Care Home: Kendler House

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What the care home does well The company that own Kendler, Small House Homes Ltd. encourages and supports staff training and development ensuring that people who live at the home receive the best possible service. People living in the home are encouraged to enjoy outside interests and maintain their independents. A survey by a relative sent to the homestates, "Excellent" when asked about the care there relative receives at Kendler. What has improved since the last inspection? The home has benefited from repainting of the dinning room and main hallway. The home has had new chairs for the dinning room. What the care home could do better: No Requirements were made in this report. A recommendation that the home should display the Company`s Complaint procedure has been made. A recommendation has also been made that the main living areas, namely the dinning room and hallway , should have a unsoiled, clean and secure carpets fitted. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Kendler House 57 Haddington Road Stoke Plymouth Devon PL2 1RP The quality rating for this care home is: two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Kim Fowler Date: 0 8 0 7 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area Outcome area (for example: Choice of home) These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to:  Put the people who use social care first  Improve services and stamp out bad practice  Be an expert voice on social care  Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Reader Information Document Purpose Author Inspection report CSCI Page 2 of 30 Care Homes for Adults (18-65 years) Audience Further copies from Copyright General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 30 Information about the care home Name of care home: Address: Kendler House 57 Haddington Road Stoke Plymouth Devon PL2 1RP 01752550479 01752265228 menna@smallhousehomes.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) : Modus Care (Plymouth) Ltd care home 4 Number of places (if applicable): Under 65 Over 65 4 0 learning disability Additional conditions: Aged 16 - 35 One Service Users named elsewhere with Emotional, Behavioural difficulties. Date of last inspection Care Homes for Adults (18-65 years) Page 4 of 30 A bit about the care home Kendler House is a terrace property that is situated in a residential area of Stoke in Plymouth. It is situated close to local amenities and bus routes. This home is owned by Small House Homes Ltd. Kendler House is registered for four people who have a learning disability although there were only 2 people living there at the time of the inspection. The home aims to support people to learn independent living skills with a view to living on their own in the community. The house provides a lounge room, dining room, kitchen, office and sleeping-in room for staff on the ground floor; a laundry room and 3 bedrooms on the first floor, one with en suite shower room and the 2 others with a private bathroom each; and on the 2nd floor, a self contained flat. The kitchen opens onto a patio area. The home would not be suitable for people with restricted mobility as the kitchen and bedrooms are accessed by stairs. The weekly fees for this service are calculated on an individual basis depending upon the each person?s support needs. Information relating to the services provided by Kendler House can be obtained directly from the home. Care Homes for Adults (18-65 years) Page 5 of 30 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 6 of 30 How we did our inspection: This is what the inspector did when they were at the care home The unannounced inspection took place over 1 day on the 8th July 2009 and started at 10:20 am and finished at 2:4pm. The homes manager and company director were available throughout the inspection. We made a partial tour of the building and spoke to one of the people living at the home. Documentation relating to the care planning process and the management of the home were examined. We also spoke to the manager and all the staff members on duty during the inspection. Any comments received during the inspection are in the relevant section of the report. What the care home does well The company that own Kendler, Small House Homes Ltd. encourages and supports staff training and development ensuring that people who live at the home receive the best possible service. People living in the home are encouraged to enjoy outside interests and maintain their independents. A survey by a relative sent to the home Care Homes for Adults (18-65 years) Page 7 of 30 states, Excellent when asked about the care there relative receives at Kendler. What has got better from the last inspection What the care home could do better No Requirements were made in this report. A recommendation that the home should display the Companys Complaint procedure has been made. A recommendation has also been made that the main living areas, namely the dinning room and hallway , should have a unsoiled, clean and secure carpets fitted. Care Homes for Adults (18-65 years) Page 8 of 30 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 Kim Fowler 33 Greycoat Street London SW1P 2QF 02079792000 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 9 of 30 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 30 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 . Prospective admissions referred to the home can be assured that they will be provided with sufficient information for them to make an informed choice about living at this care home. Evidence: The home has had one new admission since the last inspection and this admission came from one of the other companys homes. No pre-admission