Care Home: Jah Jireh

What the care home does well Jah Jireh presents as a very warm, caring and friendly care home and residents appeared relaxed and comfortable with the staff. It was evident through interviews, general observations and discussions that staff had a good knowledge of the residents` individual care needs and the level of support required. During our visit staff were observed spending a great deal of time with residents, either on an individual basis or within a group. Care was seen to be given in a discrete, sensitive manner and staff were patient and gentle in their approach. Feedback from residents was very good; comments regarding the service included:"Staff are excellent" and "The carers are very efficient and kind to me - they show such patience". Prior to admission the manager assesses residents` health and social needs. Information collected is then used to form the basis for the plan of care. Assessment documentation seen had been completed to a very good standard and included key areas regarding the residents` health and general well being. Lots of different types of activities were arranged, both in the home and out in the community. The physical accommodation is of an excellent standard, with appropriate aids and adaptations available for the residents. There is an experienced and enthusiastic team of staff who work well together and enjoy taking part in training and development sessions. The staff are motivated and keen to ensure that residents receive high standards of care. The managers made sure they checked out staff before they started working at the home and gave them training and support to make sure they did the job to the best of their ability. The managers communicates a clear sense of direction, is able to evidence a sound understanding and application of `good practice`, particularly in relation to continuous improvement, staff training, resident satisfaction and quality assurance. There were no requirements made at the last inspection but the managers and staff have paid particular attention to improving the decoration, furnishings and improvements to the personal living accommodation for the people who live in the home. This home is run on a religious ethos, Jehovah Witnesses, and people living there told us they are there because the home meets their religious needs, and staff understand this. Comments included, "I came here because I knew they could meet my religious needs and they do that very well", "we are all like one big family and the staff are wonderful", What has improved since the last inspection? There were no requirements made at the last inspection but the manager and staff have paid particular attention to improving the decoration, furnishings and improvements to the personal living accommodation for the people who live in the home. What the care home could do better: The joint managers have been working at the home for approximately 8 months and must now apply to the Care Quality Commission to become registered with us. The writing down of medicines on the recording sheets should be signed by two members of staff to avoid a mistake being made. The managers and the owners have a good understanding of the areas in which the home could further improve. Planning was in place and set out how these improvements are to be resourced and managed. Key inspection report Care homes for older people Name: Address: Jah Jireh 7 Beechfield Court Leyland Lancashire PR25 3SA     The quality rating for this care home is:   three star excellent 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: Bernard Tracey     Date: 2 1 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 Older People Page 2 of 27 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 Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The 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 Older People Page 3 of 27 Information about the care home Name of care home: Address: Jah Jireh 7 Beechfield Court Leyland Lancashire PR25 3SA 01772623710 01772454019 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Jah Jireh (Charity) Homes care home 36 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: One named service user in the category PD (Physical Disability under the age of 65 years of age) may be accommodated with the overall number of registered places. The home is registered for a maximum of 36 service users in the category of OP (Old age, not falling within any other category). Date of last inspection Brief description of the care home Jah-Jireh is situated in a residential area in Leyland, close to local shops and facilities. The home provides 24-hour personal care for up to 36 older people. Jah-Jireh homes have been established and are run wholly and solely to give accommodation and care to members of the community of Jehovah?s Witnesses. The home provides accommodation throughout two floors in both single and shared rooms, and the majority have an en-suite facility. The communal areas are situated on the ground floors. The home has a passenger lift. The grounds to the house are extensive, and private for the residents to enjoy. Care Homes for Older People Page 4 of 27 0 1 Over 65 36 0 Brief description of the care home Current weekly charges for a place in the home are from £448.00 to £538.00 Care Homes for Older People Page 5 of 27 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: e last key Inspection was undertaken in October 2006. In the following two years we undertook an Annual Service Review of the service. This is a report that we write for good or excellent services that have not had a key inspection in the last year. It does not routinely include a visit to the service. The review is an analysis of all the information that we have gathered about the service since the last main inspection. We (the Care Quality Commission) undertook a key