Care Home: Charlotte Straker House

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What the care home does well We thought the actual care of residents was excellent. All of the residents looked clean and well cared for. Residents told us that they were well looked after and were happy with the standard of care. Residents told us that staff provided them with privacy and encouraged them to remain in control of their own lives. One resident said that there were no silly rules that she expected from care homes, and, she was able to live her life as she pleased. Another resident told us that she arranges her own medical appointments and sees her doctor in private. Residents general health appeared to be good. None of the residents has pressure ulcers. Staff were clear about the care needed by individuals and appeared confident in their role. The premises were very clean, tidy and odour free. Residents told us that the home was always clean and that they received a very good laundry service. Residents rooms were very well personalised. One resident told us she was encouraged to bring furniture, books and writing equipment with her. She was content to spend most of her time in her room and appreciated the fact that she was not under pressure to join activities. The food was very good. We tasted the food and found that it was hot, well presented and well cooked. The cook told us that the menu was spread over four weeks and rotated on a seasonal basis. She stated that residents had a varied palate and she tried to reflect this in the menu. The cook aims to offer five portions of fruit and vegetables daily and home cooks cakes and biscuits. Money held for residents was well managed. Clear accounts are held detailing all transactions. Residents and relatives are consulted through quality surveys. We looked at the results of previous surveys which were very positive. Complaints within the home were well managed. Residents told us that they knew how to complain and felt able to do so if necessary. External health and safety checks were up to date. Fire safety checks were also up to date. What has improved since the last inspection? There were no areas identified for improvement at the last inspection. What the care home could do better: The written plans of care did not reflect the good care practice in place. Care plans were not comprehensive enough and did not reflect the current needs of all residents.Risk assessments did not contain enough detail of all risks or associated actions. There were a large number of unused controlled drugs stored in the cupboard including one not recorded in the controlled drugs register. Record keeping within the home could be improved including the recording of medication carried over from the previous month and medication sent for disposal. Internal safety checks were not comprehensive enough and need to be expanded. Formal supervision of staff had not been carried out. Some staff had not been supervised for over a year. Staff recruitment was mostly satisfactory but some records did not show interview records. Staff photographs were not available on all records. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Charlotte Straker House Cookson Close Corbridge Northumberland NE45 5HB     The quality rating for this care home is:   two star good service 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: Janet Thompson     Date: 1 9 0 5 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. 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. 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 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. Care Homes for Older People Page 2 of 27 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. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 27 Information about the care home Name of care home: Address: Charlotte Straker House Cookson Close Corbridge Northumberland NE45 5HB 01434-633999 01434632316 charlotte.straker@btinternet.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : The Charlotte Straker Project care home 28 Number of places (if applicable): Under 65 Over 65 28 old age, not falling within any other category Additional conditions: 0 The maximum number of service users who can be accommodated is: 28 The registered person may provide the following category of service only: Care home with nursing - Code N To service users of the following gender: Either Whose primary care needs on admission to the home are within the following category: Old age, not falling within any other category - Code OP, maximum number of places: 28 Date of last inspection Brief description of the care home Charlotte Straker House is close to the centre of Corbridge village. Residents can easily get to shops, church and other local facilities. The home provides both nursing and residential care for 28 older people. Three nursing beds are GP funded. Two of these beds are used to provide palliative care. Most rooms have en-suite facilities. The communal areas are generous in size and very pleasant. Residents can also use communal assisted bathrooms and toilets. Residents can use lifts to reach all bedroom areas. Bedrooms are at ground, first and Care Homes for Older People Page 4 of 27 Brief description of the care home mezzanine levels. The manager, deputy manager, qualified nurses, a team of care workers, dedicated kitchen, domestic and laundry staff support residents. The home has a large involvement in the local community. Occupancy levels are always high and the home has a good reputation within the community. Fees for the home vary, further information can be obtained from the home. Care Homes for Older People Page 5 of 27 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: 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. We have reviewed out practice when making requirements. Some requirements from previous inspection reports may have been deleted or carried forward to this report as recommendations. This will only happen when it is considered that people who use the service are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. Care Homes for Older People Page 6 of 27 Before the visit we looked at information we received since the last visit to the home. This includes how the service dealt with any complaints, changes to how the home is run, the views of people who use the service and the managers views of how well they care for people. We sent questionnaires to people who use the service and some of the staff at the service. 