and all the people living here have their own single room. 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 How we did our inspection: This is what the inspector did when they were at the care home The inspector visited at short notice. The last key inspection at this care home was on 14th May 2007. We had asked the Manager to complete a questionnaire about the home, before this inspection. We had asked other people to tell us what they think about the home. Seven people sent us their views. We looked at what staff had written about one persons life. We also looked around the care home and at two bedrooms. We talked to three of the people who live in the care home and to the Manager and staff. We saw how staff treated people. The weekly fees at the time of this Inspection were from £1027 to £1912. What the care home does well The care home finds out what people need and write this down. Staff read these reports so that they can help people to keep healthy and as active as possible. People were helped to have interesting lives. Staff gave them individual attention and they were treated with respect. The homes policies and procedures kept people safe. Policies are rules about how to do things. Procedures tell people how to follow the rules. People were living in a comfortable, homely and safe environment. The care home finds out information about new staff before they start work there. This helps to keep people safe. Staff have training so they understand how to meet peoples needs. The care home was well managed. People were safe and their rights were recognised. What has got better from the last inspection We had approved a new manager at the home. Rooms in the home had been redecorated. What the care home could do better 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 Tony Barker CQC CPC1, Capital Business Park Fulbourn Cambridge CB21 5XE Tel: 01223 771300 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 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 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 . Individual written needs assessments were in place before people were admitted to the Service so that their diverse needs were identified and planned for. Evidence: All the people had lived at this Service for a number of years. An assessment of their needs had been made prior to their admission, as confirmed by examination of care records at a previous inspection. 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 use the Service had very good individual plans of care which demonstrated that their health, personal and social care needs were being met and they were enabled to make decisions about their lives. Evidence: The care plan of the person case tracked was examined. It was a very clear, comprehensive, holistic and person centred set of documents - providing a good view of the persons needs, wishes and personal goals. Support Plans were backed up by Action Plan Evaluation sheets and covered a range of personal needs. The care plan also included sections entitled My Emotions, Positive Behavioural Support Plan and My Future. These sections provided useful insights into the persons emotional needs and, along with the rest of the care planning documents, provided a valuable guide to staff, ensuring that peoples needs and wishes were being met. Good quality recording practices by staff were seen in the case tracked persons daily diary with occasional evidence of the person signing against an entry. The Manager said that staff read the entry to the person beforehand. This is evidence of good practice, by involving the person in their care planning. Monthly Summaries, written by care staff, and annual funding agency-led review meetings ensured that regular monitoring of the needs, and preferences, of people living at the Service is taking place. All care plan entries were being signed and kept up to date. The Service is commended on the quality of its care planning system. Two people living at the Service were helped by their key worker to complete one of our pre-inspection surveys. They both confirmed that they can do what they want at all times. One added that, I like to listen to my music and go to the garden centre. Evidence: We spoke to the case tracked person who stated, I decide when to get up and go to bed...I choose what to wear.....I chose Twycross Zoo (when asked about an outing). We heard of many examples of people being involved in day to day matters as well as in significant events in their life. There was a good range of up to date, recorded risk assessments. These showed that the Service was aware of potential risks to which people were exposed and indicated ways of managing these risks. We noted examples of practical action being taken to minimise unacceptable risks identified on care plans. We spoke in detail to one member of staff who showed an understanding of the concept, and use, of responsible risk taking in order to increase peoples independence. For instance, he saw an example of responsible risk taking being to take people on foreign holidays. Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . The Service provided activities and services that were age-appropriate and valued by the people who live here, and promoted their independence. Evidence: The case tracked persons My Weekly Timetable showed a full range of activities including attending a monthly disco. As Karaoke there was so much appreciated by the people living at the Service a Karaoke set had been purchased for use at the Service and is enjoyed several times a week, the Manager said. She pointed out the educational benefits too - in reading the words of songs. The Service has provided a computer, in the conservatory, used by one person to play games on. Two of the people living at the Service were, or had been, attending college - one currently attends three days a week. The Manager told us that the case tracked person had studied reading & writing, cooking, woodwork and computer skills. She said the person enjoys working with their hands and there was evidence of their woodworking skills and interest in the form of bird-boxes in the rear garden. They personally told us, I like cutting grass and the evidence of this was in a well maintained rear lawn. The member of staff we spoke to was also able to provide evidence of people being involved in valued and fulfilling activities. He said that arts & crafts sessions had been introduced each Tuesday afternoon - led by two craft instructors. He added that peoples pleasure and pride at what they have produced is shown on their faces. We saw examples of greetings cards made recently. Information supplied by the Manager before the inspection indicated a good level of Evidence: involvement within the local community by the people who live at the Service. She said, Service