Care Home: Elstow House

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What the care home does well The people have their own bedroom.The people are involved in their care plan and information is written in easy words and pictures so they know how their needs are met.The people go to college.The staff help the people to look after their money safely.Some people go to the day centre.The people like the food.The people make friends in the home.The people go on holiday with staff and enjoy this.The people have meetings with staff so they can tell them things that they would like to do.The people like the staff.The staff do training to help them to look after the special needs of the people. What has improved since the last inspection? The home has a new office with staff sleep in room. New carpet has been put in the home. The downstairs basement has been decorated. The lounge has been decorated up stairs. New medication cupboards have been bought so people’s medication can be kept safe. The home is putting a wet room for people who need this to help them have a shower and keep independent.Care plans are written in easy to understand format. What the care home could do better: Display the menu in picture format so the people know what is for dinner.Provide staff more supervision where they talk to their manager about how they are meeting the needs of the people they look after. Key inspection report Care homes for adults (18-65 years) Name: Address: Elstow House Elstow House 25 Marriott Street Northampton Northants NN2 6AW 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: Ansuya Chudasama Date: 2 0 1 0 2 0 0 9 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should:  Be safe  Have the right outcomes, including clinical outcomes  Be a good experience for the people that use it  Help prevent illness, and promote healthy, independent living  Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home:  3 stars – excellent  2 stars – good  1 star – adequate  0 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. 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 Care Homes for Adults (18-65 years) Page 2 of 35 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 35 Information about the care home Name of care home: Address: Elstow House Elstow House 25 Marriott Street Northampton Northants NN2 6AW 01604461292 01604461292 genesishomes2003@yahoo.co.uk 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) : Adenike Adenuga care home 9 Number of places (if applicable): Under 65 Over 65 9 0 learning disability Additional conditions: A total of 9 Service Users No person under 30 years of age or above 55 years who falls within categories LD may be admitted to the home That the home limits its services to the following Service User category: Learning Disability - LD Date of last inspection 1 7 1 2 2 0 0 8 Care Homes for Adults (18-65 years) Page 4 of 35 A bit about the care home Elstow House is a care home and provides care for people who need help. The home is not too far from the town centre. The home is a three-story town house. All the bedrooms are single. There is a kitchen and a dining room where the people eat their food. There is a lounge where the people can relax and watch TV. It cost about four hundred to seven hundred pounds per week to stay at the home. The people who live at the home have a learning disability. Care Homes for Adults (18-65 years) Page 5 of 35 The people can visit the home and meet the staff and other people in the home. The people are given information about the home. The home tells us about things that they do to make the people in the home happy and keep them safe. The information is recorded on a report called the Annual Quality Assurance Assessment (AQAA) Care Homes for Adults (18-65 years) Page 6 of 35 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 Care Homes for Adults (18-65 years) Page 7 of 35 How we did our inspection: This is what the inspector did when they were at the care home. We spoke to the manager. We spoke to the people. We spoke to some of staff. Care Homes for Adults (18-65 years) Page 8 of 35 We looked at care plans to see how the people are being looked after by the home. We check that the home has safe policies that tell them how to do things properly. We looked at the training that the staff do to help them understand the needs of the people better. Care Homes for Adults (18-65 years) Page 9 of 35 What the care home does well The people have their own bedroom. The people are involved in their care plan and information is written in easy words and pictures so they know how their needs are met. The people go to college. Care Homes for Adults (18-65 years) Page 10 of 35 The staff help the people to look after their money safely. Some people go to the day centre. The people like the food. The people make friends in the home. Care Homes for Adults (18-65 years) Page 11 of 35 The people go on holiday with staff and enjoy this. The people have meetings with staff so they can tell them things that they would like to do. The people like the staff. The staff do training to help them to look after the special needs of the people. Care Homes for Adults (18-65 years) Page 12 of 35 What has got better from the last inspection The home has a new office with staff sleep in room. New carpet has been put in the home. The downstairs basement has been decorated. The lounge has been decorated up stairs. New medication cupboards have been bought so people’s medication can be kept safe. The home is putting a wet room for people who need this to help them have a shower and keep independent. Care Homes for Adults (18-65 years) Page 13 of 35 Care plans are written in easy to understand format. What the care home could do better Display the menu in picture format so the people know what is for dinner. Care Homes for Adults (18-65 years) Page 14 of 35 Provide staff more supervision where they talk to their manager about how they are meeting the needs of the people they look after. 