Care Home: Castlebar Nursing Home

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What the care home does well All new people receive a comprehensive needs assessment before admission. This is carried out by staff with skill and sensitivity. The home consults people using the service about their satisfaction with the service they are receiving. The home has a medication policy which is accessible to staff, medication records are up to date for each individual and medicines received, administered and disposed of are recorded. The home has a settled staff group and has the numbers and skill mix of staff sufficient to meet people needs. People who use the service are able to express their concerns, and have access to an effective complaints procedure, and are protected from abuse, and have their rights protected. The management and administration of the home is based on openness and respect, and has an effective quality assurance system. Castlebar Nursing Home DS0000007013.V376794.R01.S.doc Version 5.2 What has improved since the last inspection? The Statement of purpose and Service user`s guide have been updated and a copy of the latter document is given to each person who uses the service. The home now confirms in writing to prospective people that their needs can be met by the home, prior to their admission. There has been improvement made with regards to care planning and risk assessments. People`s weights are also being monitored more closely. All environmental and health and safety issues which were identified at the last inspection have been rectified. Most of the home has been refurbished and work is ongoing. A deputy manager has also been appointed. Staff training has improved with the introduction of e-learning. What the care home could do better: All staff must be up to date with their mandatory training to ensure people continue to receive care as is reasonable to meet their needs. Fire doors must not be wedged open unless held open by a magnetic door holder that responds to the fire warning system and need to be kept clear so that they close fully in the event of fire. Key inspection report CARE HOMES FOR OLDER PEOPLE Castlebar Nursing Home Castlebar 46 Sydenham Hill Sydenham London SE26 6LU Lead Inspector Mohammad Peerbux Key Unannounced Inspection 28th July 2009 09:30 DS0000007013.V376794.R01.S.do c Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. 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. Castlebar Nursing Home DS0000007013.V376794.R01.S.doc Version 5.2 Page 2 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 Castlebar Nursing Home DS0000007013.V376794.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Castlebar Nursing Home Address Castlebar 46 Sydenham Hill Sydenham London SE26 6LU 020 8299 6384 020 8299 6385 aura.correia@excelcareholdings.com Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Castlebar Healthcare Ltd Manager post vacant Care Home 63 Category(ies) of Dementia (63), Old age, not falling within any registration, with number other category (63) of places Castlebar Nursing Home DS0000007013.V376794.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 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: Old Age, not falling within any other category - Code OP 2. Dementia - Code DE The maximum number of service users who can be accommodated is: 63 15th September 2008 Date of last inspection Brief Description of the Service: Castlebar is a care home, which provides nursing and residential care for up to sixty-six older people with nursing needs, or support needs due to mental infirmity. The overall stated aim is that of offering care in a home from home setting, meeting individual needs and striving to offer sensitive and conscientious nursing and personal care. The registered provider is Castlebar Healthcare Limited, a company associated to an organisation called ‘Excelcare’, who run over thirty care homes in England. The home is a large nineteenth century building, which has four floors, divided into two main units: one residential and one nursing unit. The nursing care unit is on the ground and first floors and is staffed by qualified nurses and health care assistants. The residential unit is on the second and third floors and is staffed by care assistants. There is a lift. Bathrooms and toilets are on each floor. There are shared dining and lounge areas on each of the first three floors. The home has extensive grounds surrounding the property. The front of the premises is paved to allow parking for visitors and staff. The front and back doors are accessible to people in wheelchairs. The home is on Sydenham Hill, just off the London south circular road and is accessible by bus but is some distance from local amenities or a train station. Castlebar Nursing Home DS0000007013.V376794.