19 completed questionnaires were returned to us. An unannounced visit was made on the 14th of May and we returned to complete the inspection on the 19th of May. During the visit we talked with people who use the service, some staff and the manager. We looked at information about people who use the service and other records which must be kept. We checked that staff had the knowledge, skills and training to meet the needs of the people they care for and we looked around the building to make sure it was clean, safe and comfortable. Following the inspection feedback was given to the manager. What the care home does well: What has improved since the last inspection? What they could do better: The written plans of care did not reflect the good care practice in place. Care plans were not comprehensive enough and did not reflect the current needs of all residents. Care Homes for Older People Page 8 of 27 Risk assessments did not contain enough detail of all risks or associated actions. There were a large number of unused controlled drugs stored in the cupboard including one not recorded in the controlled drugs register. Record keeping within the home could be improved including the recording of medication carried over from the previous month and medication sent for disposal. Internal safety checks were not comprehensive enough and need to be expanded. Formal supervision of staff had not been carried out. Some staff had not been supervised for over a year. Staff recruitment was mostly satisfactory but some records did not show interview records. Staff photographs were not available on all records. 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. Care Homes for Older People Page 9 of 27 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The needs of people using the service are fully assessed before they enter the home. Evidence: Information is gathered about residents before they are admitted to the home. The information is used to formulate the initial plan of care. All care needs are clearly identified and other health professionals contribute where needed. There are some beds within the home that are allocated to take residents on short notice following a GP referral. Clear admission criteria is in place for those people. Care Homes for Older People Page 11 of 27 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service recieve good personal care but this is not always well planned. Evidence: Three care plans were examined and two were case tracked. This means that we spoke to the individual residents or observed their care then matched our observations to what was written in the care plan. The care plans did not fully reflect the actual care needed by residents. Assessment information was sparse, assessments did not indicate how often the area of care was to be reviewed. In one file a care plan had been signed by the resident and the nurse but it was blank, the same plan had a pressure assessment based on information that the resident had not lost weight but in fact she had lost 2kg in the previous month. This plan had not been updated to reflect the fact that the resident had become more dependant when mobilising and needed help with continence care. The resident told us that she suffered pain in her feet, but the pain assessment sheet had not been filled in. The risk assessments were not detailed enough. One risk assessment was for a resident with some confusion and Care Homes for Older People Page 12 of 27 Evidence: challenging behavior, it had been written in March 2009 and not evaluated since. There were behavior charts in place for this resident but no care plan relating to management of the behavior. We examined behavior charts for two other residents which showed a very poor standard of record keeping. Staff had doodled on them and each line was written twice. Records of food and fluid intake were generally adequate though some did not show actual amounts of food eaten. Audits of care plans are carried out but only one has been carried out this year. We thought the actual care of people was excellent. Residents told us that they were very well cared for. They said staff attend to their needs quickly and in the manner they prefer. One resident told us she can have a bath as often as she likes and this she appreciates greatly. Another resident said she liked it because there were none of the silly rules that she had expected. All surveys returned by residents, relatives and staff indicated that the care was very good. We noted that all residents looked clean and well cared for. Clothes were clean and well pressed. A resident told us that she thought the laundry service was excellent and she was amazed how quickly clothes were returned. None of the residents in the home suffered from pressure sores. Residents told us that staff were quick to obtain medical support for them and that they were free to arrange Doctors visits on their own if they wished. They described the medical care as excellent. We thought the nurse on duty showed a good depth of knowledge about the people in her care. She demonstrated respect for their privacy and dignity at all times. The home has a special interest in caring for people on end of life pathways and have developed good policies and procedures in this area. The staff have good knowledge on the subject and have developed very good community links to enable them to offer an individual and expert service to people reaching the end stages of life. Care plans contained some good information relating to wishes about death and dieing, this included advanced directives and assessments of capacity. When we inspected the medication in the home we found that a large number of controlled drugs were stored in the cupboard that