Care Home: Jenkin House

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What the care home does well To make sure the the service can meet peoples care and support needs these are assessed before coming to live in the home. Peoples needs are set out i their personal plan of care and these are looked at regularly and amended if needed to reflect and show peoples changing care needs. People are cared for and supported by staff that are trained and qualified and they are protected by the way staff are selected and recruited. The record of complaints show what people say is taken seriously and acted upon. People are also protected by the way medicines are dealt with and records show those giving medicines have been trained to do so safely. The minutes of the residents meetings show they have the opportunity to comment on the services provided.The homes returned satisfaction surveys show people and their relatives are happy with the care and support provided. People were observed relaxing in comfortable surroundings and there is a homely atmosphere created. There are enough staff on duty to meet peoples care and support needs in a relaxed and unhurried manner. A visiting District Nurse says "staff are always helpful" and there are "never any problems with the home". They also said there is "a homely atmosphere" and "people are well cared for". The visiting NVQ Assessor says "the management and staff in the home are very good" they are "always helpful". They also said "staff training has a high profile" and there is "obvious investment in keeping standards high in the home". The certificate displayed shows the homes kitchen and food preparation has been awarded Five Gold Stars following a recent visit from the Local Authority Environmental Health Inspector. The Owner, Manager Cook and Kitchen staff are to be commended for their efforts in maintaining such high standards for people living in the home. People living in the home say the "enjoy" their meals. One says they "get plenty to eat"another says they "have a choice" of menu. The returned homes satisfaction surveys show people and their relatives are generally happy with the quality of care and services provided. The report following recent Local Authority Contract Monitoring visit shows the home complies with local standards. The record of activities show people can choose from a range of activities organized on a regular basis. The records also show the involvement of the local community with visits from the Salvation Army, Methodist Church and local schools. What has improved since the last inspection? To improve the environment for people living in the home there are new Capet`s in the ground floor corridors and some bedrooms have been decorated. For the comfort and benefit of people living in the home new bedding has also been provided throughout. There is now a safe fenced patio area to the front of the home with garden furniture provided for people to enjoy during the summer moths. On the day of the visit a number of people were observed taking the fresh air, socializing and enjoying the sunshine. To maintain standards within the home the staff training records show 80% of care staff now have a National Vocational Qualification at Levels 2, 3 and 4. This investment for people living in the home in staff training is to be commended. To make sure the home is well maintained on the the day of the visit the front windows of this Grade Two Listed building were been renovated. To maintain the dignity of those choosing to live in shared bedrooms there are new privacy screens provided. For the safety of people living in the home there are now call buttons provided in both lounges and the dining room. To help with the administration and running of the home there is now an Operations Manager. The registered Manager says the appointment of the Operations Manager will "free time up to be with people living in the home". What the care home could do better: The assessments and the care plans show and reflect peoples choices and preferences, likes and dislikes. However, the daily records do not contain many descriptive words to reflect and show peoples choices and preferences or any decisions they make about how they live their day to day lives. The record of activities show what activities have taken place. However, they do not reflect if people have been asked if they would like to participate or who did indeed take part. To make sure people are protected from any kind of abuse, the records show there a a few new staff that need to have Safeguarding training. The homes returned quality assurance surveys show that people, their relatives and visitors are generally happy with the services provided. However, this information has not yet been collated or a report provided reflecting and showing what they said about the home, or any changes to the way the home runs as a result of their comments. Key inspection report Care homes for older people Name: Address: Jenkin House Jenkin Road Horbury Wakefield West Yorks WF4 6DT     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: Tony Railton     Date: 0 9 0 9 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 25 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 25 Information about the care home Name of care home: Address: Jenkin House Jenkin Road Horbury Wakefield West Yorks WF4 6DT 01924275143 01924275143 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mr Anthony Harry Robinson care home 25 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: Can accommodate one service user over 65 years of age - MD(E) category Date of last inspection Brief description of the care home Jenkin House is situated in Horbury near Wakefield. It is a listed building that has been refurbished internally to