Care Home: Cambuslodge Uk Ltd

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What the care home does well People who live in Cambuslodge are involved in all aspects of planning their care and in the running of the home. The Manager and staff promote peoples independence. They constantly seek new opportunities for people for their personal development and social life. `The service has continually impressed me with their approach on person centred practice. Staff are supportive of service users needs to develop their skills and strongly encourage this. There is an excellent key working system that works to service users advantage. There is an overall holistic approach on encouraging service users to improve their quality of life` Quote from social care professional What has improved since the last inspection? Cambuslodge have maintained the excellent standard and met the requirements of the last inspection. What the care home could do better: Although Cambuslodge have no formal complaints and staff support people in a way to preempt any complaints. All `concerns` expressed by residents should be documented in the complaints book with the action taken so that trends can be seen. Key inspection report Care homes for adults (18-65 years) Name: Address: Cambuslodge Uk Ltd Cambuslodge 151 Wandsworth Bridge Road Fulham London SW6 2TT     The quality rating for this care home is:   three star excellent 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: Ann Gavin     Date: 2 3 0 3 2 0 1 0 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 Adults (18-65 years) 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 Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 26 Information about the care home Name of care home: Address: Cambuslodge Uk Ltd Cambuslodge 151 Wandsworth Bridge Road Fulham London SW6 2TT 02077315814 0207315814 cambuslodge@btinternet.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Cambuslodge (UK) Limited Name of registered manager (if applicable) Ms Margo Monica McLaughlin Type of registration: Number of places registered: care home 5 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who can be accommodated is: 5 The registered person may provide the following category of service only: Care Home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Learning disability - Code LD Date of last inspection Brief description of the care home Cambuslodge is a registered care home providing personal care and accommodation for five people with a learning disability. At the time of this inspection there were three men and two women living in the home and no vacancies. The home is located in a terraced house on the Wandsworth Bridge Road, with easy access to local shops in Parsons Green and the shopping centre at Wandsworth. There are good transport links and many local amenities such as parks, restaurants and leisure centres available for Care Homes for Adults (18-65 years) Page 4 of 26 Over 65 0 5 Brief description of the care home service users use. The home opened in 1989 and is owned and run by Cambuslodge (UK) Ltd. All five service users have lived together for more than ten years. Care Homes for Adults (18-65 years) 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: three star excellent 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 peterchart Poor Adequate Good Excellent How we did our inspection: This unannounced inspection was took place on 23 March 2010 from 10:15 to 5pm. Time was spend talking with people who live in the home, with the Manager, proprietor, deputy manager and two care staff. The care of two people who live in Cambuslodge were tracked. This involves talking with them, the staff involved in their care, reviewing their care plan and all other documentation linked to them. Questionnaires were sent to people in the home, their relatives, professionals involved in their care and the staff of the home. All feedback received was very positive some of the comments are included within the report. Care Homes for Adults (18-65 years) Page 6 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. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 7 of 26 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 8 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, 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. Cambuslodge have a stable group of people living in the home. They do have procedures to asses prospective residents Evidence: Cambuslodge has a stable group of people who have lived in the home since it began. Everyone has their own individual contract.The manager said that they update their Service User Guide and Statement of Purpose regularly. In the event of someone leaving the home Cambuslodge do have procedures for the assessment of prospective residents Care Homes for Adults (18-65 years) Page 9 of 26 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 are involved in planning and reviewing their care. They are also involved in creating positive ways of managing those areas of daily living that could present risks. Evidence: The home helps me with my needs and activities Quote from person living in the home Two people who live in the home were case tracked which means time was spent talking with them, their key worker, looking at their care plans, medication and finances records and any other records linked to them. The care plans seen were excellent with clear achievable goals. They were person centred and focused on peoples strength and preferences One person had a daily walk as a goal and there were clear details of how they were going to achieve this, by walking in the park at weekends when they have more time and by going for a walk Care Homes for Adults (18-65 years) Page 10 of 26 Evidence: during college breaks. The plans are developed creatively firstly with the person living in the home using flip chart with photos of them carrying out different aspects of daily living and leisure. From this goals are agreed and the plan completed with how the goals will be achieved. One persons goal of working in a shop was not possible at the moment so an alternative of learning a language was decided upon as an interim plan. The person was encouraged by the course and has turned a disappointment into a positive area of new challenge. Observing the interaction between the people living in the home and the staff gave evidence of mutual respect and how much people are involved and supported to be active owners of their own plans and their home. Everyone has an advocate apart from one person who is very able to express themselves and all agree that advocacy would not be appropriate. One person is making a major life change as they are getting married in December. Whilst this has been discussed with them, their fiance and care manager the current plan is that they will remain in the home after their marriage. With such a major decision an advocate needs to be involved and all the options discussed with the person and their fiance. This was being done by the Manager. Each care plan had assessments of possible risk areas which are managed with positive measures. People are encouraged to be independent and support is offered with discretion. One of the people at the home rang to say that they were leaving college and were on route home. Another person likes to