Care Home: Dene Bungalow Care Home

What the care home does well The staff are good at involving the residents in the day to day running of the home. Minutes of residents meetings show how seriously staff take the views of the residents in order for them to experience positive choices in their lifes. The staff engage the residents in various social and recreational activities. Records show that residents enjoy a wide variety of social and recreational activities, including the opportunity to access adult education facilities at the local college. The home is clean and well maintained. It is well furnished and equipped to meet the needs of the residents. The bed rooms are personalised and reflect individual preferences and taste. Comments by staff, residents and relatives via the CQC questionnaires include the following: "The home is excellent at giving support to both service users and staff". "Yes, I am very happy here". "The manager is really supportive of the staff". "Since this new manager, the staff have been working as a team". There is good professional relationship between the staff and the residents. Staff treat the residents with dignity and respect. What has improved since the last inspection? Since the last inspection there has been a change in the management and ownership of the home. Choices Care took over the running of the home from the health authority which managed and run the home for several year until September 2009. The new manager is reviewing the current support plans and examination of records show that the home is making good progress on the quality of information in the support plans. A number of requirements and recommendations in the last inspection report have been addressed. The kitchen has been completely re-furbished and now provides clean and hygienic environment for the residents. What the care home could do better: The manager should make an application to the Care Quality Commission to be registered. The manager and senior staff must receive training in Mental Capacity Act and Deprivation of Liberty Safeguards. This training should eventually be extended to all staff. This training should be given priority as the manager acknowledged that the staff should by now have received this training from the previous provider. Choices Care should look at the possibility of creating an office space in the home so that staff can have their supervision sessions and meetings in a more suitable location. Choices Care should review their written policies to make sure that references are made to English standards, guidance and regulations rather than Scottish ones which may not necessarily relate to services run in England. Key inspection report Care homes for adults (18-65 years) Name: Address: Dene Bungalow Care Home Dene Bungalow Care Home Newcastle Road Sunderland Tyne and Wear SR5 1NA     The quality rating for this care home is:   two star good 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: Sam Doku     Date: 0 7 0 1 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 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: Dene Bungalow Care Home Dene Bungalow Care Home Newcastle Road Sunderland Tyne and Wear SR5 1NA 0 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Choices Community Care Service Ltd Name of registered manager (if applicable) Type of registration: Number of places registered: care home 4 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who can be accommodated is: 4 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, maximum number of places 4 Date of last inspection Brief description of the care home Dene Bungalow was an established NHS service, and was taken over by Choices Care in September 2009. The service provides personal care and accommodation for four people with learning disabilities. The service is located in Sunderland in the grounds of Monkwearmouth Hospital, and is near to local facilities and aminities. There is a ramped access to the garden areas Care Homes for Adults (18-65 years) Page 4 of 29 Over 65 0 4 Brief description of the care home around the home. There is a patio and seating areas in the garden to the rear of the building. The scale of charges for the home is difficult to calculate at the moment as Choices care is still in negotiation with the local authority as to the appropriate charges to be made to the residents. 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: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating of this service is 2 Star. This means the people who use the service experience good quality outcomes. The inspection was unannounced and commenced on 7 January and completed on the 11 January 2010. Before the visit the inspector looked at: Information we have received since the last inspection visit on 14 April 2009. How the home dealt with any complaints and concerns since the last inspection. Any changes to how the home is run. The providers view of how well they care for people, as highlighted in the details provided in the Annual Quality Assurance Assessment (AQAA). During the visit the inspector did the following. Talked to the people who use the service, the manager and the care staff who were on duty at the time of the inspection visit. Looked at information about the people who use the service and how well their needs are met. Looked at other records which must be kept. Checked that staff have Care Homes for Adults (18-65 years) Page 6 of 29 the knowledge, skills and training to meet the needs of the people they care for. Looked around the home to make sure it is safe and secure. Checked what improvements have been made since the last inspection. Consider the comments made by other staff and residents in the CQC questionnaires that were received from both residents, staff and relatives. 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 the 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. 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: The manager should make an application to the Care Quality Commission to be registered. The manager and senior staff must receive training in Mental Capacity Act and Deprivation of Liberty Safeguards. This training should eventually be extended to all Care Homes for Adults (18-65 years) Page 8 of 29 staff. This training should be given priority as the manager acknowledged that the staff should by now have received this training from the previous provider. Choices Care should look at the possibility of creating an office space in the home so that staff can have their supervision sessions and meetings in a more suitable location. Choices Care should review their written policies to make sure that references are made to English standards, guidance and regulations rather than Scottish ones which may not necessarily relate to services run in England. 