Care Home: Liberty House Care Homes

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What the care home does well People are able to do interesting activities and staff support them.People have detailed care plans. These tell staff how the person needs to be, and likes to be supported. This ensures people get the support they need, in the way they prefer.People all have their own bedroom. These contain items which are important to each person, and are a comfortable place to sleep and relax.Staff ensure the home is a safe place to live, and complete health and safety checks. What has improved since the last inspection? The home is now kept clean and tidy and comfortable in which to live. A volunteer said the best thing about the home was a homely atmosphere.Changes have been made to the way new staff are checked before they start work, to ensure they are suitable to work in the home.Medication storage has been improved this ensures medication is available when needed and cant be lost or stolen.Staff have had training in areas that will help them do their job better and ensure they know how to respond if they think anyone is being harmed. What the care home could do better: We found some care needs which had not been planned for. Recording these needs will ensure all staff support people in the same way.We found one member of staff was working long hours, often overnight and by herself. We found this area needed further attention to ensure people get the support they need. Key inspection report Care homes for adults (18-65 years) Name: Address: Liberty House Care Homes 55 Copeley Hill Erdington Birmingham West Midlands B23 7PH The quality rating for this care home is: one star adequate 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: Alison Ridge Date: 0 7 0 1 2 0 1 0 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should:  Be safe  Have the right outcomes, including clinical outcomes  Be a good experience for the people that use it  Help prevent illness, and promote healthy, independent living  Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home:  3 stars – excellent  2 stars – good  1 star – adequate  0 star – poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area Outcome area (for example: Choice of home) These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement Care Homes for Adults (18-65 years) Page 2 of 33 Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by:  Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice  Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983  Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services.  Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2010) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 33 Information about the care home Name of care home: Address: Liberty House Care Homes 55 Copeley Hill Erdington Birmingham West Midlands B23 7PH 01213270671 F/P01213270671 liberty55@btconnect.com 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) : Liberty House Care Homes Ltd care home 6 Number of places (if applicable): Under 65 Over 65 6 0 learning disability Additional conditions: The maximum number of service users who can be accommodated is: 6 The registered person may provide the following category of service only: Care Home Only (Code PC); To service users of the following gender: Either; Whose primary care needs on admission to the home are within the following categories: Learning disability (LD) 6 Date of last inspection Care Homes for Adults (18-65 years) 0 5 0 8 2 0 0 9 Page 4 of 33 A bit about the care home Six people who have a learning disability can live at the home. The home has a lounge, dining room, kitchen, laundry and bathroom. Each person has their own bedroom. There is a large garden at the back of the home. Our reports are in the home for people to read if they want to. Care Homes for Adults (18-65 years) Page 5 of 33 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: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and health care support Concerns, complaints and protection Environment Staffing Conduct and management of the home Care Homes for Adults (18-65 years) Page 6 of 33 How we did our inspection: This is what the inspector did when they were at the care home One inspector undertook this visit over one day, and the home did not know we, the commission were coming. 6 people live at Liberty House. We spoke to two people who could talk with us. We watched other people who live in the home. We looked at one persons care and support. This includes meeting the person, asking staff about this persons care, looking at medication and care files and looking at the areas of the home they use. Care Homes for Adults (18-65 years) Page 7 of 33 We looked at how staff are checked and trained to ensure they are able to work safely in the home. We sent out surveys to people living at the home and to their relatives. We received four surveys back from people who live at the home and one from a relative. What the care home does well Care Homes for Adults (18-65 years) Page 8 of 33 People are able to do interesting activities and staff support them. People have detailed care plans. These tell staff how the person needs to be, and likes to be supported. This ensures people get the support they need, in the way they prefer. People all have their own bedroom. These contain items which are important to each person, and are a comfortable place to sleep and relax. Care Homes for Adults (18-65 years) Page 9 of 33 Staff ensure the home is a safe place to live, and complete health and safety checks. What has got better from the last inspection The home is now kept clean and tidy and comfortable