assessment was available in their file, however there were details of meetings held were this individual indicated and discussed their agreement to a move from their previous placement. The minutes showed that the person moving home, family members and professionals involved in this individuals care were in attendance at all the meetings arranged and held. Information was also recorded that this person visited the home before admission. One file examined showed a contract between Small House homes and the individual. However this contract did not state any fees payable and was with their previous home dated 4 years ago. Care Homes for Adults (18-65 years) Page 11 of 30 Evidence: The homes AQAA returned to the Commission stated, We carry out in-depth assessments of the service users before they come to Kendler. Care Homes for Adults (18-65 years) Page 12 of 30 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 . People are encouraged and supported to make daily decisions about their own lives to maintain their independence. Evidence: All the files examined held comprehensive care plans in place with a complete breakdown of each area of a individuals life. This included Independent living skills, social life and any work placements. Each file held recent review meetings and showed that the individual concerned was involved and attended these meetings. The homes AQAA under how they have improved in the last 12 months states, We have ensured that the frequency of residents meetings and keyworker sessions have increased. These plans are accessible for the staff on duty and each plan showed they gave clear guidance on all aspect of the individuals needs. The guidelines in place included how to meet the individuals personal care needs and clear guidelines to assist people who may challenge the service. Care Homes for Adults (18-65 years) Page 13 of 30 Evidence: Observed during the inspection were people making everyday choices about were to go out for a trip and getting out of bed when they wanted. Recorded into two files were that these people were responsible for their own money with some staff support. This included drawing money out of the bank and paying their own bills. One person had a visit from a local advocate in the privacy of their own room. Observed a future meeting being arranged with the individual concerned and staff at the home. All files held comprehensive risk assessments on every part of peoples lifes. This included risk assessments on outside activities, in house daily tasks and clear behaviour management risk assessments. Each person living in the home has a clear missing person procedure in place for staff to follow when it is required. Any restrictions on choice or freedom had been discussed, agreed and recorded for each person concerned. Any restrictions in place are to protect individuals Health and Safety and always involved other professionals. Care Homes for Adults (18-65 years) Page 14 of 30 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 . The people living in Kendler can be confident that the home will promote and provide support for them to access the local community and leisure activities as much as possible. Evidence: Each file examined held details on education and occupation activities. No one currently has a job but several attend course at the local college. These courses include computer and Life Skills which include maths and English. The staff confirmed that they are currently looking at another course for one person due to commence after the summer break. The homes AQAA stated, We encourage the service users to attend job fairs and local inclusion activities in order for them to find out what is available. Each person in the home has one to one staff support and these staff will assist with Care Homes for Adults (18-65 years) Page 15 of 30 Evidence: activities and additional staff are available to support people if they access the community. Daily records show regular activities are undertaken and these activities are supported by individual guidelines and risk assessments drawn up with other professionals involved in the individuals care. The home has an Activity Tracker sheet for each person and includes places visited and these included going swimming, cinema and meals out. The home has their own transport and the cost each person pays is shown in individual files but people are encouraged to use public transport were possible. Information recorded into daily records and confirmed by the staff state that family members visit people on regular bases. One person is going to visit and stay with family in the next few days. Other files examined showed family and friends visit and involvement for each person. One person was observed receiving their personal mail when it arrived. People are encouraged to maintain as much independence as possible and recorded into individuals files is independent task people undertake daily. Each person has a key to their own private bedroom and staff were observed knocking to talk to people. Observation showed that the staff and people living in the home interacting with each other in a relaxed and friendly way. The staff confirmed that the menus are planned weekly with people living in the homes involvement. Then everyone is encouraged to help with the shopping and preparation of the meals. Two staff spoken with agreed that the home has plenty of provisions available and that the staff member on duty will cook each of the meals and people have access to the kitchen when needed. One person spoken with said the food was, OK and that they helped with the shopping. Care Homes for Adults (18-65 years) Page 16 of 30 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 . Staff were observed promoting