should have been disposed of. We asked a pharmacy inspector to visit on a separate day. His findings are as follows. Morning medicine administration was observed on the residential unit and was generally observed to follow good practice guidance although the senior carer signed the administration record before observing that medication had been taken. Medicine administration record (MAR) charts were looked at on both floors. There were no gaps in the medication records but the quantity of any medication carried over from the previous month is not recorded on the MAR chart and some handwritten entries did not include the amount of medication received into the home. This makes it difficult to maintain a complete record of medication in the home and to check if Care Homes for Older People Page 13 of 27 Evidence: medicines are being given as prescribed. Some handwritten entries on MAR charts did not include the signature of the person making the entry, the date or a witness signature confirming their accuracy. The controlled drug cupboard appears to meet safe custody regulations. There were no discrepancies between controlled drugs held in the home and the relevant entries in the controlled drug register and on the MAR charts. There was no evidence of regular controlled drug checks although one had been completed a week earlier. The disposal of medicines that are not controlled drugs is not recorded. The door of the treatment room was not always locked when not in use during the inspection which means that medication awaiting disposal is not securely stored. Care Homes for Older People Page 14 of 27 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are encouraged and supported to maintain good social links and maintain individual interests. Evidence: An activities co-ordinator is employed for three days per week. She supports residents to use a range of services within the local community. Residents are encouraged to be in control of their own lives and enjoy their own interests and hobbies. Religious services are held in the home and some residents attend their own church in the community. One resident goes out to her local hairdressing salon and a hairdresser attends the home regularly. The activities on offer meet the minimum standard expected for a nursing home. The standard could be exceeded if more attention was given to activities as the resident group is very diverse and willing to participate. Residents told us that they had a high degree of choice in respect of how they spend their day. One resident chooses to stay in her room and appreciates that staff respect her wishes in this area. One resident was keen on letter writing and her room was well equipped to enable her to do this. The local community is very involved in the home and residents are supported by a local voluntary group of friends of the home. In questionnaires one relative thought residents should go out more. This has been Care Homes for Older People Page 15 of 27 Evidence: passed to the manager for consideration. The remainder of questionnaires indicated a high degree of satisfaction in this area. Residents also said they liked the food. They told us that they could have a choice of what to eat and chose whether to eat in their rooms or the dining room. The dining room was clean and tables were nicely set. The atmosphere at lunch was very relaxed and sociable. We ate the food at the home which was excellent. The Cook told us that the four week menu rotates on a seasonal basis and is currently under review. The menu was varied in content and offered a variety of dishes to suit most palates. All cakes and some biscuits are home made. Care Homes for Older People Page 16 of 27 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are assured that their complaints are taken seriously and they will be listened to. Evidence: Staff follow the homes policies and procedures relating to the management of complaints and allegations of abuse. Staff are kept up to date with information and training about adult protection. There has been one meeting of the adult protection team about a resident in the home. This involved a review of the residents continued placement and was not related to the actions of any staff member within the home. Residents are told how to complain through the complaints procedure. This was clearly visible within the home. Residents spoken to said they would complain if they needed to but none of them had any current complaints. Care Homes for Older People Page 17 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents live in a clean, comfortable home that is well equipped to meet their needs. Evidence: The home was very clean and tidy on the day of inspection. There were no offensive odours. The decor and furnishings are well maintained and are under constant review. Some of the bedrooms for people requiring nursing care have been fitted with overhead lifting equipment and floored with a non slip laminate. This is easy to keep clean and helps reduce the risk of infection. Residents told us that the home is always clean and tidy. One resident said that was why she wanted to come into the home, when she came to look around it smelled fresh. Some of the bedrooms are fitted with en-suite showers. Most of those occupied by people requiring nursing care are not. There is currently no communal shower facility on the ground floor though consideration is being given to the provision of one. The laundry area is well equipped and was very clean and well organised. In questionnaires residents praised the laundry service for its efficiency and quality of cleaning. One resident said it was without equal. Care Homes for Older People Page 18 of 27 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are cared for by an experienced and competent staff team. Evidence: The current staffing levels are: Daytime. Three care staff upstairs, three care staff downstairs and one qualified nurses. Night time. Three care staff and one qualified nurse. Residents spoke very highly of staff and said they were friendly, dedicated, helpful and caring. Relatives said staff were