in which to live. A volunteer said the best thing about the home was a homely atmosphere. Care Homes for Adults (18-65 years) Page 10 of 33 Changes have been made to the way new staff are checked before they start work, to ensure they are suitable to work in the home. Medication storage has been improved this ensures medication is available when needed and cant be lost or stolen. Staff have had training in areas that will help them do their job better and ensure they know how to respond if they think anyone is being harmed. Care Homes for Adults (18-65 years) Page 11 of 33 What the care home could do better We found some care needs which had not been planned for. Recording these needs will ensure all staff support people in the same way. We found one member of staff was working long hours, often overnight and by herself. We found this area needed further attention to ensure people get the support they need. If you want to read the full report of our inspection please ask the person in charge of the care home Care Homes for Adults (18-65 years) Page 12 of 33 If you want to speak to the inspector please contact Alison Ridge Care Quality Commission City Gate Gallowgate Newcastle Upon Tyne NE1 4PA 03000616161 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line - 0870 240 7535. Care Homes for Adults (18-65 years) Page 13 of 33 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and health care 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 14 of 33 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. People have the information needed to enable them to make an informed decision about whether they would like to live at the home. Evidence: The statement of purpose and service user guide were available in each persons bedroom. The documents contained most of the information people would need to know about the home, and they had been reviewed in October 2009, ensuring they contain up to date information. Since the last inspection work had been undertaken to provide the documents in a pictorial format. A specific fee rate is not available in the document, and we were informed this is due to each placement being individually calculated depending on the persons level of care and support needs. The certificate of registration was on display in the entrance of the home, and a copy of the last inspection report was available so people can read this if they wish to. The people living at Liberty House have lived there for many years so we did not assess the pre-admission process. A policy and procedure regards this is available, and suggests a full assessment and trial visits would be completed. This would ensure the home could Care Homes for Adults (18-65 years) Page 15 of 33 Evidence: meet the persons needs, and that they would have a chance to try out the home before deciding about moving in. Five people returned a survey to us. These all stated they had been given enough information before they moved into the home, and that they had been issued with a contract. Care Homes for Adults (18-65 years) Page 16 of 33 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. Staff mainly have the information they need so they know how to support people safely to meet their needs and make choices about their day-to-day lives. Evidence: We were told that each person has a written care plan. This is an individual plan about what support is required from staff so the persons needs can be met. We looked at the file of one person. This told us how the person likes to be supported in the areas of sleeping, dressing, leisure, relationships, health care needs and eating and drinking. The plan showed the person had been involved in writing it. This means that all the staff have the information they need to support each person in the way they prefer. We spoke with one person who said that staff did know how to support them, and they were happy with the care and help they are offered. Five people commented in a survey about staff support. Four people said staff always provide the care and support they need, and one person said they usually do. We could see from records and from observing how people were being supported that the written plans are followed, ensuring people are getting the care they need. The plan we looked at had been reviewed in October 2009, this ensures it is up to date. Care Homes for Adults (18-65 years) Page 17 of 33 Evidence: Staff support was very limited on the day of our visit. Everyone was at home as the day centres were closed due to bad weather. The opportunities available to people on this day were limited, and were not as they had chosen, but we could see that on most days people are able to undertake activities which they have chosen. The people who live at Liberty House are supported by a very stable staff team. This means people get to know each other well, and can be confident staff know and understand how to support them. Records included risk assessments. These are documents that help people live as independently as possible and identify where they need help. These had been kept up to date. Two risks were identified for the person we tracked which had not been assessed. The manager has been asked to look at this. Care Homes for Adults (18-65 years) Page 18 of 33 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. People experience a meaningful lifestyle. They are offered a varied diet reflective of their choice and cultural needs, this ensures their well being. Evidence: We found that the range of opportunities available to people living at Liberty House are very varied. It was good to find that people can learn about things that are of specific interest to them, as well as