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: Ansuya Chudasama Care Quality Commission (East Midlands) City Gate, Gallowgate, Newcastle Upon Tyne NE1 4PA Tel: 03000616161 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line - 0870 240 7535. Care Homes for Adults (18-65 years) Page 15 of 35 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 16 of 35 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. Needs assessments are carried out by the home prior to people being admitted to the home to ensure that their needs will be met. Evidence: We are told in the AQAA that the home has not had any new people admitted to the home. On the day of the inspection there was one vacancy at the service. We were told that one person had moved on to live independently in the community and another person went to live with their boyfriend. The home has a Statement of Purpose and a Service User Guide and these are updated in a format the people can understand. We are told that a copy is given to the people and their representatives. The inspection report is kept in the office. The people spoken to told us that they had visited the home with their family or social worker before they moved in the home. One person said that they visited the home and said it was quite nice. It was also said that they have lived at the home for a long time. We are told that the home carries out peoples needs assessments and has meetings with Care Homes for Adults (18-65 years) Page 17 of 35 Evidence: the funding authority, and the persons family. This is to make sure that the home is able to meet the persons needs. The people in the home have contracts so they know about their rights and responsibilities of staying at the home. The AQAA says what we could do better is to continue to listen to our service users. Care Homes for Adults (18-65 years) Page 18 of 35 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. Care plans are indivisualised in a format the people understand to meet their needs. Evidence: All the people in the home have care planning documents. We looked at two peoples care plans in detail and discussed their care needs with staff on duty. They had good understanding of the needs of the people. The plans had information about the peoples health, personal and social care needs. The care plans were being reviewed on a six monthly basis or when needs changed. The home had completed the person centred planning (PCP) with five people and one person refused to do one. Two people did some work on this but got stressed and this was not carried on further. We were told that PCP was done with the support of the day centre and the peoples key workers being involved in the process. The people were proud of their plans. Reviews for the people were being held by social services on an annual basis. The Care Homes for Adults (18-65 years) Page 19 of 35 Evidence: manager did three and six monthly reviews and a copy is sent to the peoples family to keep them up to date of the progress made of their family member. The home was having a review on one of the peoples care needs by a continuing care assessor on the day of the inspection. A range of risk assessments are in place that enable the people to take risks as part of an independent lifestyle. The peoples information was kept secure in the office. The AQAA says for our plans for improvements in the next 12 months is focusing more on our service users needs. Care Homes for Adults (18-65 years) Page 20 of 35 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. Meals served are nutritious so that the people have a balanced diet to meet their needs. Evidence: One of the people told us that they now have a key to their own bedroom and were able to lock their door. They kept their bedroom clean and tidy and had things that they enjoyed collecting. There was a picture on their wall that they had painted and said that they were proud of this. It was said that the staff knocked on their door before they come inside their room. We were told that they used to help out in a cafe and they wanted to go back to the place. It was said that the home and their social worker were helping them with this. We were told that they had been offered other day care places but they only wanted to help out in the cafe. The advocacy service was also involved in this process. At present the person went out twice a week with staff from the day centre. We were told by one person that the home was a nice place and I am getting used to Care Homes for Adults (18-65 years) Page 21 of 35 Evidence: it. It was also said that they had made friends in the home. They some times helped with washing up in the kitchen, doing their laundry, answer the homes phone and the front door. We were told that their money was kept in the office. This was because they used to look after their own money but used to spend it all. They feel happy now that the staff help them manage their money better. Most