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is two stars. This means the people who use this service experience good quality outcomes. This unannounced visit to the home was undertaken as a part of the inspection process for the year 2009/2010. In writing the report, consideration has also been given to information received throughout the year such as comments from people who use the service, reports of incidents and complaints. The acting manager facilitated this inspection. Some of the people were spoken to, however due to their cognitive ability it was difficult to seek their views, though some individuals commented positively on the care they are receiving. One person stated, “I like living here”. They are all thanked for their time and all of those who provided feedback for their support in the inspection process. A tour of the building was also carried out. All registered adult services are now required to fill in an annual quality assurance assessment (AQAA).It is a self-assessment that the provider (owner) must complete every year. The completed assessment is used to show how well the service is delivering good outcomes for the people using it. Some information from the AQAA is included in the report. What the service does well: All new people receive a comprehensive needs assessment before admission. This is carried out by staff with skill and sensitivity. The home consults people using the service about their satisfaction with the service they are receiving. The home has a medication policy which is accessible to staff, medication records are up to date for each individual and medicines received, administered and disposed of are recorded. The home has a settled staff group and has the numbers and skill mix of staff sufficient to meet people needs. People who use the service are able to express their concerns, and have access to an effective complaints procedure, and are protected from abuse, and have their rights protected. The management and administration of the home is based on openness and respect, and has an effective quality assurance system. Castlebar Nursing Home DS0000007013.V376794.R01.S.doc Version 5.2 Page 6 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. Castlebar Nursing Home DS0000007013.V376794.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection Castlebar Nursing Home DS0000007013.V376794.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the 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 may use the service and their representatives have the information needed to choose a home that will meet their needs. No one is admitted into the home without a comprehensive assessment being undertaken. This means the home is aware of how people will need to be supported and can be confident that their healthcare needs can be met. EVIDENCE: The home provides a statement of purpose that is specific to the individual home and the people group they care for. It clearly sets out the objectives and philosophy of the service supported by a service user’s guide. Both documents have recently been updated in line with a requirement made at the last inspection. The service user’s guide, previous inspection report, statement of Castlebar Nursing Home DS0000007013.V376794.R01.S.doc Version 5.2 Page 9 purpose, complaints procedure and information about activities are readily available in reception area of the home. All relatives and people who use the service have a copy of the service user’s guide and the statement of purpose is made available to them. A history pack and a monthly newsletter are also available in the reception area. Admissions are not made to the home until a full needs assessment has been undertaken. A member of staff visits the prospective person either in their own home, hospital or other facility. A detailed assessment of needs is completed, ensuring that admissions to the home only take place if the service is confident staff have the skills, ability and qualifications to meet the assessed needs of the prospective individual. Prospective people and their families are given the opportunity to visit and spend time in the home. Whenever possible they are able to choose the room most suitable. A trial period of four weeks ensures that needs are able to be met to the satisfaction of both parties. Intermediate care for rehabilitation and return to the community is not provided by this home. Castlebar Nursing Home DS0000007013.V376794.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the 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’s care plans include detailed information about their needs and personal goals. This helps staff to know the individual’s needs and how to meet them. Overall the arrangement for health care needs of the person is good and they receive personal support in the way they prefer. EVIDENCE: Five people’s care plans were sampled at random and it was noted they generally included information necessary to deliver the persons care needs. The care plan is a working document reviewed regularly. Reviews focus on asking what has worked for the individual, where there are progress, achievements, concerns and identifies action points. Care plans are signed either by the person or their next of kin. Castlebar Nursing Home DS0000007013.V376794.R01.S.doc Version 5.2 Page 11 It was positively noted that the home actively promotes a person’s right of access to the health and remedial services that they need, both within the home and in the community. A full range of external services are available at the home for example; an optician visits on a regular basis, tissue viability nurse, care home support team, chiropodist, district nurse and dentist. The home has a retained General Practitionner who visits the home weekly and as required. The home has a medication policy which is accessible to staff, medication records are up to date for each individual and medicines received, administered and disposed of are recorded. A detailed administration of medication policy is widely available in the home. Staff who are responsible for the administration of medicines have completed the company medication workbook (level 2). People who wish to administer their own medication are enabled to do so by the provision of a lockable facility in their room and a comprehensive risk assessment. All staff are encouraged to complete the medication module on e-learning. The home works creatively and actively with other services and organisations to ensure that the persons whole life needs are met, and goals addressed. The service recognises its own limitations and when to seek support from others to meet the individual needs of people. Observation of the staff team interacting with people that live in the home showed that the carers were mindful how they addressed individuals, and they were seen to be polite and friendly. People who were spoken to stated that they are happy with the way that the staff delivers their care. Castlebar Nursing Home DS0000007013.V376794.