having chance to do things together or in a group. One person spoke to us about the things they do each week. They were pleased with their activities. They said, I have lived in other care homes, you can get bored. I am never bored here, there is plenty to do In the surveys returned to us people listed activities as one of the things the home does well. Comments included, What does the home do well Activities and developing personal skills another person said, Some nice activities. Lots of interesting things. We are allowed to watch soaps like the bill and coronation street. That always keeps me calm and in a good mood. I attend drama classes and computer skills. I do volunteer work at Oxfam. The garden project and cook cakes. Another person when asked what the homes does well said, Take us out on trips. Help us at bath times Care Homes for Adults (18-65 years) Page 19 of 33 Evidence: We could see that each person has a mixture of in house and community based opportunities each week. These include learning courses, social clubs, leisure activities like the cinema or eating out and seeing friends and family. In house people can relax and watch films or TV, listen to music, karaoke, or help with the running of the home and light housework. Volunteers visit the home each week, and help people tend the garden. A selection of photos on display show what they have achieved. Family and friends are important to some of the people at Liberty House. It was clear from talking with people and looking at records that this is supported, so people can stay in touch with those who are important to them. There is a menu, which is planned and set each week. This contains a variety of dishes from different cultures and parts of the world. It also contains vegetarian and halal dishes. It was good to see that people can have other food they fancy, and one person reported making cheese on toast for his breakfast, which was different to the planned menu. People are weighed each month, and the person tracked had maintained a healthy weight, showing the menu is healthy and nutritious. Care Homes for Adults (18-65 years) Page 20 of 33 Personal and health care 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The personal care and health care needs of the people living at Liberty House are mainly met, so ensuring their well being. Evidence: We met all six people during our visit, and everyone had been supported to dress and undertake personal care in a way which reflected their gender, culture and the cold weather that day. The care plan we looked at showed that the person had been supported to attend the health appointments they need. This included the GP, optician, dentist, and specialist nurses. We found entries in daily notes about two areas of difficult behaviour. It was good that these had been discussed with the psychiatrist, and in one case a specialist nurse was also involved. We could not find any record to show staff how to support the person in these areas. This could result in staff responding in different ways which could make the behaviour worse. One person has a medical need, which can result in emergency medication being required. We found a detailed plan in place, which showed the home had sought specialist advice. The action to be taken in event of staff not trained in this area being on duty should be made clear. Care Homes for Adults (18-65 years) Page 21 of 33 Evidence: In the comments cards we received, all five people said the home always made sure that their medical care needs were met. Medication is well managed in the home. We looked at one persons medication records. All of the audits showed they had received the medication they need. The home had made the storage of medication safer, as we had asked at the last inspection. They also need to show how they audit this medication between uses. We identified this in August 2009 and action had not been taken. Care Homes for Adults (18-65 years) Page 22 of 33 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Arrangements are in place to listen and act upon peoples concerns. staff may not have the knowledge needed to ensure they recognise and report possible harm, which could impact on peoples well being. Evidence: Liberty House has a very open complaints procedure. Copies of it are displayed around the home, and one person we spoke with said they felt confident to raise any concerns with the staff on duty. Five people returned comment cards to us, everyone reported that they would speak with someone informally if they were unhappy, and three of the five people said they knew how to make a formal complaint. We have not received any complaints about this service, and none have been recorded at the home. The recruitment procedure has been improved since our last inspection, and we are now confident that only staff who have been checked will be able to work at the home. This should protect people from harm. Training in Safeguarding had been provided since our last inspection, and it was evident that training had been requested for a new staff member. Training had been requested for all staff in the Mental Capacity Act, and Deprivation of Liberty Safeguarding. Until this is delivered people had been given leaflets to increase their awareness. The home keeps a small amount of personal money for people. In August 2009 we found this to be well managed, and we did not look at this at this inspection. Care Homes for Adults (18-65 years) Page 23 of 33 Care Homes for Adults (18-65 years) Page 24 of 33 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. People live in a comfortable and homely environment which meets their needs. Evidence: Liberty House