Care Home: Craven House

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What the care home does well People are well assessed and have regular reviews of the care they receive, this is important to make sure that all their changing needs are consistently met. People are treated with dignity and supported with their health needs. Staff have a good understanding of people`s communication and are able to help people in making day to day decisions in their lives. Individuals have many opportunities to take part in activities that interest them and staff encourage people to live a fulfilling life. People live in an excellent environment which meets their physical needs, the home is comfortable, homely and well maintained. What has improved since the last inspection? This is the first inspection. What the care home could do better: The service must have a Service User Guide which relates to the care provided at Craven House, they must also have a Contract or Terms and Conditions outlining their rights whilst living at the home. Management of Health and Safety must improve. The medication and any chemicals in the home must be stored safely and managed safely. People must be protected from financial abuse, the financial procedures, Service User Guide and Terms and Conditions must inform people where additional charges are made. This is where charges are made when staff are supporting individuals when purchasing specialist equipment to meet their disability needs. Staff recruitment information should be available in the home to confirm that staff are safe to work in the home. Key inspection report Care homes for adults (18-65 years) Name: Address: Craven House Craven House Oakdene West Lane Sutton-in-Craven BD20 7AS     The quality rating for this care home is:   one star adequate 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: Linda Trenouth     Date: 0 3 1 1 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 29 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) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 29 Information about the care home Name of care home: Address: Craven House Craven House Oakdene West Lane Sutton-in-Craven BD20 7AS Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Valerie Ann Lowe Type of registration: Number of places registered: care home 4 Catholic Care (Diocese of Leeds) Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: 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: Learning disability: Code LD. 2. The maximum number of service users who can be accommodated is: 4. Date of last inspection Brief description of the care home Craven House is situated in the village of Sutton in Craven run by Catholic Care. The home has been opened since May 2009 but the people at Craven House have lived together for some years at a small care home in the centre of Skipton owned by the same organisation. The home is a single story building with disabled access. All bedrooms are single and two are ensuite. The lounge and dining room are spacious and comfortable and within Care Homes for Adults (18-65 years) Page 4 of 29 Over 65 0 4 Brief description of the care home easy access of the bedrooms. There are good lighting levels throughout the home. The home has an enclosed garden to the rear with a drive and parking area to the front of the home. The Service User Guide is still being developed but people living at the home or visitors can have access to the inspection report if they wish. The fees for living in the home on the 8th November 2009 are £1,361.24 per week. Care Homes for Adults (18-65 years) Page 5 of 29 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: one star adequate 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 report follows a unannounced visit to the home. The inspection also included gathering information and facts before and after the visit to decide the overall judgement. This is the first inspection of the home. The three people who live at Craven house originally shared a home in Skipton, the needs of the people living in the home changed and it was felt that this new environment was more comfortable and could provide a better quality of life for people. During the visit the records were reviewed and we watched staff working, and talked to people who live at the home. We also looked around the building. The main purpose of this inspection is to make sure that the home continues to provide a good standard of care. Care Homes for Adults (18-65 years) Page 6 of 29 Surveys were sent to people who use the service and the staff, to give them the opportunity to comment on how well they thought the home had done. Seven were returned and the comments are included in this report. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations, but only when it is considered that people who use services 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. Feedback was given to the manager at the end of the visit. The requirements made during this visit can be found at the end of the report. Care Homes for Adults (18-65 years) Page 7 of 29 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 8 of 29 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 9 of 29 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. People are well assessed before they use the service, but information must be available for them to understand and protect their rights whilst living at the home. Evidence: People do not have a Service User Guide or Terms and Conditions for living at the home. The manager says that the Service User Guide is being addressed but people have never had a Contract or Terms and Conditions whilst with Catholic Care. It is important that people are given enough information, so that they know what they can expect when they live at the home. Individuals should all have a Contract or Terms and Conditions this is important to make sure that their rights are protected. Staff tell us that the same individuals have lived together for some time. If the service had a new admission they would be encouraged to visit and stay at the home to help them decide if the home is right for them. They also say it is very important in such a small home that everyone is happy with the move and people living at the home get Care Homes for Adults (18-65 years) Page 10 of 29 Evidence: the opportunity to see if they are happy too. Care Homes for Adults (18-65 years) Page 11 of 29 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 benefit from choices to enable them to exercise day-to-day control over their lives and from having their personal care needs met in the way they preferred and with respect for their privacy and dignity. Evidence: Assessments and care plans were complete and reviews regularly undertaken. This makes sure that the changing needs of people living at the home are continually met. Some people living at the home are unable to communicate verbally. We saw lots