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 9 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 10 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The company policies and procedures provide information to staff on the general admission processes, although there need to be a service specific service user guide for the residents and future prospective residents. Evidence: Although there have been no admissions to the home since Choices Care took over the running of the home in September 2009, the manager described the process that the home would follow in any future admissions. This would include the opportunity for prospective residents to visit the home, spend time with staff and other residents, arrange for overnight stays if this is considered necessary and flexible admission arrangements to suit the needs of the prospective resident. The manager stated that admission would only take place when the home has carried out their assessment of the prospective resident and are confident that the home has the necessary skill and resources to provide care for the person. Choices Care has a contract in place but these have not yet been issued to the Care Homes for Adults (18-65 years) Page 11 of 29 Evidence: residents as the fees levels have not yet been set by the local authority. The manager and his line manager, both confirmed that as soon as the fees are set, each resident would be issued with a contract detailing the terms and conditions of residence. Care Homes for Adults (18-65 years) Page 12 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. Support plans reflect the assessed needs of the residents, thus promoting their welfare and wellbeing. Evidence: The home has instituted Choices Care support plans for each resident. These provide details of each residents needs and goals. The needs and aspirations of the residents are further established through meetings with residents to find out from them what they would like to do, and also to seek their views on the running of the home. The individuals files for the residents contain details of risks that have been identified with individuals and plans about how best to manage those risks. These include risks in the home, in the community, wheelchair use, ironing, laundry and use of transport. These risks plan are reviewed on a monthly basis and where necessary changes are made to reflect the residents current care needs. 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. There are good arrangements for the residents to engage in social, recreational and educational activities which enhance the quality of their life. Evidence: The manager confirmed that the social and recreational activities that the residents are used to have continued under Choices Care management. The manager indicated that the residents would continue to enjoy their holiday arrangements and further efforts would be made to enhance the opportunity for more holidays.The staff consult regularly with individual residents about daily activities and what they would want to do. The files show a list of activities that they are involved in. Some of these activities include helping with the homes grocery shopping, going to the cinema, visiting the local theatre, going shopping, going out for meals and to the pubs. Consideration is being given to one residents who it is thought would benefit from Care Homes for Adults (18-65 years) Page 14 of 29 Evidence: independent living setting. The manager stated that this has been discussed with the resident who expressed the wish for a more independent living arrangement. One resident is keen to help with household activities such as shopping and helping with meal preparation. Staff have supported him with these activities, and risk management plans have been put in place to make sure that he does these activities safely. The residents are offered choice of meals on daily basis. The residents are consulted when the menus are being planned. Examination of past menus show that the home continues to provide the residents with nutritious, home made and balanced meals. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The healthcare needs of the residents are fully met. This promotes the health and welfare of the residents. Evidence: The residents records show that each resident has their own GP. Each resident is supported to attend GP appointments and other specialist appointments when needed. Records also show that the residents receive medical support from other healthcare professionals and agencies such as physiotherapy, speech and language therapy, psychiatrist, clinical psychology, chiropody and others medical support. The inspector examined the support plans for three of the residents, and these highlight the health and social care needs of the residents. The staff provide details of how those needs are to be met. Records are maintained of how identified needs have been met, and these are kept under regular review. The support plans that have been introduced by Choices Care are accompanied by risk assessment and risk management plans for all staff to follow. These risk assessments and support plans are very detailed so that staff can support the residents Care Homes for Adults (18-65 years) Page 16 of 29 Evidence: appropriately and safely. The Choices Care has good policies on medication but these policies need to be reviewed to reflect specific legislations or guidance that relate to practices in England. The medicines in the home are appropriately stored. A random check of medicines in the home showed that the staff adhere to safe medication administration in the home. No discrepancies were noted and all the records have been appropriately maintained. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The homes polices and staff practices protect the residents from all forms of potential abuse, thus safeguarding the residents safety and welfare. Evidence: Choices Care has a general safeguarding policy and the manager stated that staff have covered this in the induction training program for staff when Choices Care took over the running of the home in September 2009. One staff member who transfered from the previous provider to Choices Care stated that she had received safeguarding training. The manager indicated that it was difficult to establish exactly which staff member had undertaken this training as all the staff records, including training records have been kept by the previous provider. The manager confirmed that all staff would be provided with a refresher training to make sure that they are up to date with safeguarding matters. The inspector discussed the training relating to the Mental Capacity Act and Deprivation of Liberty Safeguards. The manager indicated staff training in this respect is difficult to establish as all the records relating to staff training have been retained by the previous provider. The manager assured the inspector that Choices Care is planning to provide this training as a priority to the staff. This was confirmed by the line manager for the home when the inspector met with her at the companys offices as part of the inspection process. Care Homes for Adults (18-65 years) Page 18 of 29 Evidence: There are other policies which are designed to protect and safeguard the residents. These are well written and staff who were spoken with had good understanding of the polices. These include policies on whistleblowing, residents finances and, recruitment and selection. The inspector spoke with staff about complaints and safeguarding matters. Staff had good understanding of their role and what actions they need to take to address any complaints and safeguarding matters. The residents have regular meetings to discuss matters relating to the running of the home. Minutes of these meetings are kept in both hard copy and in pictorial format for the benefit of the residents. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is clean and suitably mainitaned and equipped to meet the needs of the residents. However, the lack of space and office accomodation compromises the residents privacy and confidentiality. Evidence: The home is clean and maintained to a good standard. There is cleaning rota which is followed by the domestic staff. The kitchen has been refurbished following requirements from the last key inspection. The building has limitations due to its location and the way it was constructed. Although the bedrooms meet the needs of the residents, it lack facilities such as washhand basins in all the bedrooms except one. There is no choice of bathing facilities for residents to choose from as there is only one Parker Knoll bath facility. There is no office available and the staff often use one of the residents room for confidential meetings and staff supervision sessions. Although this is done with the consent of the resident concerned, is it still consider an unnecessary infringement on the residents lifestyle. The inspector discussed with the manager the current location of the clinical waste Care Homes for Adults (18-65 years) Page 20 of 29 Evidence: container which is very close to the windows of residents bedrooms. He indicated that this arrangement is unlikely to change as the hospital has no where suitable to located this container. 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. There is sufficient and competent staff team to meet the needs of the residents, thus promoting their health and welfare. Evidence: Staff rotas show that there is always sufficient staff on duty to meet the needs of the residents. There is always three care staff on duty between the hours of 08:00 and 20:30, and then after that there is a waking staff on duty through the night. The staff files which relate to the time they worked for the previous provider have all been transfered to the Health Authority. These files include staff training and supervisions records which are not available to Choices Care. This has made it difficult for the new provider to know exactly what training individual staff members have had in the past. As a result, Choices Care has made the decision to provide all staff with statutory training, including Mental Capacity Act and Deprivation of Liberty Safeguards. The new staff files created by Choices Care were examined at the providers regional headquarters. These show that the Choices Care has been following proper recruitment procedures, including taking references, CRB checks, completed application forms and interview notes. Care Homes for Adults (18-65 years) Page 22 of 29 Evidence: Staff who were spoken with stated that they receive good support from Choices Care, and in particular the new manager. This is supported by the two staff questionnaires that were sent to the Commission by the staff. The manager maintains a record of staff supervision which is carried out on regular basis. 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 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 managed by a competent manager who ensures that the needs of the residents take precedence over all else. This promotes the residents safety and welfare. Evidence: The home has recently been taken over by Choices Care, and since then a new manager has been appointed to take charge of the day to day management of the home. The new manager stated that he is in the process of applying to the Care Quality Commission to be registered. Staff spoke positively about the new manager and about the good personal and professional support that he provides them. Choices Care has a quality assurance system (audit tool) in place and the manager completes this on a three monthly basis. A copy if this was seen during the inspection. The inspector also looked at the company written policies and procedures. A large number of these policies relate to Scotland and the manager was advised to discuss this with Choices Care to make sure that policies relate to English standards, guidance or regulations. The policies in their current form can be confusing to staff of homes or Care Homes for Adults (18-65 years) Page 24 of 29 Evidence: services that operate in England. The ethos of the home is putting the residents at the centre of their activities. There is good professional standard amongst the staff team. Staff are very motivated and showed good commitment to promoting the welfare of the residents. Choices Care health and safety policies are of good standard, except that there is a lot of references to Scottish regulations. A record is maintained of regular servicing of fire equipment, bath lifts/hoists, overhead tracking hoists, gas and electrical appliances. These have been serviced and certificate of inspections have been maintained. 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 23 13 Mental Capacity Act and Deprivation of Liberty Safeguards (DOLs) must provided for the staff to further protect the residents from all forms of abuse. Staff need a good understaning of DOLs to further uphold the rights of the residents. 30/04/2010 2 31 7 The manager must make an application to the CQC to be registered as the Registered Manager. The manager is newly appointed but has not yet made formal application to the CQC to be registered. 31/03/2010 Care Homes for Adults (18-65 years) Page 27 of 29 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 1 The manager should ensure that a service user guide is produced as soon as possible and copies made available to all the residents. An office space should be made provided to ensure that the home is conducted in a way that protects the residents privacy and confidentiality. Choices Care should review the organisations written policies and procedures to make sure that they relate to English standards and regulations. 2 28 3 41 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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