go out on their own but can get distracted and not be aware of certain dangers. They have agreed that staff can accompany them at a distance and only intervene if there is a difficulty. One person needs extra care needed walking up stairs this was noted by hand on the risk assessment which was dated 2008. The updated risk assessment was on the computer but needs to be on the file accessible to all. Care Homes for Adults (18-65 years) Page 11 of 26 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live in Cambuslodge enjoy a full and active life both within the community and the home. They are encouraged and supported to develop and try new interests and skills. Everyone in the home plans and prepares the menus and meals. Evidence: I like everything, I have no complaints. I like holidays, I like my room, I like the food Food,clean,do things I like Quotes from questionnaires from people who live in the home answering what does the home do well The people spoken with at the home had very full and active lifestyles which they clearly chose and enjoyed. Friendships are encouraged and links with peoples families Care Homes for Adults (18-65 years) Page 12 of 26 Evidence: supported. The majority of people living in the home are involved in the local community People are able to attend any religious services as they wish. One of the people goes regularly to volunteer at a local church. One person returned from voluntary work and showed the NVQ level 1 they had achieved. They said how much they enjoy working and learning a new language. They also spoke of the holidays they had enjoyed with the others in the home and how close they all are. The conversation was interrupted by another person in the house playing loud music but the person showed great tolerance and understanding of the level of music and assured the inspector that the level would reduce soon. This was one of the examples of the respect for each persons preferences and the ability people have to make space for the other. One person who is very artistic had a care plan which showed a variety of creative courses from pottery, design and make and needlecraft. They also enjoy dancing and the classes they attend also help with developing their mobility and balance. They spoke of how they are learning more numeracy and also the computer. Their room was decorated with many of their own art and craft work. One person said how they like to have a lie in on Saturdays and it was clear that everyone is able to set their own routine. The weekends are also time to explore different parts of London or the surrounding area and take advantage of the numerous special events that take place. The home has increased the level of staff at weekends to offer one to one support for two of the people who live in the home. One person is supported to visit their boyfriend another person supported to go to the zoo or other specific places. All the people spoken with said how much they enjoy their holidays together and that they decide together where they want to go. Each of the people in the home has one evening when they cook the meal. The menu is chosen together sitting around the kitchen table and each one chooses what they would like to cook. Completing the menu together also means that if people want to cook the same thing it can be planned on different weeks. The staff support people to include healthily options and have a balanced diet. There was fresh fruit on the table and the menus seen were varied and balanced. Everyone takes it turns to do the shopping. One person who finds it more difficult to go out is now going out daily to buy the milk. Care Homes for Adults (18-65 years) Page 13 of 26 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who life in the home have their health care needs monitored and met. The home has good links with local healthcare professionals. All staff have completed training in medication. Evidence: On the occasion when we see staff with their clients they are always supportive and respectful towards their clients Quote from social care professional The staff ensure that service users are well supported and attend my clinic regularly. They communicate effectively particularly if there are any concerns Quote from health professional Each person who lives in the home has an annual health check. The home enjoys good relationship with health professionals. People go regularly to the chiropodists, dentist and opticians. One person had a real fear of the dentist but through being supported Care Homes for Adults (18-65 years) Page 14 of 26 Evidence: by the staff over a period of time they have now managed to go to two dental appointments. Both the person and the staff were delighted at this. One of the people in the home has quite complex medical problems which also include the need to do specific exercise and follow a low cholesterol diet. They are being supported to do both and they said that it helps having people encourage you. The home has made sure that all of their conditions are closely monitored and any changes told to the healthcare professionals. The care plans seen included good health care support and monitoring with clear guidelines for any physical or emotional needs. The medication records and cupboard were all in correctly stored and signed for with no gaps. Boots provide the medication in blister packs and any medication outside of these were clearly labeled and dated including creams and bottles. All the staff have had medication training and two staff carry out the medication audits. Care Homes for Adults (18-65 years) Page 15 of 26 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are able to talk about any concerns and feel they are listened to and their complaints acted upon. Staff have annual training in safeguarding vulnerable adults. Evidence: They listen to me Quote from person who lives in the home Talking with the people who live at Cambuslodge and reviewing their questionnaires it was clear that they knew how to raise concerns and that they were confident they would be acted upon. The Manager said that they encourage people to talk through issues before they develop into complaints. There have been no complaints documented for a number of years. This was discussed with the Manger who talked through and a number of occasions of how issues are dealt with. For example people might have complained about someone not doing their share of the washing up or leaving things lying around. One of the people often plays their music too loud. This is managed through talking and the person respects the others comments. Care Homes for Adults (18-65 years) Page 16 of 26 Evidence: It was clear that all these complaints had been listened to and acted upon to the satisfaction of all. However they had not been documented outside of the daily log or in the residents meetings. It is important to document how peoples concerns were managed and actioned within the complaints book so that trends can be seen. Looking at the notes of the residents meetings which are held regularly one person living in the home spoke of the need for everyone to have table manners and say excuse me if they wish to leave. Another person in the home said that the issue of leaving the cups in the sink was better and encouraged the others to keep it up. There was clear