users access the local pub, garden centres, shops, educational facilities, theme parks and cinemas. The Manager also told us in the pre-inspection questionnaire that, We promote family contact...we pick one parent up from home to enable them to spend time with their (relative). This persons My Weekly Timetable showed these fortnightly visits. Each persons Communication Book recorded their contacts from family members, advocates and family friends - whether these be face-to-face or on the telephone. The staff member we spoke with said that people living at the Service all had differing degrees of contact with their families and added that they also make friends with people they meet at the monthly disco. The case tracked person confirmed by saying, I have friends at the Coleshill disco. The staff member we spoke with said that routines at the Service are flexible and he gave examples of how routines promote peoples independence. He said one person living at the Service puts their clothes in the washing machine and hangs them on the washing line afterwards. He also said that all the people do their own ironing. Both these domestic routines were undertaken by staff in the past, he added. Care plans examined showed several domestic activities having associated Support Plans and Action Plan Evaluation sheets. The Services menu is organised each week, in advance, from discussions held with the people who live at the Service. This ensures that food is provided that reflects their preferences. Peoples food preferences were recorded on file. The case tracked person told us that they liked the food here and added, I like fish & chips each Friday. The menus indicated that people were being provided with a varied and nutritious diet. All the people are involved in food shopping, preparation and clearing up after a meal, the Manager said. Food stocks were found to be at a satisfactory level and included fresh fruit and vegetables. We noted a relaxed atmosphere during the evening mealtime and food portions were of a good size. 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 . The Service was providing people with personal support in the way they preferred and required and was meeting their physical, emotional and health needs. Evidence: At this Inspection we observed positive interaction between staff and the people living here - with their dignity needs clearly being recognised. The staff member we spoke with gave examples of how staff meet the dignity and privacy needs of people living at the Service. For example, he said, We always knock on doors and wait for a reply. We observed the Manager knocking on bedroom and bathroom doors before entering, while a tour of the premises was being undertaken. Some eating aids had been purchased for one person living at the Service, as a way of maximised the persons independence. Information supplied by the Manager before the inspection referred to one person using Makaton sign language. The Manager confirmed this to us at the inspection and described this persons good comprehension but lack of any verbal ability. The Manager had also informed us that, All people have opportunity to join the Companys Self Advocacy Forum, and one person has expressed an interest, the Manager told us. The Manager also referred, in the pre-inspection questionnaire, to, plans for all staff to attend Deprivation of Liberty Safeguards training. At the inspection she told us that she and two other staff had attended this training. We saw the Services Mental Capacity Act/Deprivation of Liberty Safeguards folder, showing that the Company has taken a pro-active approach to this legislation and was looking responsibly at each persons mental capacity to make decisions. Care plans provided evidence of each persons health care needs being met. There was evidence on the case tracked persons records of involvement of a range of external health professionals, including psychiatrist, GP, dentist, chiropodist and optician. Health appointment records included a space for feedback from the appointment. Evidence: Health Action Plans were person centred folders covering extensive areas such as Supporting me at Health Appointments, Health History and Medication Record. The Medication Administration Record (MAR) sheets, of the people who live at the Service, were examined. The standard of recording on these sheets was good. There was no record of staff signatures/initials, to ensure that signatures can be crossreferenced against staff names. Medicines were securely stored. No controlled drugs were prescribed. All staff were receiving annual training in the safe use of medicines, the Manager said. 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 . Good procedures for handling complaints were in place and the people living here felt safe. Evidence: The Services complaints procedure was displayed on a notice board in the dining room, in an easy read style, for the benefit of the people living here. The Manager stated that one complaint had been received, from staff on behalf of a person living at the Service, within the previous 12 months. We spoke to the Manager about this positively reflecting staff members advocacy role. We also examined a well-designed complaints record. The Service had a written policy and procedure on the prevention of abuse and a whistle blowing policy. There was also a safeguarding leaflet in a format more understandable by the people living at the Service. There was, however, no copy of local Derbyshire safeguarding procedures or of Reporting Sheets, to be used for referral to Social Services in the event of actual or suspected abuse. The Service had made a safeguarding adults referral to the local community team, in November 2008, concerning local specialist services refusal to support this care home following a serious incident involving one person living at the Service. The Manager was advised that safeguarding referrals should go to the Social Services manager with specific responsibility for safeguarding matters. The Service had appropriately notified us of this incident, and an incident earlier in the year, involving this person. We then asked the Manager whether she would investigate an allegation of abuse: she said she would, after contacting Social Services. She was advised that investigation of a potential safeguarding matter should not be initiated, beyond a brief information gathering exercise, until Social Services had agreed the way forward. This is to prevent potential contamination of evidence should the police become involved. The member of staff we spoke with was clear about what forms of abuse vulnerable adults may be exposed to and about the Services whistle blowing procedures. He felt that the people living here, and staff, were safe. The case tracked person spoke of feeling safe living here. Evidence: The Manager said that all staff had been provided with training, on the subject of safeguarding adults, within the past three years. She also said that staff had been taught diversion techniques to address behaviour, exhibited by people living at the Service, which staff may find challenging. This training has also included awareness of potential triggers of such behaviour and of appropriate forms of physical restraint to prevent people becoming hurt. The Manager described good and safe practice. There was a good set of records used to record such behaviour and resultant staff actions. 