of the people in the home have families and they maintain contact with them. One person told us that I sometimes see my family in town. We were told that the people in the home go on holiday abroad with staff in small groups. One person said that they went on a plane and enjoyed this. They had been to Tenerife. The people go to the pub on Fridays and on Saturdays they go to town. Some people go to the movies, and to the local shops. One person likes to help out with cooking, and do this at the day centre. the people go on day trips and they went to Blackpool recently. The people choose the meals by using pictures and this is recorded in the meal book. We asked a person what was for dinner and they were not able to tell us. This was discussed with the manager and we were told that they will now display the meal for the day/week in the kitchen. This is so every one is able to see and know what meals they are having each day. The AQAA says what we could do better is to continue to support our service users about the way they have chosen to live their lifes. Care Homes for Adults (18-65 years) Page 22 of 35 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. Peoples health care needs are met by the home. Evidence: One person spoken to said that the staff helped them with personal care when they needed help. Staff spoken to also explained how they provided personal care to some people. Evidence in the care records showed that people are offered support for their physical and emotional health needs. One person in the home now needs two staff to support them. The person had a reclining chair, commode and a special bed to meet their needs. The staff use a stair climber to get the person downstairs. This was recommended by the fire officer and the occupational therapist. The person has breakfast in their room. We were told that the staff do exercises in the morning with the person as instructed by the physio therapist. On the day of the inspection the physio therapist was observed doing exercises with the person. We were told that the person came downstairs from their room at 2pm and stays downstairs until 5pm. We discussed this with the manager and it was agreed by them Care Homes for Adults (18-65 years) Page 23 of 35 Evidence: that they will bring the person downstairs for lunch. This is to ensure the person is not spending too much time in their room. A chart for turning the person in bed at night time was seen. This was to minimise the person from getting sores. We were told that when the person was discharged from hospital, they had bed sores. These were now healed. There were records of district nurses, general practitioner, and hospital appointments, and people have access to the opticians, dentists, and other health care professionals. One person told us that if they did not feel well, they would tell the staff. It was also said that staff accompany those people who needed this help. The home had health action plans and these were completed in picture format and had information about peoples health needs. There were risk assessments in place for nutritional, pressure sore, wound care, and in other areas to keep the people safe. The AQAA says the service users wish is incorporated in their care plan which is done with them and they say how they want to be cared for. Annual health checks are also carried out. The home has a new medication and controlled drugs cupboard. These are kept secure in the office. We were told that all staff who gave out medication had received the accredited training. There were medication profiles for each person. The medication records looked at showed that there were no gaps in the record. The records and medication checked was satisfactory. Care Homes for Adults (18-65 years) Page 24 of 35 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 peoples concerns are listened to by staff to ensure their needs are met. Evidence: The home has a complaints policy and the people spoken to say that if they had any concerns, they would talk to the staff. The complaints procedure is displayed in the home. The manager says that the staff chats with our service users and relatives. Issues raised are solved immediately and plans are put in place to reduce the level of occurrence. The manager tells us that they have not had any formal complaints, however it was said that they document any issues related to complaints even if the complainant does not want to make it formal. One concern was raised from an anonymous person about the home to the safe guarding team of social services. This concern was investigated by them and it was not substantiated. The staff spoken to informed us that they had completed the safe guarding of vulnerable adults procedures training. They had good understanding of this and understood the peoples behaviours to know if they were unhappy or not feeling well. However it was said that most of the people in the home know how to make a complaint to the home or the day centre or their family if they are not happy. Care Homes for Adults (18-65 years) Page 25 of 35 Evidence: The AQAA says for our plan for improvements for the next 12 months is to have more staff awareness on ethical issues that might develop from complaints or comment. Updating staff with new guidelines or legislation. Improving our service users awareness on the complaints procedure. Care Homes for Adults (18-65 years) Page 26 of 35 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 is clean and