is a large building, which has been adapted to a care home. It is homely and people were seen to be very comfortable and confident around the home. One person showed me the lounge, dining room, kitchen, bathroom and their bedroom. They were aware of the areas the manager hopes to improve. Five people returned a comment card to us. All five people said the home is always clean and fresh, and two people commented that the home has a family atmosphere. We spoke with a volunteer at the time of our visit, they said one of the best things about the home was that it has a very comfortable feel and homely atmosphere. Each person has their own bedroom. The bedroom I saw was very comfortable and spacious. There was a double bed, en suite shower, and lots of the persons own things. Care Homes for Adults (18-65 years) Page 25 of 33 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The number of staff on duty does not always ensure people receive the support they need. Evidence: There is a very stable team of staff at Liberty House, which ensures people feel confident that staff know them and their needs. One new member of staff had started work since our last visit. We could see that all the recruitment checks needed had been undertaken, that the person had been given a good induction to the home, and that more experienced staff were supporting them. Training had been identified and requested for them. Training had been provided for all staff since we last visited the home. This means staff have a greater awareness of peoples needs, as well as information about first aid, and fire safety in the event of an emergency. Five people returned a comment card to us. Comments about staff were that four people felt staff were always available, and one person thought they usually were, and three people reported staff always listen to them, one person said they usually do, and one person said they sometimes do. People at Liberty House greatly benefit from volunteers who work at the home. We could not see that these people had been checked to ensure they were suitable to work in the Care Homes for Adults (18-65 years) Page 26 of 33 Evidence: home, and records to support these checks being made must be held at the home. The staff rota showed that most of the time two staff are on duty. We were concerned to find that one staff member was working a high number of hours, which included some late afternoons, nights and mornings on their own. There was no risk assessment to underpin this. We have asked the manager to look at this, to ensure this is safe practise. Care Homes for Adults (18-65 years) Page 27 of 33 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is mainly run in the best interests of people living there, and people living there are protected from harm. Evidence: The Registered manager has many years experience of supporting people with a learning disability, and in management. She has completed courses in management and in care, and attends training on a regular basis to ensure she stays up to date. The manager has addressed most of the matters we addressed at the last inspection. We found action was still needed to fully meet the requirements made regards recording recording some medications, and recording who takes part in fire drills in greater detail. The manager undertakes audits of the support provided to ensure people are happy with the way the home is run. The last report we could find about this had been written in January 2008, so this needs to be updated to give a current picture of the home. Health and safety checks were sampled, and we found that the fire system, electrics, hot water and gas had been inspected as is required. The home had undertaken the checks it Care Homes for Adults (18-65 years) Page 28 of 33 Evidence: needs to on hot water temperatures, the fire alarm and emergency lighting. Records showed that hot water temperatures are cooler than is required. One person said that the shower was often cool, and notes in one persons file supported this. It was advised that this be reviewed and the temperature increased within safe limits if possible. Fire drills had been undertaken every three months. The records of these should be further developed to show who has taken part, to ensure all staff undertake these on a regular basis. Care Homes for Adults (18-65 years) Page 29 of 33 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 30 of 33 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 1 9 13 Risk assessments must be completed for people. 26/02/2010 So people can live as safely and independently as possible. 2 18 17 Some medications must have 28/02/2010 stock records maintained. To ensure an adequate supply is always available. 3 20 17 All care needs must be underpinned with a detailed plan. 31/03/2010 To ensure people are supported in the way they need and prefer. 4 33 18 Staff must be provided in adequate numbers. 26/02/2010 Care Homes for Adults (18-65 years) Page 31 of 33 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 To ensure peoples needs are met, and people can be supported in event of an emergency. 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 42 Hot water delivery temperatures should be reviewed and increased to provide water at a more comfortable temperature within a safe range. Fire drills should be undertaken and a record maintained to show all staff have undertaken this on a regular basis. 2 42 Care Homes for Adults (18-65 years) Page 32 of 33 Helpline: Telephone: 03000 616161 or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2010) 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. 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