inspection, which included an unannounced visit to the home. The staff at the home did not know the visit was going to take place. The manager was asked to fill in a questionnaire, called an Annual Quality Assurance Assessment (AQAA), telling us what they thought they did well, what they need to do better and what they have improved upon. Where appropriate, these comments have been included in the report. We spent five and half hours at the home over one Care Homes for Older People Page 6 of 27 day.During this time, we looked at care and medicine records to ensure that health and care needs were met and also studied how information was given to people before they decided to move into the home. A tour of the building was undertaken and time was spent looking at records regarding safety in the home. We also examined files that contained information about how the staff were recruited for their jobs, as well as records about staff training. We spent time speaking to six residents, as well as speaking to four staff, two visitors and the joint managers. We have not received any complaints about the service since our last Inspection. Care Homes for Older People Page 7 of 27 What the care home does well: What has improved since the last inspection? There were no requirements made at the last inspection but the manager and staff have paid particular attention to improving the decoration, furnishings and improvements to the personal living accommodation for the people who live in the Care Homes for Older People Page 8 of 27 home. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 27 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are admission and assessment procedures in place to ensure the care needs of people are being met. Evidence: We looked at the records of three people living in the home. We saw they had assessment details from social workers and other healthcare professionals. The information we looked at showed the home is provided with a full history of the care needs of the person to be admitted so that they know what their needs are and whether they will be able to manage those needs. In addition the home uses its own assessment procedures which determines how the needs of the person will be met when admitted to the home. The manager told us this helps them to make an informed decision about the staff ability to meet personal care needs. Staff we spoke to said they felt they find the information useful and it helps them recognise individual needs at the point of admission to the home. Care Homes for Older People Page 11 of 27 Evidence: Written information about the home informs people it is based upon a religious ethos, and people we spoke to said they found the home suitable because it met their physical and spiritual needs. Comments included, I came here because we are all part of a big family, I like to read the scriptures and I have brothers and sisters to help me in understanding the word better. I also enjoy the meetings at the Kingdom Hall. Care Homes for Older People Page 12 of 27 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents health and personal care needs are being met and are addressed in detailed care plans. Evidence: Care plans were examined, two of which related to residents who had lived at the home for a relatively short time. Each resident in the home had a detailed, up to date and individual plan of care, covering all personal, health and social care needs. Any areas of risk for the resident were highlighted, along with the planned action to reduce that risk. Care plans demonstrated that residents personal choices and preferences had been taken into account by staff. We spent time talking with care staff who were working in the home, they were able to demonstrate knowledge, skill and a caring manner in carrying out their specific tasks. They were also supported by the District Nurses from the local surgery who support and advice for the residents living in the home. Care Homes for Older People Page 13 of 27 Evidence: All care plans had been regularly reviewed by staff on a monthly basis. Evidence of resident or relative involvement was seen on two of the care plans, one of which had recently been reviewed with relatives. The care plans of the two residents who had moved in recently had been signed or agreed with them or their representative. Care plans clearly recorded GP, District Nurse,and care management involvement. Residents spoken with said these health professionals were contacted when necessary. One resident described the care as wonderful and delivered in a caring and diligent fashion All of the residents spoken with were satisfied with the overall care provided at the home. . Healthcare arrangements were also good. Residents had good access to their local doctors, dentist and optician and some were also under the care of a district nurse. There is an efficient Medication Policy supported by practice guidelines. Staff follow robust systems to make sure that medication records are fully completed, contain required entries and are signed by appropriate staff. Hand transcribed medication must be signed by two staff members to avoid errors being made Personal care was provided privately in bedrooms or bathrooms, and door locks or engaged signs were used. Residents wore their own clothes and were dressed appropriately for the weather and their activity. A relative spoken with during our visit stated The residents are very well cared for. The staff are very approachable if I need to ask them for anything. My wife is quite content here and all the residents seem to be well cared for personally and individually. It is an excellent care home Care Homes for Older People Page 14 of 27 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Social activities and meals provide daily variation and interest for people living in the home Evidence: We spoke