evidence of people freedom to observe and request change. All staff have now completed training in safeguarding vulnerable adults and it is now part of the annual training. There are clear process in place to safeguard peoples monies.Each person has two accounts one a mini ISA and one a savings reward. All transactions have receipts and are are clearly explained. There is clear accounting of each persons personal accounts. They are well documented with a good audit trail. As the people in the house often go out together they sometimes have shared receipts. These are divided up and the receipts are cross referenced. Care Homes for Adults (18-65 years) 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, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live in Cambuslodge are involved in the planning of the decoration of the home and of their own rooms. The home is welcoming, bright clean and homely. Evidence: Cambuslodge is welcoming bright and homely. The people who live in the home decide together with the staff on the decoration of the communal areas. Every one chooses their own decoration for their rooms. Two of the people in the home were happy to show me their rooms and both rooms reflected their individual personalities. One person had much of their art and also craft work displayed. Another had their certificates and posters. Everyone who lives in the house are involved in cleaning the home. They have divided up the cleaning and laundry tasks amongst them. The home also employs a part time cleaner. Cambuslodge has a lounge with a large TV, DVD and video player. There is also a spacious kitchen and dinning room which is much used by all. One of the people also has all their music collection and their various music decks and other audio equipment there. Care Homes for Adults (18-65 years) Page 18 of 26 Evidence: There is a small garden leading off the kitchen dinning room with a BBQ. There are steps with handrails for easy access. In their AQAA the Manager said that they are planning to install an electric shower in the upstairs bathroom with an appropriate water gauge for safety. They will also be decorating the bathrooms within the coming months. The home has a regular rolling decoration and maintenance programme for the communal areas of the home. They have recently repainted the outside of the home and laid new stair carpet. Care Homes for Adults (18-65 years) 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, 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 staff seen were confident in their roles and knowledgeable about the people they support. Staff have good access to ongoing training and are well supported. Evidence: Cambuslodge have procedures in place to ensure the safe recruitment of staff. All staff have face to face interviews where their identity and references are verified. A written record is kept of the interview. People who live in the house are involved in interviewing and in the decision process for prospective staff. There is good training available to staff both internally and externally. Some of the recent training includes diversity, break away training, safeguarding, dementia and mental capacity act. The health and safety yearly training is now carried out in house as the Manager has completed a train the trainers course. The courses she covers are safeguarding, infection control, manual handling, fire training and role of the carer. Staff have complete induction and there is a programme for staff to obtain NVQ and LDQ qualifications. The Manager spoke about delays in NVQ due to Assessors not always working to timescales. Care Homes for Adults (18-65 years) Page 20 of 26 Evidence: The three members of staff spoken with were clear about their role and demonstrated knowledge of the people they support. Their records showed that they have received regular training and they were happy with the standard and frequency of training. Every day I learn something new one staff member said. All staff receive regular and supportive supervision. There are yearly staff appraisals. Staff said there was a very open management style and it was easy to raise concerns and talk through any issue . There are staff meetings every month and the level of support and professional development was high according to the staff seen. The staffing levels have not changed except for the extra waking staff which was in place during a specific period which has now ceased. There is now one sleep in member of staff on at night and two people on at all times and often three to support people with activities. The staff rota was clear and verified the level of staffing. At each handover a checklist is completed and there are clear tasks to complete each shift. There was a good rapport observed between the people who live in the house and the staff. Care Homes for Adults (18-65 years) Page 21 of 26 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Cambuslodge is well run and led by an experienced Manager who has the best interests of the people in the home as their priority. There are good health and safety procedures in place. Evidence: The Manager has been in post for over ten years and has worked closely with the deputy Manager since they started five years ago. The whole ethos of the home is focused on the best interests of the people who live in the home. This is reflected in the management style which seeks to involve people in every aspect of their care and in the running of the home. The Manager is undertaking a foundation degree in long term conditions and the deputy is planning to start an NVQ level 4 once she has sourced a course. The proprietor of the home is closely involved in the home and covers some shifts during holidays. The home sends out annual questionnaires to all who live in the home their families Care Homes for Adults (18-65 years) Page 22 of 26 Evidence: and any professionals who are involved in their care. These are usually completed at the same time as the persons annual review. The home has good relationships with other local professionals. Cambuslodge keep good records of events. Care needs to be taken to ensure the more recent assessment is on file and not on the computer. It would be helpful if the system for care plans was revised to make the information on people more accessible.The care plans are kept in the office but all in different sections. Some information could be archived and all sections of peoples care plans stored together. The health and safety records seen were well kept and up to date. The home has regular fire safety checks and fire drills. There are personalised fire escape routes for those people who will benefit. Care Homes for Adults (18-65 years) 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 Adults (18-65 years) 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 2 9 22 Updated risk assessments need to be on the file accessible to all not left on the computer. All complaints expressed by residents should be documented in the complaints book with the action taken so that trends can be seen. It would be helpful if the system for care plans was revised to make the information on people more accessible. 3 41 Care Homes for Adults (18-65 years) 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. 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