of evidence to demonstrate that the manager and staff use information from a variety of sources, and their professional skills, to establish peoples choices and needs by observation of body language and facial expressions. This is important to enable individuals to make day-to-day decisions and help people express their concerns or opinions. The service cares for individuals who have sight difficulties and staff showed a good Care Homes for Adults (18-65 years) Page 12 of 29 Evidence: awareness of how they support and enable individuals in their new environment to be comfortable and feel safe. Staff were able to give many examples of how they make sure that areas of the home remain unchanged to make sure people are able to independently move around the home. Staff were able to give examples of how they support people to make their own decisions from day-to-day, this recently has been about choosing furniture and items for their new home. The care plans recorded examples of how staff enabled people with their personal care. Details in the care plan included how people should be supported to do as much as possible for themselves. This is important to make sure people maintain their independence and dignity. Individuals are encouraged to be involved with the planning of menus and shopping for food in the home. Staff said that they encourage everyone to be involved and individuals have the opportunity to eat what they like and try different foods. A well balanced diet is also encouraged. Care Homes for Adults (18-65 years) Page 13 of 29 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are well supported to live a fulfilling life at the home. Evidence: There are many varied activities happening throughout the week, which are appropriate to the needs, age and abilities of the people living at the home. Activities include personal shopping, walking, social clubs, visiting family, eating out and day trips. People have day trips and an annual holiday from the home. The staff at the home support people to choose where they would like to go. In addition to this there are regular local daily outings and meals out. Staff tell us that peoples birthdays are always celebrated with special birthdays being a big event. Care Homes for Adults (18-65 years) Page 14 of 29 Evidence: People are supported to develop and maintain relationships with families and friends. They are assisted to visit their families and can meet their visitors in private. During the visit people appeared relaxed and comfortable. There was a positive atmosphere and friendly banter between the staff and people living at the home. Staff tell us, Craven House is a very relaxed family home environment, lots of emphasis on privacy, dignity and choice Two individuals living at the home have their own cars, which they finance and are responsible for the upkeep. This allows staff to support people on a one to one basis and smaller group activities. People are offered a varied and nutritious diet and are involved with the menu planning at the home. People are encouraged to try different and new foods and meals. Staff tell us that everyone joins together for their meals where possible to ensure a social occasion within the home. Care Homes for Adults (18-65 years) Page 15 of 29 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples general health care needs are well met but the unsafe storage of medicines compromises peoples health and safety in the home. Evidence: People are treated with dignity and respect. Care was observed to be being carried out discreetly and staff are very aware of how people should be supported in order for peoples dignity to be protected. Staff have good knowledge of peoples personal support needs. Staff were courteous, polite and respectful of peoples dignity when attending to any personal care needs. People looked well-dressed and groomed and are supported with dignity where they needed. Medical appointments and all information relating to this is recorded on each individuals personal file. Referrals to other health care professionals are made as required. Staff make sure that people are given support to attend appointments to meet their Care Homes for Adults (18-65 years) Page 16 of 29 Evidence: health care needs. Staff are prompt in supporting people at the home to get health checks or referrals as and when the need arises. Staff confirmed that they are having training in the completion of a new health action plan. Each person will have a health booklet which details past medical history and present concerns. This is important to make sure that peoples health care needs are consistently met. Staff tell us they have completed training on specific health needs such as Epilepsy. All staff have basic training in administering medication. The manager and deputy confirmed that they have completed more comprehensive training in the safe administration of medication. Other staff are waiting to complete this training in the next few months. The home uses a monitor dosage pre packed system for medicines. We checked some medication administration records and these were found to be in good order. The storage of medicines however raised concerns and this was discussed with the manager. The medication cupboard was unlocked with the key left permanently in the door. The medication fridge was also unlocked. Staff confirmed the keys are always left in the door to give staff easier access. The medications must always be stored safely and comply with the Royal Pharmaceutical Guidance on the storage of medicines in Social Care settings. Care Homes for Adults (18-65 years) Page 17 of 29 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be confident that their concerns and complaints are dealt with but clearer financial guidance will better protect people from potential abuse. Evidence: There are adequate written policies and procedures in place to deal with complaints and the care staff spoken to confirmed they were aware of these. Staff knowledge of these helps ensure they are able to address any issues or anxieties of the people living in the home, and their relatives. The manager and staff spoken to were clear in the protection of vulnerable adults protection procedures. All staff surveys returned confirmed that they were confident in what they would do if someone had concerns. All financial transactions are accurately recorded in the individual persons money record. These records are checked daily by staff. It was noted that when people who live at the home eat out they pay for staff food and drinks and this is not taken from the food budget. The staff tell me that this has always been the case. This practice needs reviewing as it was not clear whether the use of peoples monies in this way had been properly agreed. People do not have a Service User Guide or Terms and Conditions and the financial Care Homes for Adults (18-65 years) Page 18 of 29 