Care Home: Derby Road Care Home

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What the care home does well Everyone likes living at the home. They say they are happy there and it is friendly. People living there said: ` I like it here, I have got to know the staff very well and we get on`, `I am happy being here`, `they always listen to me` and `I always enjoy going out in the bus`.People who live at the home can choose which activities they want to do.Staff were recruited properly. This means they are checked to make sure they are the right person to work at the home.The home is clean and comfortable.Staff are well trained. This means they know what to do if someone is upset or worried. They help them to feel better and sort out problems.Other visitors to the home, such as social workers and nurses, said the home was ‘excellent’ and ‘great to work with’.People living in the home have learnt how to speak up for themselves.The home provides information in a way that is easy to understand. What has improved since the last inspection? Some parts of the home have been redecorated and people have chosen the colours.People are doing new activities such as going to college and going abroad for holidays.Peoples` money was being kept safely. The right amount of money for each person was in the home. People also had their own bank accounts.There are enough staff on each day to make sure people get the help they need. What the care home could do better: Some repairs, such as holes and scratches in walls should be mended quickly.The home should think about new ideas for activities inside and outside the home.Training for staff should include courses on health issues and medicines. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Derby Road Care Home Derby Road Doveridge Derbyshire DE6 5JY two star good service The quality rating for this care home is: 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 Morrow Date: 1 8 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. They reflect the things that people have said are important to them: 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 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 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. 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. Internet address www.cqc.org.uk Information about the care home Name of care home: Address: Derby Road Care Home Derby Road Doveridge Derbyshire DE6 5JY 01889560921 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) : 138manager@voyagecare.com Milbury Care Services Ltd care home 4 Number of places (if applicable): Under 65 Over 65 4 0 learning disability Additional conditions: The registered person may provide the following category/ies 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 The maximum number of service users who can be accommodated is: 4 Date of last inspection 0 8 0 6 2 0 0 8 A bit about the care home All the bedrooms are upstairs. There is a garden. Four people live at the home. Everybody who lives at the home has their own bedroom. Nobody has to share a room. 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 How we did our inspection: This is what the inspector did when they were at the care home We looked at the information in files for staff on how to support people. These are called support plans. We watched how people spent their day and what the meals were like. We looked at some of the policies and procedures in the office. Policies are rules about how to do things. Procedures tell people how to follow the rules. We also talked to staff in the home. We talked to 3 people who live at the home. What the care home does well Everyone likes living at the home. They say they are happy there and it is friendly. People living there said: I like it here, I have got to know the staff very well and we get on, I am happy being here, they always listen to me and I always enjoy going out in the bus. People who live at the home can choose which activities they want to do. Staff were recruited properly. This means they are checked to make sure they are the right person to work at the home. The home is clean and comfortable. Staff are well trained. This means they know what to do if someone is upset or worried. They help them to feel better and sort out problems. Other visitors to the home, such as social workers and nurses, said the home was ‘excellent’ and ‘great to work with’. People living in the home have learnt how to speak up for themselves. The home provides information in a way that is easy to understand. What has got better from the last inspection Some parts of the home have been redecorated and people have chosen the colours. People are doing new activities such as going to college and going abroad for holidays. Peoples money was being kept safely. The right amount of money for each person was in the home. People also had their own bank accounts. There are enough staff on each day to make sure people get the help they need. What the care home could do better Some repairs, such as holes and scratches in walls should be mended quickly. The home should think about new ideas for activities inside and outside the home. Training for staff should include courses on health issues and medicines. If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact Janet Morrow Nottingham Office Edgeley House Rivserside business Park Tottle road Nottingham 01223 771300 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 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 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 . Sufficient admission information was available to ensure that the home was suitable and could meet the peoples needs. Evidence: One persons care file was examined. The manager said that assessment documents had been archived as the service user group had remained the same over the last twelve months. However, the previous inspection report of June 2008 showed that full assessments were undertaken prior to admission. Information from external professionals, in the form of care reviews, was available. Detailed information about individual needs was available in the file examined and good use had also been made of information obtained from health care professionals, previous placements and families. The records showed that regular reviews were taking place and the information was updated as required. All four surveys received from people living in the home said that they were asked if they wanted to move into the home and that they received enough information prior to their admission. A survey received from a visiting professional responded that the service usually ensured that accurate information was gathered and that social and health care needs were usually monitored, reviewed and met by the service. It also stated that the service had developed excellent working practices with service users. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Detailed care planning and risk assessments ensured that peoples needs were met in the way that they chose. Evidence: One persons care file was examined and showed that a comprehensive care plan was in place that demonstrated how individual needs would be met. Care was reviewed on a monthly basis. The files and the details provided contained sufficient information to enable staff to deliver care in a consistent way. One person spoken with accessed their records independently and was able to discuss parts of the record. There were pictorial aids throughout the care and support records to aid understanding. Specific areas of need were addressed and the file examined contained information on how to address behavioural issues and how to enable the person concerned to make choices. The written information supplied by the home stated that One service user has planned an over seas holiday, including obtaining a passport, booking flights and making a pictorial plan for activities’. This was confirmed in discussion by the manager and the person concerned. The person spoken with was able to discuss in detail how they had been supported to choose their holiday and had a record of the activities they wanted to undertake whilst away. They also discussed how they had run their own care review meeting and showed the pictorial planning notes they had made in the planning process for their review. The service is therefore commended for the effort it had made in enabling people to make choices and decisions. Evidence: Risk assessments were also available that showed how identified risks were minimised and these covered all areas of daily activity. Staff spoken with were knowledgeable about individual peoples support needs and were able to discuss how they would deal with behavioural problems in line with the risk assessment. Independence was encouraged; for example, one person had obtained voluntary work and the written information supplied by the home stated that the employer often calls to say how well he is doing and how effectively the staff support him. An activity chart using images was available for each person and this showed a choice of activity was available each day. The manager and staff both confirmed that these had been drawn up with the person concerned and were their choice of activity. All four surveys received from people living in the home responded that they always made decisions each day. One commented that I make decisions during our service user weekly meeting about what activities I want to do and another commented that I mostly like to do things 1:1 and not with others so I sometimes refuse activities that involve everyone. 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 . Well-managed meals, contacts with the community and activities ensured people had a good quality of life. Evidence: People living at the home were observed to have their own routines as far as possible, with some choosing to go out and one person remaining in the building. The written information supplied by the home stated that Two of our service users go to college, the other two have expressed an interest, one in literacy and numeracy and one in gardening. We hope to enrol them on appropriate courses. A range of other daily activities were available including food shopping, walking and cycling locally and domestic activities to increase daily living skills. The written information also stated We have improved our range of activities offered to include more educational input, including regular visits to the farm, various museums, recycling, arts and crafts as well as college and a voluntary job. Two staff spoken with stated that they thought the service could improve if there was a larger budget available for activities, as cost sometimes limited what people living in the home could attend. A visiting professional spoken with stated that the person they were involved with had good structured activities and all four surveys received from people in the home said they could do what they wanted during the day, evenings and week-ends. One survey commented I always do what I want. I love it. Evidence: People living at Derby Road were encouraged to maintain links with their families as appropriate. Families were welcome and several regularly visited and one person went to visit their family regularly. The lunchtime meal was observed and everyone had a simple burger and salad meal. All people at the home were independent in eating and one person enjoyed setting the tables and serving drinks. Food stocks were examined and were adequate, although stocks in the fridge were getting low. The manager said that the shopping was due to be done on the day of the inspection visit. The food stocks seen showed that a range of preferences could be catered for. The budget for food shopping was discussed and staff and the manager confirmed that it was sufficient. An internal satisfaction survey seen had stated that there was very good food. 