independence and providing support to individuals promoting privacy and dignity at all times. Access to health care is maintained to promote the wellbeing of all who live in the home. Evidence: All personal support details are recorded into individual care plans. These plans show clear guidelines for staff on what task they are to undertake. People currently living in the home are fairly independent, however each support plan provides description on how individual support in their emotional, personal and health care needs are to met by the home. Information was recorded on what additional health care input each person receives. This includes information on dentist, GPs and opticians. Incident forms are completed when required and each person has a behaviour management guideline in place were needed. Care Homes for Adults (18-65 years) Page 17 of 30 Evidence: All files showed specialist support was provided to each individual and this included the Challenging Behaviour service. This additional support ensures that each person living in this home has there health care needs met. All incidents of behaviour which may challenge the service are clearly documented and advice sort from other professionals involved in the person care. This includes the Challenge Behaviour service. Each person has clear instructions for staff on how to manage such behaviour. The AQAA states, We encourage the service users to have annual check ups via their GP, opticians and Dentist. No one in the home currently receives any medication, however all staff confirmed they had received medication training with only the senior staff member on duty administering medication when the need arises. The home has a designated medication cabinet in place. Care Homes for Adults (18-65 years) Page 18 of 30 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 people living at Kendler can be confident that any complaints or concerns raised will be listened to, acted upon and well managed by the home, which protects the welfare of all. Evidence: The home and company has a complaints procedure in place. However this is currently not displayed for people who live in the home or for people visiting the home to access. The manager stated that at time the complaints procedure had been remove by people living in the home but stated that they would find a way of displaying a notice to inform people that they can complain and how. The home has a complaints file held in the home and this showed that the home had not received any complaint. The Commission had not received any complaints. There is also a Moans and Groans log were everyday issues are recorded. This included the nature of the complaint, the action taken and comments and evaluation carried out by the homes manager. Due to the Data Protection Act guidance now in place the home needs to separate any personal information held on the same page. The manager discussed their plans to meet this guidance. One staff member confirmed that they had completed the POVA (Protection of Care Homes for Adults (18-65 years) Page 19 of 30 Evidence: Vulnerable Adults) training with the local Safeguarding team. The AQAA said, All staff have completed in house child protection and adult protection course and are aware of how to report concerns. Care Homes for Adults (18-65 years) Page 20 of 30 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 . Small House homes continues to update and upgrade a suitable environment for its stated purpose and people living at the home can be assured that they will live in a comfortable home that is regularly maintained. Carpets that are not secured to the floor pose a trip hazard and risk of falls. Evidence: A partial tour of the premises showed that the home is suitable for its stated purpose. The home is well kept, safe and accessible for all the people currently living at the home. The manager was able to confirm that all maintenance and repairs are ongoing as is the general update of the home. The manager stated that the last recommendation that the carpets should be replaced as they posed a trip hazard had been completed. However during the tour of the premises the carpets in the main living area including the dinning room and hallway were heavily stained and soiled and many of the edges are coming away form the walls and threshold, again posing a trip hazard. The homes AQAA returned to the Commission stated, The carpets in the dinning Care Homes for Adults (18-65 years) Page 21 of 30 Evidence: room are regularly stained so we need to ensure they are cleaned on a regular basis and any spillage cleaned up straight away. The last admission to the home was able to state that they had chosen the colour scheme in their own room before admission. And went onto say when asked that the home was clean and warm. This person spoken to said, I like living here. The individual bedrooms seen showed that peoples rooms contained personal items including furniture, ornaments and pictures that reflect their personality and interests. Since the last inspection the dinning room and hallway has been repainted and the dinning room has some new chairs. Care Homes for Adults (18-65 years) Page 22 of 30 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 . People living in this home are supported by well-motivated and caring staff in sufficient numbers to meet the needs of those currently living at the home. Staff training is carried out regularly for all staff to ensure that all assessed needs of the people living at the home are met. Evidence: Throughout the inspection the staff on duty were observed responding sensitively and respectfully to each person living in the home and thus were able to use their knowledge of individuals to encourage choice and independence were