to some of the people living at the home and staff about what the routines are. They told us they are flexible so people can choose how they want to spend their time. This includes no restrictions on what time people get up and go to bed, whether they choose to stay in their rooms or use the communal facilities. We saw people using various parts of the home throughout the inspection. Some people choose to stay in their rooms where they have included TV and audio equipment of their choice as well as furnishings which make it homely. Staff told us they are given the time and the resources to provide activities which they said was usually enjoyed by everyone although they respect peoples rights if they choose not to join in. Activities include board games, trips out. Some people told us they like to read and do their own thing including using their rooms as they choose. This is a home where the religious needs of people come first. People we spoke to including residents, visitors and staff told us, the home takes every opportunity to Care Homes for Older People Page 15 of 27 Evidence: ensure the religious values and beliefs of people using the service are met. There are regular bible reading groups, people who can attend church services are helped to do so. Others who are unable to attend have access through the homes television network to watch the services being conducted at the Kingdom Hall. Comments included, I came here because I knew they could meet my religious needs, all the staff are my brothers and sisters and understand the importance of us being able to keep in touch with our religion. We spoke to people about meals in the home. They told us they enjoyed all the meals and the staff know if they dont like something and are then offered an alternative. They told us they use fresh ingredients wherever possible and they are provided with information about peoples individual nutritional needs when they are admitted, so they can identify any specific nutritional need if necessary. We joined people having lunch in the dining room. There was a relaxed atmosphere when lunch was served and it was not hurried. People who needed support were done so with dignity by the staff team. Care Homes for Older People Page 16 of 27 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Complaints were managed well and people living at the home were adequately safeguarded. Evidence: There was a clearly displayed and easily accessible written complaints procedure for the people living at the home and their relatives and this was included in the homes information pack. All six people who we spoke to told us that, in general, the staff listened to them and acted up on what they said. All six said that they would know who to speak to if they were unhappy and they would know how to make a complaint if they needed to do so. People who we spoke to said that they had no complaints at all about the service provided and that they were quite happy with the care and support received. However, they said that they would know what they needed to do should they wish to make a complaint. There was information readily available about the use of advocacy services and where people could get advice if they needed it. The home had started working towards implementing strategies around the Mental Capacity Act so that everyone living at the home were given the same opportunities. Care Homes for Older People Page 17 of 27 Evidence: When we visited we were informed that no person lacked capacity to consent to the arrangements made for their care or treatment and is being deprived of their liberty without the authorisation of the appropriate supervisory body. There were policies and procedures in place for the Protection Of Vulnerable Adults and the training matrix showed that some of the people working at the home had not been given training on abuse awareness. We were informed that this training is planned and when implemented all staff will attend. All staff members we spoke to on the day of our visit told us that they would know what to do should a person living at the home, their relative, advocate or friend be concerned about the welfare of someone living at the home. Evidence was available to show that where complaints or safeguarding adult issues had been raised, the managers at the home dealt with them in accordance with agreed polices and procedures and in an effective and efficient manner. Systems for recording any such issues were satisfactory although a record should be kept of minor complaints to assist the managers in their quality audit. Care Homes for Older People Page 18 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is clean, safe and well maintained, and provides a high quality living environment for the residents. Evidence: Jah Jireh is a well maintained, attractive home and has very good access to community facilities and services. It has a wide range of up to date specialist equipment and adaptations to meet the individual needs of people who use the service. Accommodation is provided on two levels. It is fully accessible to people who are physically disabled and is fitted with aids and adaptations to promote independence. The main entrance hall is spacious and there is ample information available regarding the home and the service it provides. The home is well maintained, decorated to a high standard and was clean and tidy during the site visit. A partial tour of the building was undertaken, one bathroom, a shower room and six bedrooms were viewed. The bathroom and shower room were clean and tidy and hot water temperatures are recorded each month to ensure the hot water is delivered to a safe temperature. Bedrooms viewed had individual items and were homely. A resident said, I have everything I need, including some of my own furniture. The manager also arranged for my telephone to be