meets the needs of the people. Evidence: Since the last inspection, the manager has made many positive changes in the environment. The home was clean and odour free. The people had their own keys to lock their own bedroom door. We were told by the people that they like having a key to their room. The bedrooms seen were individualised to the people and those spoken to tell us that they like their rooms. One of the peoples bedroom was made bigger to meet their needs. The home had new carpets put in all the communal areas of the house. The lounge, dining table and kitchen area was refurbished. The lounge, kitchen and reception area in the basement was also refurbished and we were told that this looked lovely and homely by the staff and the people. One of the bedrooms upstairs was turned into an office with sleeping in room for staff. The paperwork in the office was managed well because information was easy to find. The manager was going to carry out a risk assessment on the radiators in the home to find out if they needed covering up to ensure people are not at a risk of hurting themselves. The bathroom on the second floor was being fitted with a wet room to meet the needs of Care Homes for Adults (18-65 years) Page 27 of 35 Evidence: one of the people in the home. We are told that there is regular planned maintenance program which is adhered to. Painting and decoration is done on regular basis and service users view and advice on colours and furniture are taken into account. Evidence confirmed this on the day of the inspection. The AQAA says we take adequate step to ensure that the environment is safe for our service users and this is by having fire equipment checks every 3 months. Care Homes for Adults (18-65 years) Page 28 of 35 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. The staff have good induction training to meet the needs of the people Evidence: The staff recruitment procedures showed that the manager was obtaining all the relevant information needed about staff before they started work. This was to safe guard the people from any potential harm. The staff files were organised well and we found the information easy to find and understand. We were told that the people sit on the interview panel and their decision is vital in the selection process. The AQAA says the home have managed to retain our staff due to good management of resources. The retention of staff also provides continuity to the people in the home. The staff say that they work hard to look after the peoples needs well. We were told that the staff enjoy working at the home and with the people. They say that they get good induction and training. AQAA says that some of our training courses are accredited in accordance with the national minimum standard. We are also told that the home has provided more in-house training by purchasing training materials from recognised providers .The Home has over 80 of staff with NVQ Level 2 or above in care. Care Homes for Adults (18-65 years) Page 29 of 35 Evidence: Staff spoken said that they are getting supervision on a three monthly basis to monitor their practice. Care Homes for Adults (18-65 years) Page 30 of 35 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 run in the best interest of the people living at the home. Evidence: The manager of the home is qualified and competent in running the home. He has undertaken lots of training to manage the home at a high standard. The staff spoken to say that the manager is supportive and they can talk to him about any concerns. The people tell us that they are happy living at the home. The home undertakes the views of the people and other stakeholders through annual survey questionnaires. The information received was positive. The manager also undertakes regulation 26 monitoring visits once a month of the home to make sure they are meeting the needs of the people. The maintenance records and evidence showed that the work was being completed in the home. The staff tell us that they have undertaken fire safety, manual handling, first aid, and food hygiene training. We were told that they have fire drills and the people are involved in this process. Evidence showed that weekly fire testing and monthly emergency testing Care Homes for Adults (18-65 years) Page 31 of 35 Evidence: was being carried out. A fire risk assessment was undertaken. The peoples finances checked was satisfactory, and risk assessments were put in place for how the people managed their money. This are also audited by the funding authorities at reviews. The home sends us regulation 37 notifications about thing that happens in the home about the people. The AQAA says our plan for improvement in the next 12 months is to continue with our commitment to staff development and support to achieve personal goals. Care Homes for Adults (18-65 years) Page 32 of 35 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 Care Homes for Adults (18-65 years) Page 33 of 35 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 17 Display the menu in picture format that the people can see each day. This is so they know what they are having for dinner. Provide staff six supervisions per year to monitor their practice to find out how they are working with the people. 2 36 Care Homes for Adults (18-65 years) Page 34 of 35 Helpline: Telephone: 03000 616161 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) Care Quality Commission (CQC). 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