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the 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 tries to be flexible and attempts to provide a service, which is as individual as possible. Dietary needs are well catered for and a well balanced diet is provided, to ensure health and enjoyment of food. EVIDENCE: Staff are aware of the need to support people to develop their skills, including social, emotional, communication, and independent living skills. People using the service are given the opportunity to take part in a variety of activities both within the home and in the community. Major activities, celebrations and outings for the year are planned. People who use the service have the opportunity to develop and maintain important personal and family relationships. The home has open visiting arrangements and individuals know they can entertain their family and friends Castlebar Nursing Home DS0000007013.V376794.R01.S.doc Version 5.2 Page 13 in their own room. If they prefer they can use communal areas of the home to talk to visitors. People who use the service are encouraged to maintain links with their community and families are encouraged to take them out. It was clear from the menus that a wide variety of different food options were available in the home with a lot of consideration given to the nutritional value of the meals provided. Staff are ready to offer assistance in eating where necessary, discreetly, sensitively and individually, while independent eating is encouraged for as long as possible. Picture menus are also available. The menus reflect the wishes of people, who are consulted prior to them being revised. Menus are displayed in the dining rooms along with the mealtimes. Cultural choices are available everyday. Hot and cold drinks are served morning, afternoon and evening, between meals with biscuits in the morning and home baked cakes in the afternoon. Supper is available with the evening drink usually consisting of sandwiches, cheese & biscuits, sweet biscuits or toast. Castlebar Nursing Home DS0000007013.V376794.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the 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 are able to express their concerns, and have access to an effective complaints procedure, and are protected from abuse, and have their rights protected. EVIDENCE: The home has an open culture that allows people to express their views and concerns in a safe and understanding environment. The service has a complaints procedure that is clearly written and easy to understand. Unless there are exceptional circumstances the service always responds within the agreed timescale. There is a general comments book and people that live in the home, relatives and any other visitors can make comments about the service. There is also a suggestion box where people can make anonymous comments. There are policies and procedures for safeguarding people who use the service. The acting manager stated that most of the staff working within the home are fully trained in Safeguarding Adults and know how to respond in the event of an alert. Training is ongoing. A step by step guide to dealing with incidents is Castlebar Nursing Home DS0000007013.V376794.R01.S.doc Version 5.2 Page 15 displayed in the managers office and available to anyone in charge of the home. Castlebar Nursing Home DS0000007013.V376794.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the 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 generally hygienic and clean, homely and comfortable; this environment therefore facilitates the individual’s health and emotional wellbeing. EVIDENCE: The home provides a physical environment that is appropriate to the specific needs of the people who live there. The well-maintained environment provides specialist aids and equipment to meet their needs. People who live in the home are encouraged to personalise their bedrooms. A maintenance programme is in place which ensures that routine checks and repairs are carried out. The home has undergone a major refurbishment, there is just the ground floor to complete. All bedrooms on the first, second and third floors have been Castlebar Nursing Home DS0000007013.V376794.R01.S.doc Version 5.2 Page 17 decorated and recarpeted, with vanity units and upgraded lighting. The ground floor rooms are being upgraded as they become available, many will have ensuite facilities. The reception area and main hall will be redecorated and enhanced to make a feature on arrival at the home. The bathrooms and shower facilities will be refurbished along with the hairdressing salon. A new dining room will be created and the exisiting conservatory and lounge will be upgraded. The first, second and third floor upgrades are complete. There is a selection of communal areas both inside and outside of the home, this means that people using the service have a choice of place to sit quietly, meet with family and friends or be actively engaged with other people who use the service. The home is kept clean and hygienic and free from offensive odours throughout. Systems are in place to control infection in accordance with relevant legislation and published professional guidance. Castlebar Nursing Home DS0000007013.V376794.