Evidence: policy does not give adequate guidance to staff in the use of peoples money. There wwere also concerns that one individual had funded the purchase of his own tracking hoist and in the previous home had paid for the maintenance contract to maintain the stair lift. There were no records of his agreement to this charge. There clearly needs to be greater protection for the people living at the home who are unable to consent to their money being used in this way. Care Homes for Adults (18-65 years) Page 19 of 29 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a comfortable environment which meets their needs. Evidence: Craven house is a detached bungalow set in the village of Sutton in Craven. The home has disabled access to the front and rear. There is a drive and parking space to the front of the home and small secured garden to the rear. Staff commented that, Craven House being on one level makes work easier and the home is very comfortable, even if you are in the office you can hear everyone People living at the home have easy access throughout all the communal areas and their individual bedrooms. There is a communal lounge, dining room and conservatory. Individual bedrooms are within easy walking distance of these areas. Two of the bedrooms have en suite facilities and one room has a tracking hoist. Each bedroom is individually decorated and individuals have their personal possessions and have also chosen and purchased the furniture for their rooms. Care Homes for Adults (18-65 years) Page 20 of 29 Evidence: There is a small laundry adjacent to the bedrooms of the home and the kitchen is situated in a central position within the home. On the day of the visit Environment Health completed a food hygiene inspection and said they were happy with food safety in the home. The home was well decorated, very clean throughout and well maintained. Care Homes for Adults (18-65 years) Page 21 of 29 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. People are supported by a well trained and competent staff team. Evidence: There has been only one new member of staff start work at the home since the home was registered in May 2009, all other staff previously worked at the original Craven House in Skipton. The personnel files were limited and did not have all the information required to ensure that this person had been recruited safely. The manager said that all the necessary checks were in place but this information was held elsewhere. This should be held in the home. Records showed that staffs training was up to date. The manager has good records on staffs training and can easily see when updates are due. Staff felt they receive good training from the organisation. Staff told us, The training is good and I feel more confident in my work All of the permanent staff have completed an NVQ (National Vocational Qualification) in care at level 2 or above. Care Homes for Adults (18-65 years) Page 22 of 29 Evidence: Staff meetings are held every month. The manager and staff confirm that regular supervision takes place. Staff say, I have supervision where I meet with my manager We have staff meetings and supervision regularly, where I can discuss my work I have worked for Catholic Care for several years and really enjoy my work Staffing levels meet the needs of people living at the home but three of the staff surveys felt that staffing levels could be increased, The home could provide more day time staff for outings as all residents have high needs and have aged. More staff cover for days out and to cover unexpected sickness. The rota confirmed that staffing levels are two staff consistently on shift for the three people living at the home. At times this increases to three staff for particular activities. Care Homes for Adults (18-65 years) Page 23 of 29 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Some aspects of the home were well run but Health and Safety must be consistent and people must be better protected by robust financial procedures to make sure everyones safety and welfare is promoted. Evidence: The home has a comprehensive range of health and safety policies and procedures in place. Staff are given opportunities to read and become familiar with these. In the AQAA, the manager confirmed that all health and safety checks are up to date. Records are kept in good order. The Fire and Gas safety certificates were reviewed at the visits and were found to be up to date. Concerns were raised with the manager regarding the type of lock on the front door and the ease of exit in an emergency. Advice must be sought from the fire officer regarding exit doors. The home has a risk assessment and fire procedure in place but this needed further review. The fire risk assessment and evacuation procedure for Care Homes for Adults (18-65 years) Page 24 of 29 Evidence: Craven house must be reviewed to include all possible risk. The storage of cleaning chemicals was of concern and discussed with the manager. The key was permanently left in the cupboard and thus chemicals not stored safely. Concerns were also raised with the manager regarding the safe storage of medicines in the home and the practice of leaving storage areas unlocked and keys in place in the doors. The manager must ensure the safety of medicines whilst in the home and the safety of people living at the home. The service must also review the financial procedures to ensure everyone is sufficiently protected from financial abuse. One individuals monies has been used without apparent consent, this needs urgent review to protect people who live and work at the home. Care Homes for Adults (18-65 years) Page 25 of 29 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 26 of 29 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 1 5 A Service user Guide and Terms and Conditions must be available to each individual living at the home. This is to make sure they have all the information they need and their rights are protected whilst living at the home 23/12/2009 2 20 13 Medicines must be handled 30/11/2009 according to the requirements of the Medicines Acts 1968 and the guidelines from the Royal Pharmaceutical Society of Great Britain. They must be stored safely at all times. This is to ensure that peoples health is protected at the home. 3 22 13 The financial procedures must be robust to ensure that people are adequately protected. 31/01/2010 Care Homes for Adults (18-65 years) Page 27 of 29 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 33 42 Staff recruitment records should be held on the premises to be sure that staff are safe to work at the home. A fire risk assessment and evacuation procedure must be further developed to ensure all aspects of fire safety are in included to make sure people are safe. Care Homes for Adults (18-65 years) Page 28 of 29 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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