possible. All staff were observed to be friendly, good-natured, courteous and respectful at all times. They interacted well with the people living in the home and observation of some of the activities sessions being discussed and arranged showed that the staff and the people living in the home having fun in a relaxed friendly atmosphere. One person living in the home was able to confirm, as were the staff spoken with, that there were sufficient staff on duty to met the current needs of people living in the home. On the day of the inspection there was the manager, deputy manager and 3 support staff for 3 people living in the home. The home provides a waking staff Care Homes for Adults (18-65 years) Page 23 of 30 Evidence: member and 1 sleep in staff and an on-call system for the management. And the AQAA under their plans for the next 12 months said, To continue to ensure that staffing levels are at appropriate levels and enhance the lifestyles of the service users. Observation showed that the staff members on duty were aware of individuals needs and how best to support them. One person was able to say that the staff team were good and it was evident that there was a good rapport between everyone living and working in the home. Examination of staff files showed that all staff had the required pre-employment checks, including CRB (Criminal Record Bureau Disclosure) in place ensuring as far as possible unsuitable staff are not employed. However one staff file showed a CRB received 2 weeks after the person started with no POVA check held on the individual file. The manager stated that new employees work in head office for the first week receiving training and then are supervised on the second week. Discussions with manager and the staff showed that all staff participate in and update training course when needed. The training recorded in individuals files show that Safeguarding, medication, Fire Safety and National Vocational Qualifications (NVQs) and courses related specifically to working with people with learning disabilities is regularly undertaken. The Challenging Behaviour service provide specialist training for the staff team. The homes AQAA records, Robust staff recruitment procedures, induction and ongoing training, encourage personal development ensure that we have a knowledgeable and effective staff team. Several staff members were spoken with during this inspection and all confirmed regular training was offered. These staff also felt that they were able to express their view at staff meetings held in the home. Regular consultation with staff ensures staff can contribute to the running of the home and are aware of the homes aims and objectives, philosophies of care and promotes consistency and improvement. Mental Capacity training is booked for later this month and supervision is carried out on a regular bases. One staff member said of the home, Its a good staff team here. One person living in the home said, I go out with the staff. The home is currently going through a change of ownership and several staff members were apprehensive about how these changes will effect them. The home has a clear Induction programme completed during new staff members 3 monthly probation period. Care Homes for Adults (18-65 years) Page 24 of 30 Evidence: Care Homes for Adults (18-65 years) Page 25 of 30 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 management of this home is very good and ensures that records are effectively maintained. And the staff team are well trained to meet the needs of people living at the home. Evidence: The acting manager in post is yet to completed the Registration process with the Commission. However she does hold an NVQ 3 and 4, a Registered Managers award and a GNVQ Advanced in Health and Social Care. She also has many years experience working in the care profession and has been in day to day control of this home since October 2008. The manager is currently being supported by the companys Operations manager and with regular visits from the new Director of the company. The AQAA records under the plans for the next 12 months, To continue with staff training and to ensure that they all understand the legal aspect of the Mental Capacity Act and Deprivation of Liberty Act in relation to there work. Care Homes for Adults (18-65 years) Page 26 of 30 Evidence: The Quality Assurance survey were competed recently and these included surveys from the people living in the home, visiting professional and relatives. One relative survey said, The staff are very good and a professional wrote, Staff are very aware of service users wishes and needs. Sampling of servicing records indicated that equipment is serviced regularly and maintained in good working order, including the fire alarm system. Certificates were available on all Health and Safety equipment and gas and electrical appliances were being routinely serviced and checked. The fire protection system was well maintained. Maintenance checks are being carried out. Staff are receiving appropriate fire protection training to ensure they have the skills to deal with emergencies and many staff were attending a fire safety training course during the inspection. Good health and safety practices reduce any unreasonable risk, affecting people living at the home, to an acceptable level. Care Homes for Adults (18-65 years) Page 27 of 30 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 28 of 30 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 22 The home should display the Complaints procedure for all to access. Care Homes for Adults (18-65 years) Page 29 of 30 Helpline: Telephone: 03000 616161 or Textphone : or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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