provide accommodation for people over the age of 65 years, including some who have dementia type illnesses. The home stands in its own grounds overlooking the countryside, which provide a pleasant environment for the service users to sit and relax or to walk in. There are two large lounges, and also two very pleasant and spacious dining areas. The service users rooms are available on three floors in the home and a shaft lift is installed. The home has the required number of baths and toilet facilities and handrails and ramps have been fitted to assist with accessing all parts of the home. Service users medical care is provided by the local Health Centres. Specialist care needs are referred through the local GPs. Fees at the home are £359.00 plus a £15.00 top up where appropriate per week. Residents pay for Care Homes for Older People Page 4 of 25 0 0 Over 65 25 25 Brief description of the care home Chiropody treatment and any Hairdressing services they receive. The home has a notice board where they provide information about Fire procedures in the home plus other useful information. The Care Quality Commission (CQC), local office details are visible and a copy of the latest inspection report is given to everyone in the information pack provided to everyone who makes enquiries about living at the home. Care Homes for Older People Page 5 of 25 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 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: Following this visit the service has been given a Two Star rating which means people living in the home experience good quality outcomes. This visit started at 08:30 and ended at 13:30. During the visit there was the opportunity to speak with people living in the home, the Owner, Registered Manager, Operations Manager, senior carers, carers, cook, kitchen and domestic staff. There was also the opportunity to speak to a visiting District Nurse and the National Vocational Qualification Tutor/Assessor who was also working in the home. A sample of peoples records were seen and included assessments, risk assessments, care plans, reviews, daily and medical records. Some staff records were also seen and included, application forms, references, Police and POVA (Protection of Vulnerable Adults List) checks. Some staff training records were seen and included the staff training MATRIX. Other information seen included the record of activities, record of complaints and maintenance records. Other information considered included the Annual Quality Assurance Assessment sent to the Commission by the providers. Other documents seen included a report following a recent Local Care Homes for Older People Page 6 of 25 Authority Contract Monitoring Visit and a report from the Fire Safety Officer. The service history and previous inspection report were also considered. A tour of the premises was undertaken. This was a very positive visit and the inspector would like to thank the people living in the home, the owner, manager and the staff team for their cooperation and hospitality. Care Homes for Older People Page 7 of 25 What the care home does well: What has improved since the last inspection? To improve the environment for people living in the home there are new Capets in the ground floor corridors and some bedrooms have been decorated. For the comfort and benefit of people living in the home new bedding has also been provided throughout. There is now a safe fenced patio area to the front of the home with garden furniture provided for people to enjoy during the summer moths. On the day of the visit a number of people were observed taking the fresh air, socializing and enjoying the sunshine. To maintain standards within the home the staff training records show 80 of care staff now have a National Vocational Qualification at Levels 2, 3 and 4. This investment for people living in the home in staff training is to be commended. To make sure the home is well maintained on the the day of the visit the front windows of this Grade Two Listed building were been renovated. To maintain the dignity of those choosing to live in shared bedrooms there are new privacy screens provided. For the safety of people living in the home there are now call buttons provided in both lounges and the dining room. To help with the administration and running of the home there is now an Operations Manager. The registered Manager says the appointment of the Operations Manager will free time up to be with people living in the home. Care Homes for Older People Page 8 of 25 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 25 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 25 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. To make sure the service can meet peoples personal care and support needs these are assessed before moving to the home. The home does not provide a specialist intermediate care service. Evidence: To make sure peoples personal and healthcare needs can be met by the service these are assessed by the Registered Manager before coming to live in the home. This was confirmed by the Owner and Registered Manager. A sample of peoples records also confirmed and show their needs are assessed before moving to the home. The assessments are comprehensive and include personal details, likes , dislikes a social history. The Registered Manager says people and their relatives are fully involved in the assessment process and there are plans to demonstrate this by obtaining their signitures on the assessment forms.. Records show people are informed by letter about having s [place in the home. The owner and Registered Manager confirmed the home does not provide a specialist Intermediate Care Service. Care Homes for Older People Page 11 of 25 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples personal and health care needs are met and they are protected by the way medicines are dealt with. People are treated with dignity and their wishes are respected. Evidence: To make sure peoples personal and health care care needs are met these are set out in a plan of care showing staff how people should be cared for and supported. To make sure peoples needs are met the care plans are looked at regularly and changed to reflect peoples changing care needs. To make sure people are safe there are Moving and Handling Assessments.To make sure people have enough to eat there are nutritional assessments and peoples weight is checked regularly. The daily records show that peoples care has been given, however, there are not many descriptive words to reflect and show peoples choices and preferences or The Registered manager says to get the assessments and care plans right people and their relatives are fully involved in reviewing peoples care and support plans. Records show that some people are supported by the District Nurses who visit the home regularly. One visiting District Nurses says there is a homely atmosphere created in the home. They also say the Care Homes for Older People Page 12 of 25 Evidence: staff are very helpful in making sure that peoples health care needs are met. Peoples records show that visits from health care professionals including General Practitioners,District Nurses,Chiropodists and Optician are recorded in their care plans. People are protected by the way medicines are dealt with as some peoples medicines were checked and found to be safely administered and recorded. The Registered Manger says there have been improvements to the way medicines are dealt with as there is a new medication system going to be introduced on the 1st October 2009, which includes regular checks by the Pharmacist. To protect people further staff training records show staff giving medicines are trained in how to do this safely. Throughout this visit people were observed being treated with dignity and having their wishes respected. Care Homes for Older People Page 13 of 25 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. People find the lifestyle experienced meets there expectations and they enjoy a choice of a varied and balanced diet. Evidence: The minutes of the residents and relatives meetings show they have the opportunity to comment on the quality of the meals provided and discuss the menu. People say the meals are very good and they get plenty to eat. The cook says that the food provided is sourced locally and people enjoy fresh meat and vegetables. The Certificate displayed shows the homes kitchen and food preparation is very good as they have been given a Five Gold Star rating by following a visit from the Local Authority Environmental Health Inspector. The Cook, Manager and staff team are to be commended for their efforts in providing such a high standard for people living in the home. A tour of the premises found people enjoy their meals in relaxed and pleasant surroundings. The record of activities show people enjoy a variety of activities and give the names of people that participated.However, the records do not show that everyone has been asked if they want to take part. Other visitors to the home include Motivation and Co, the Salvation Army, the local Methodist Church and local schools. On the day of the visit people were enjoying a visit from the hairdresser who said people in the home are wonderful and theres a quiet homely atmosphere. Care Homes for Older People Page 14 of 25 Evidence: People were observed relaxing a socializing in the lounges, dining room and taking the sun on the garden patio. Care Homes for Older People Page 15 of 25 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. People know that what they say will be listened to and acted upon and they are protected from any kind of abuse. Evidence: The record of complaints show that what people say is taken seriously and is acted upon. The Care Quality Commission has not received any complaints about the service. The complaints policy and procedure is accessible as it is displayed in the home and is also found in the Residents Handbook given to everyone using the service. People are protected from any kind of a abuse as there is a Safeguarding Policy and Procedure for them to follow. The Safeguarding Policy also contains Wakefield Local Authority Protocols. Records show the home has not had to make any Safeguarding Referrals to the Local Authority. People are further protected as staff training records show they have Safeguarding training and update training. The manager said there is Safeguarding training planned for two new staff and update training for those that require it. Care Homes for Older People Page 16 of 25 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a well decorated , well maintained environment that is comfortable, homely, clean and safe. Evidence: People were observed relaxing in the lounges and dining room and outside on the patio at the front of the home. To make sure people are safe and improve the security of the home there is now a fence around the patio area making it safer for people to use. The views from the front garden and the rooms to the front of this grade two listed building are spectacular. People enjoy the views of the surrounding countryside overlooking Emily Moor. For the benefit and comfort of people living in the home new carpets have been provided in the lobby and ground floor corridors. Discussion with the domestics found the are supported and have everything they need and require to keep all ares of the home clean. It was noted that all areas of the home are clean and free from any unpleasant odors. The owner and Operations Manager say to improve standards in the