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff in the home are trained, skilled and in sufficient numbers to support the people who use the service. EVIDENCE: There are consistently enough staff available to meet the needs of the people using the service, with more staff being available at peak times of activity. The staffing structure is based around delivering outcomes for residents. The acting manager stated that there are enough qualified and experienced staff to meet the health and welfare of people using the service. The service does not use agency staff and has a bank of staff who work regularly within the home thus maintaining continuity of care. In order to ensure staff are able to carry out their duties effectively the service actively discourages them from working in excess of their contracted hours, unless in an emergency. Each floor has dedicated domestic staff to ensure every area is cleaned daily. Separate laundry staff are employed. The manager is supernumary and an administrator is employed for 40 hours per week. A full time activity coordinator is also employed. 24 staff have an NVQ level qualification at level 2. Castlebar Nursing Home DS0000007013.V376794.R01.S.doc Version 5.2 Page 19 Recruitment procedures seemed appropriate. Three staff files were examined at random and found to contain all the information required by the Care Homes Regulations 2001 including a completed job application, terms and conditions of employment, an enhanced CRB check and proof of their identity. All employees receive a contract of employment and staff handbook which details the code of conduct and policies and procedures. The service recognises the importance of training, and tries to delivers a programme that meets any statutory requirements. The acting manager is aware that there are some gaps in the training programme and plans to deal with this. All staff must be up to date with their mandatory training to ensure people continue to receive care as is reasonable to meet their needs. The service is also able to recognise when additional training is needed. The home has a development plan for staff and a training plan specific to the needs of the home. Castlebar Nursing Home DS0000007013.V376794.R01.S.doc Version 5.2 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides guidance and direction to staff to ensure individuals receive consistent quality care. There is a quality monitoring system and this ensures the home is run in a way that is in the best interests of the person. EVIDENCE: Since the last inspection a new manager has been in post and she is in the process of registering with the Commission. She has made a positive difference to the home and improved many managerial issues that had been lacking, particularly relating to relationships with staff, visitors and external agencies. People and staff are encouraged to voice their opinions and regular meetings Castlebar Nursing Home DS0000007013.V376794.R01.S.doc Version 5.2 Page 21 are held. The manager has a policy of openness and transparency in all areas of management. Effective quality assurance and quality monitoring systems, based on seeking the views of residents, are in place to measure success in meeting the aims, objectives and statement of purpose of the home. The annual quality assurance assessment (AQAA) was received on time and contains clear and relevant information. The AQAA lets us know about changes the home has made and where they still need to make improvements. It shows clearly how they are going to do this. There is also a yearly quality audit where questionnaires are distributed to relatives and people that live in the home. The home keeps a small amount of money in separate envelopes for each person with a running balance sheet appropriately maintained for sundries, such as hairdressing costs. A sample of these was seen and was accurate and well maintained. Certificates relating to health and safety were up to date servicing certificates. These included gas safety, fire safety and portable appliance test. During the inspection it was noted that three fire doors were propped open by different objects. Fire doors must not be wedged open unless held open by a magnetic door holder that responds to the fire warning system and need to be kept clear so that they close fully in the event of fire. Castlebar Nursing Home DS0000007013.V376794.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 2 Castlebar Nursing Home DS0000007013.V376794.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP30 Regulation 18 (1) Requirement All staff must be up to date with their mandatory training to ensure residents continue to receive care as is reasonable to meet their needs. Timescale for action 27/10/09 2. OP38 13(4) Fire doors must not be wedged 03/08/09 open unless held open by a magnetic door holder that responds to the fire warning system and need to be kept clear so that they close fully in the event of fire. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Castlebar Nursing Home DS0000007013.V376794.R01.S.doc Version 5.2 Page 24 Care Quality Commission Care Quality Commission Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: 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. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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