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 . Access to health professionals and clear systems ensured that peoples health and personal care needs were met. Evidence: One persons care and support records were examined and showed that there were details about individual preferences available and the type of assistance and guidance needed to meet health care needs. For example, the records described particular behaviours and what the person concerned was trying to communicate by these behaviours. One person was visiting the local General Practitioner (GP) surgery on a regular basis and was able to confirm this in conversation. There were regular reviews of care held with other health professionals that ensured changing needs were addressed. One visiting professional spoken with said that the person they were involved with was settled and stable and that they were really pleased with how the home provided the service. Comments on one survey received from a visiting professional stated that staff appeared to have a good grasp of needs and wants and another said that the service was excellent in this department in response to seeking and acting on advice to meet health and social care needs and improve well-being. An internal satisfaction survey completed by a vesting professional stated that staff seem to cope with behaviours much better these days. The written information supplied by the home stated that as a result of promoting a healthy lifestyle, one service users condition was now medication controlled rather than by injection. This was confirmed by the person in discussion. Another service user also said that they had been supported to change their medication from syrup to tablets, which they were pleased about. Evidence: It was observed that personal support was offered sensitively and warm relationships existed between staff and people in the home. One survey from a person living in the home said they let me have privacy and another said they always listen to me. Medication records were examined and one persons medication administration record (MAR) chart was looked at in detail. These were completed accurately and had the amount of medicines received recorded. There were no controlled drugs in the home at the time of the visit but there were secure storage facilities for them should they be required. A general check on medication stocks showed that this was satisfactory and those medicines seen were well within expiry dates. The home did not have a specific medication refrigerator but there were secure storage facilities in the homes main refrigerator and temperatures were recorded daily to ensure that the medication was stored safely. Two staff files seen showed that medication training had taken place in October 2008 and as part of induction and three of the four staff surveys received responded that they received training that gave enough knowledge about health care and medication. However, one staff survey responded that there was not enough training on health and medication and commented that the service could improve by providing a bit more training. 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 . Systems were in place that ensured peoples concerns were listened to and that they were safeguarded. Evidence: There was a complaints book that showed the last complaint received was in January 2009 and the action taken was recorded. There had been no complaints received at the office of the Care Quality Commission (previously the Commission for Social Care Inspection) since the last inspection in June 2008. Records of meetings with people living in the home were available and the manager was able to describe what action had been taken in response to some of the queries raised. Two of the surveys received responded that they sometimes knew how to make a complaint and two responded that they always did. Two commented that they would speak to the manager or their keyworker. One survey commented that they make me feel safe and secure. One person spoken with was able to describe how they had been helped to understand about having no secrets and as result was able to give an example of being more assertive and not disclosing personal information inappropriately. The company had corporate procedures on dealing with safeguarding issues and allegations of abuse and these included information from the Local Authority and whistle blowing procedures. Those staff spoken with were aware of their responsibility to report any suspicions of abuse and training records showed that safeguarding training had been provided in July 2008 and also as part of the induction process. Three of the four staff surveys responded that they knew what to do if concerns were expressed about the service and one responded that they did not know. All four responded that they knew the services policies and procedures on safeguarding adults from abuse. Evidence: The written information supplied by the service stated that All service users have appointees outside of the home for their monies. Service users money is kept in a locked safe only accessible to manager and seniors. Three peoples financial records were examined and the money held corresponded with the written record. This showed that people were signing for transactions and there were receipts available. Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . The home was well maintained which ensured people had safe and comfortable accommodation to live in. Evidence: The written information supplied by the home stated that All service users have a large bedroom with an en suite bath or shower room. The service users bedrooms are very personal and demonstrate individual preferences. The premises were viewed and individual bedrooms seen, which confirmed the information provided by the home; for example, one service user had a football theme and another had a beach mural on one wall. All four surveys responded that the home was always fresh and clean and all commented that they assisted with cleaning; one person said I like to help clean and polish and another said I like helping around the house to keep my house clean. The home was clean and tidy and free from odour. Staff spoken with were knowledgeable about how to control the spread of infection and confirmed that there were plentiful supplies of gloves and aprons. There had been some improvements and repairs since the last inspection visit in June 2008, such as re-decoration and purchase of a new three piece suite, although there continued to be ongoing repairs required. For example, there were scratches and marks on the walls and woodwork. Staff spoken with stated that repairs were responded to much more quickly and the manager stated that they now keep better written record of repairs and have a system for chasing them up if there was a delay in the job being done. The repairs record was seen and showed that repairs were generally attended to within a week of being reported. Evidence: Staff supported people to use the separate laundry facilities provided at the home. 