home there are plans to redecorate and re-furbish the lounges and dining room over the coming year. The development plan confirmed this. For the comfort and benefit o residents new bedding and towels have been provided since the previous inspection visit. It was noted that lots of people have brought their own furniture with them and are surrounded by their own possessions. For the safety of people in the home it was noted that the call system has been extended and is available in the lounges and dining rooms. People said they like living in the home and Care Homes for Older People Page 17 of 25 Evidence: have everything they need. A visiting District Nurse says there is a always a homely and relaxed atmosphere when they visit. A visiting hairdresser says everyone is always relaxed and comfortable. Care Homes for Older People Page 18 of 25 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. Peoples needs are met by the numbers and skill mix of staff that are both trained and qualified, and they are protected by the way staff are selected and recruited. Evidence: People are protected by the way staff are selected and recruited as records show references, police and POVA (Protection of Vulnerable Adults List) checks are taken up before they are employed. To keep people safe and promote there health staff records show they have Moving and Handling,First Aid, Food Hygiene and Infection Control training. To maintain standards of care records show nearly 90 of staff have a National Vocational Qualification at Levels 2, 3 or 4. This good practice is to be commended. Discussion with the NVQ Trainer/ Assessor found that they enjoy coming to the home as the staff and managers are always very helpful. They also said that NVQ training has a high profile in the home and there is an obvious investment in the staff for people living in the home. The minutes of the staff meetings show they have the opportunity to comment on the running of the home and the quality of services provided.The minutes of the management meetings show there is an investment in training. The supervision records show staff are supported in the work they do. Discussion with staff found they enjoy working in the home and the people they work with.Throughout the visit positive relationships were observed between people living in the home and those caring for them. The minutes of the residents and relatives meetings show they have the opportunity to comment on the quality of care and Care Homes for Older People Page 19 of 25 Evidence: support provided. People said they like living in the home and the people caring for them. The manager said they have a very low staff turn over which demonstrates people enjoy working at Jenkin House. The owner says as well as keeping training records in staff files they intend to have a master sheet or training MATRIX showing staff qualifications, training and planned update training. Care Homes for Older People Page 20 of 25 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. People live in a well managed home that is run in their best interests and where they have a say in what happens to them and where their health , safety and well-being is promoted and protected. Evidence: Peoples records show that their care needs are assessed , planned for and met by the home. The staff records show people are protected by the staff management systems and in particular the way staff are recruited nd selected, by the staff training and by the investment in staff qualifications. The satisfaction surveys, residents and relatives meetings, staff meetings, management meetings and providers monthly visit reports show people have the opportunity to comment on the running of the home. The record complaints also show that what people say is taken seriously and acted upon. The minutes of the management meetings, supervision sessions for the Registered Manager and employment of an Operations manager to coordinate the homes management systems must be viewed positively in improving services for people living in the home. The maintenance checks and Health and Safety policies and Care Homes for Older People Page 21 of 25 Evidence: procedures, and staff training, promote the safety and well-being of people in the home. The homes returned returned satisfaction surveys show the views of people living in the home, their relatives and other stakeholders is sought. However, this information has not yet been collated or a report provided showing what people said about the home or any improvements or changes as a result of their comments. Care Homes for Older People Page 22 of 25 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 23 of 25 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 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 7 The daily records would benefit from an increase in the use of descriptive words to show and reflect peoples choices and preferences plus any decisions they make about how they live their daily lives. As with the daily records, the record of activities should contain descriptive words to show and reflect peoples choices and preferences and in particular to demonstrate that people were asked if they would like to participate in any activities arranged on a day to day basis. To protect people living in the home the staff requiring Safeguarding training should do so as soon as this is practicable. The information gathered through satisfaction surveys should be collated and a report provided to reflect and show what people say about the home and the quality of the services provided and any changes made as a result of their comments. 2 14 3 18 4 33 Care Homes for Older People Page 24 of 25 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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