polite, respectful and knowledgeable. One resident told us that the staff made her feel part of a big happy family. Another resident was keen to tell us that staff worked hard and tried their best at all times to accommodate everyones wishes. Training records showed and staff confirmed that over 50 of staff had achieved NVQ level 2 or above. Some essential training had lapsed, though this has now been planned. A training overview plan is in place to ensure this does not happen in future. Staff have received some vocational training in subjects relating to their role. Care Homes for Older People Page 19 of 27 Evidence: Five staff recruitment files were examined. These were for one new carer, one new nurse and three long term employees. Information varied. One file showed thorough background checks had been carried out before employment. An interview form was used and two references had been obtained. One file showed that an interview form had not been used and there was no photograph identifying the staff member. Two staff had been employed as casual workers then offered permanent posts, old information was retained and used for the permanent application. One of these was a change of role from carer to registered nurse. New information should be obtained following any gap in employment or change of post. Residents were protected through checking of criminal records information for all employees. Care Homes for Older People Page 20 of 27 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management of the home is not thorough enough to ensure residents safety and welfare. Evidence: The home has an experienced registered manager. She has been assessed as having the competency and skills to run the home. The manager regularly updates her skills through training. Residents and staff told us that the manager was approachable and well liked. Staff said she listened to their views and supported them in their work. Staff had a clear understanding of their role and there were clear lines of accountability within the home. The home does operate a quality assurance system. Residents, their relatives and professionals are consulted about the service provided through questionnaires. These have not yet been issued this year. We looked at the results of last years questionnaires which were very positive. Quality audits were not carried out frequently Care Homes for Older People Page 21 of 27 Evidence: enough. Audits of care plans and medication had not picked up the issues identified in this report. Staff are consulted through meetings which are held approximately every three months. Residents meetings have not been held recently as residents said they did not want to meet regularly. This decision is to be reviewed from time to time. Servicing and maintenance agreements are in place for facilities and equipment. External health and safety checks were up to date. All fire safety checks; tests and instructions to staff are conducted at the required frequency and recorded. There were no obvious trip hazards in the home. Fire exits were clear of obstruction and all hazardous fluids locked away. Internal health and safety checks did not cover all areas of risk. For example hot water checks are not carried out for showers or baths, window restrictors or bedside rails. Staff supervisions were not up to date. Some staff had not received formal supervision for over a year. Residents personal monies were well accounted for. Records were examined and showed that two signatures were obtained for all transactions. Four amounts of money were counted and were correct. Care Homes for Older People Page 22 of 27 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 23 of 27 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 Care plans must be kept up to date and reflect the current needs of residents. All care needs should be fully documented. All records should be clear and compiled in a professional manner. Risk assessments must be robust and kept under regular review. Regualtion 15(1) requires you to prepare a plan to demonstrate how residents needs are met and part 2(b) of that regulation require you to keep the plan under review. 01/08/2009 2 9 13 A record must be kept of all medicines received, administered and leaving the home or disposed of. Regulation 13(2) requires 27/07/2009 Care Homes for Older People Page 24 of 27 you to do this to maintain a full audit trail and to ensure there is no mishandling of medication. 3 36 18 Ensure staff are formally supervised six times per year. Regulation 18(2) requires you to ensure that staff are appropriately supervised. 4 38 13 Carry out regular health and 01/08/2009 safety checks on hot water delivery, window restrictors and bedside rails. Regulation 13(4) requires you to assess potential risks and hazards and take reasonable steps to prevent them. 01/09/2009 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 9 The treatment room should be locked when not in use and should be used solely for the storage of medicines and related products. The desk and computer equipment should be removed. A system should be in place to record all medication in the home including medication carried over from the previous month. Regular controlled drug stock checks should be carried out and recorded. Staff should sign and date handwritten entries they make on MAR charts. Each entry should be checked and countersigned by a second person to reduce the risk of error when copying information. Care Homes for Older People Page 25 of 27 A list of signatures and initials should be maintained to identify all staff authorised to administer medicines. Audit of medication should be done more frequently and include reconciliation checks of medication stock against administration records on a small sample of MAR charts to confirm that staff are following the medication policy. 2 32 Carry out regular and through audits of systems and practice in the home. Care Homes for Older People Page 26 of 27 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). 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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