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 were living in a comfortable, homely and safe environment. Evidence: The Services environment was homely and well decorated. Re-decoration had taken place since the last inspection to address a requirement made then. Two of the bedrooms were examined with the people accommodated there. They were well furnished and nicely personalised. All but one of the people living here had a key to their room and all had a wash hand basin. There was also a good number of communal washing facilities - one bathroom and two shower rooms. The Manager described the individual use that the conservatory is put to. A large rear garden provides gardening opportunities to two of the people living at the Service - those two who have expressed an interest in this activity. The garden is laid out in areas that provide individualised settings for people. From the tour of the premises there was evidence of good standards of cleanliness and hygiene throughout, with no unpleasant odours. The staff member we spoke with described good practice regarding the transportation of soiled articles of clothing and bedding within the premises. The Manager said that all staff had completed Infection Control training. 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 . The Service had a group of well-recruited, and well trained, staff to ensure that people living here were safe and their needs were met. Evidence: The Manager confirmed that seven of the eight staff had achieved a National Vocational Qualification (NVQ) in Care to level 2 or above. Of these seven, six had achieved an NVQ in Care at level 3. This exceeds the National Minimum Standard to maintain a staff group with at least 50 qualified staff and is commendable. From information provided by the Manager, in writing and in person, it was clear that staffing levels were good. The member of care staff we spoke to confirmed information from the staff rota - that normally three care staff are on duty throughout waking hours. The Manager said that the Service is currently holding one care staff vacancy and that a male is being sought to fill this vacancy - so that the staff group better reflects the gender balance within the group of people who live at the Service. The file of a recently appointed member of care staff was examined. It was found to contain all of the elements, required by current Regulations, regarding recruitment practices. There was recorded evidence that new staff receive a five-day induction training to Skills for Care, Learning Disability Qualification standards. Training records confirmed that staff had been provided with all mandatory training to ensure the safety of people who live at the Service. One member of staff who completed our pre-inspection questionnaire, was positive about the Services training programme - stating that, staff are encouraged by management to further their career, offering courses to obtain qualifications, eg. NVQ level 3. 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 . The Service was well managed so that people living here were protected and their best interests were promoted by the systems in place. Evidence: The Manager had worked with people with learning disabilities for eight years - all spent at this Service. She had managed this Service for 18 Months and was approved as the Registered Manager here in May 2009. She had achieved an NVQ qualification in Care at Level 4 and was due to complete a Leadership & Management in Care Award by November 2009. Monthly independent audit visits to the Service, on behalf of the Registered Provider, as required by Regulation 26, were taking place. The Service had a well developed 2008/09 Annual Plan to give an overview of service aims over the current 12 monthly period. Quality assurance questionnaires were being completed annually by the people who live at the Service and by staff. Also, relatives and external professionals were being asked, each year, for their views on the quality of Service provided - though none had been returned by the latter group. Evaluations of these completed questionnaires were examined and were found to be generally positive. There was evidence of action being taken to address any negative points made. The Manager stated, in her pre-inspection questionnaire, that, we hold house meetings and staff meetings on a monthly basis. We read positive comments about the Service from questionnaires returned to us by relatives and staff. One staff member stated, The home at 703 is a relaxed and homely environment...the service users happiness and well being is of prime importance. One relative said, The Service provides a very high standard of care ensuring a secure and happy life. Evidence: Good food hygiene practices were noted. The safe storage of cleaning materials was observed as required by the Control Of Substances Hazardous to Health (COSHH) Regulations. The pre-inspection questionnaire, completed by the Acting Manager, indicated that equipment at the Service was being maintained and good Health and Safety practices followed. Incident records were examined and these were comprehensive and robust. No Health and Safety hazards were found at this inspection. Are there any outstanding requirements from the last inspection? Yes  No  Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No Standard Regulation Requirement Timescale for action 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 23 13 13(6) Investigation of a 01/07/2009 potential safeguarding matter must not be initiated, beyond a brief information gathering exercise, as stated in local safeguarding procedures. This is to prevent potential contamination of evidence should the police become involved. 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 20 23 There should be a record of staff signatures/initials kept with MAR sheets. A copy of the local Derbyshire safeguarding procedures should be kept at the Service and of Reporting Sheets, to be used for referral to Social Services in the event of actual or suspected abuse. Helpline: Telephone: 03000 616161 or Textphone : or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). 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