installed. Care Homes for Older People Page 19 of 27 Evidence: Bedrooms have door locks and storage space for valuable items. Bedrooms have a call system with a hand held buzzer to call for assistance. The home has a well equipped laundry and there was evidence of gloves and aprons for staff use. Infection control training is given to staff and infection control policies are available. Residents commented on the good laundry service they experienced saying that care was taken with their clothes and they were returned to their room in good time. Residents say that there is always plenty of hot water and the temperature in the home can be changed to meet their personal choice, especially in their own rooms. The home is always very well lit, clean and tidy and smells fresh. Residents individual rooms are light and spacious and those seen showed a good level of personalisation with furniture and memorabilia. The home provides a well maintained, clean, comfortable and attractive place in which to live and which meets all the assessed needs of the residents. Care Homes for Older People Page 20 of 27 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. At the time of our visit to this service the number and skill mix of staff on duty met peoples assessed needs and those working at the home had received training so that they could do their jobs properly. Evidence: The managers had provided details of the staffing arrangements in the home prior to the inspection, the details of which were checked during the visit. Staffing levels within the home were seen to meet the needs of residents. Care staff that undertook their duties in a friendly and caring manner, promptly supported residents needs. Residents confirmed that staff were always respectful and met their needs competently. In the main, residents were satisfied with the support they were given and described staff as find time to listen and very caring and good with me when I need extra help. Sufficient ancillary staff were employed, e.g., domestics, laundry and kitchen assistants, cook and handyman. Staff were, in the main, knowledgeable about the needs of residents and demonstrated that they understood their own role. Staff files demonstrated that a robust recruitment process is in place, with all Care Homes for Older People Page 21 of 27 Evidence: appropriate checks being undertaken. These include references, Criminal Record Bureau disclosures, application forms and references with one from the previous employer always obtained. New staff undertake a full induction programme that is followed by further in-house training. Several staff are presently undertaking National Vocational Qualifications in care at Level 2. The home has an ongoing training programme that staff can apply for. Since the last inspection several staff have received training in abuse awareness and more are booked to attend in the future. Staff spoken with showed that their knowledge had increased since the training and that they were more aware and confident in reporting concerns. Care Homes for Older People Page 22 of 27 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well managed and run in the best interests of the residents Evidence: Since our last visit there has been a change in the management arrangement in the home. The previous manager has left and the post is now filled by a job share between two new managers. These managers have yet to apply to the Commission to be registered with us. Throughout the inspection we were able to evidence the professional, capable and approachable manner in which the managers undertook their when dealing with residents, staff and visitors. Staff and residents said they were accessible and welcomed the open door policy as well as providing structure and a sense of direction through more formal meetings. The managers operates a quality assurance programme made up of audits and satisfaction surveys to gain feedback on the quality of the service offered at the home. Care Homes for Older People Page 23 of 27 Evidence: The responses to the latest survey had not been collated as yet but showed that respondents were very happy with the care provided. A set of management audits was used to monitor the standard of care planning, medication records, upkeep of the building and provision of meals. The managers also sees every accident/incident report and is therefore able to implement any newly identified safety measures accordingly. The managers holds small amounts of spending money of behalf of some residents. Any spending was accounted for with receipts and the records were open to scrutiny by residents or their advocates. There is a sound system in place for promoting the health, safety and welfare of staff and residents. All services and equipment for the building were under contract for regular testing and repair and the appropriate documentation to support this was available for examination. There was information on, and staff had received training in, fire safety, safe moving and handling, and the safe use of chemicals, food hygiene and first aid. Care Homes for Older People Page 24 of 27 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 25 of 27 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 31 9 The managers must apply to 11/03/2010 be registered with the Commission. So that we can confirm that she is a fit person to manage the home Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 2 9 16 Hand transcribed medication must be signed by two staff members to avoid errors being made A record should be maintained of all minor complaints to assist the managers in their audit of quality and help to make i,mprovements to the daily life of residents when this is identified Care Homes for Older People Page 26 of 27 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). 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