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 were sufficient well-trained staff available to ensure that people living in the home were supported properly. Evidence: The staff rota for the weeks beginning 11th and 18th May 2009 was examined and showed that there were four staff to cover each shift in the day and two waking staff at night. The manager stated that there had been no recent problems with covering shifts and staff spoken with confirmed this. The written information supplied by the home stated that New starters spend two weeks shadowing experienced members of staff, observing how service users should be supported in certain situations, learning the wants, needs likes and dislikes of service users as well as communication methods. This was confirmed by staff spoken with and all four staff surveys received responded that the induction process gave them the information they needed. The written information also stated that four of twelve care staff had achieved a National Vocational Qualification (NVQ) to Level 2. The home had therefore not yet met the target of having a minimum of 50 with this qualification. Staff confirmed in discussion that they had undertaken mandatory health and safety training as well as training applicable to the job, such as dealing with challenging behaviour. There had also been a training session provided on the Makaton communication system. The manager stated that she had undertaken training on the Mental Capacity Act 2005 and the associated Deprivation of Liberty Safeguards and was planning for more staff to undertake this training. All four staff surveys responded that they received relevant training although one commented that they could do with a bit more training and Evidence: highlighted medication and health training as one area of improvement the service could make. One survey from a visiting professional responded that staff always had the right skills and experience and one responded that they usually did. One survey commented that staff were motivated. Two staff files were examined and showed that recruitment procedures were comprehensive and it was documented that all the information required by the Care Homes Regulations 2001 had been received prior to staff commencing employment. This helped to ensure that people living in the home were safeguarded. Although original documentation was not available in the home, there was a signed checklist for both files saying that the relevant information such as Protection of Vulnerable Adults (POVA) checks and Criminal Record Bureau (CRB) checks had been received. The original information was stored at the companys head offices. All four staff surveys received responded that their recruitment was done fairly and thoroughly. 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 was well managed, which ensured it was run in peoples best interests. Evidence: The manager was registered with the Care Quality Commission (previously the Commission for Social Care Inspection) and had seven years experience of working with people with learning disabilities, autistic spectrum disorders and challenging behaviours. The written information supplied by the service stated that the manager was enrolled on a National Vocational Qualification (NVQ) course at level 4 and she confirmed this in discussion. The manager received positive feedback from visiting professionals; one professional spoken with stated that she was really good and one survey received described her as excellent. All four staff surveys responded that they received enough support from the manager and one survey commented that the service provided support for staff and service users. The company had clear processes for quality assurance and completed an annual service review when they tried to obtain views and comments from a range of different people including visiting professionals and relatives. Monthly audits were undertaken and an action plan was then devised and followed up on the following month. This was in addition to the usual monthly visits undertaken in response to Regulation 26 of Care Homes Regulations 2001. Comments from the internal surveys received in June 2008 were generally positive; for example, a relatives survey seen said mostly satisfactory, a person living at the home had said very good what staff do every day with pictures to help me. Where negative comments had been received, for example re losing clothes, the manager was able to show what action had been to address the issue. Evidence: Staff spoken with confirmed that health and safety training was undertaken in food hygiene, infection control, basic first aid, moving and handling and fire safety and training certificates showed that this had taken place in September and October 2008 and was also carried out as part of the induction process. The written information supplied by the service also confirmed that maintenance checks were undertaken regularly; for example, it stated that fire equipment and alarms had been tested in December 2008, emergency call equipment had been checked in December 2008 and portable electrical appliances in June 2008. Water temperatures were tested on a monthly basis and the fire risk assessment had been reviewed in January 2009. Are there any outstanding requirements from the last inspection? Yes  No  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 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 Description 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 Description 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 12 The service should consider reviewing the range of activities available to people inside and outside the home to ensure that more options are available. The service should continue to develop its training programme to ensure individual needs are catered for and that subjects related to health care and medication are updated regularly. 2 35 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. 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. 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