Care Home: Meadow Park

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What the care home does well Meadow Park DS0000055016.V375349.R01.S.doc Version 5.2 The home provides a good range of information to people thinking of coming to the home, so they can make an informed decision. The home makes a full assessment of a person`s needs before deciding if it can meet all those needs. The home draws up plans to meet the care needs of its service users. Service user`s health care needs are also fully assessed and properly met. The home stores medicines safely, and administers them correctly and safely. Service users say that staff treat them well and treat them with respect. The staff are working hard to provide a stimulating atmosphere in the home, with appropriate social activities for service users. Service users are encouraged to keep in regular contact with family and friends, who say they are always made welcome in the home. One relative said, "The family are very happy with the care they provide here. We visited several other places and without doubt this place was the best and after almost two years we are still very satisfied with the care provided. Another relative said, "My relative is happy here, she struggled at home to remain independent, now with support she has her independence back and she has a new lease of life". Service users are also encouraged to take as much control over their own lives as they are able, and make their own decisions. Without exception, the service users were very complimentary about the care that they receive, several spoke highly of the staff and all were very happy with the accommodation. Service users were very complimentary about the food, and there is a balanced diet, with service users choice included. Complaints and concerns are taken seriously and are responded to properly. The home is kept clean and hygienic and free from odours. The home has enough staff to meet the needs of service users The staff team had very good knowledge of the service users care needs. The home is very careful as to how it recruits new staff, and runs all the necessary checks on them to protect its service users. Meadow Park DS0000055016.V375349.R01.S.doc Version 5.2 Page 7The manager is experienced and is providing positive leadership to the home. The home is being run in the best interests of the service users. Service users finances are protected by the home`s policies and accounting systems. The health and safety of the service users and of the staff are protected by the home`s policies and systems. What has improved since the last inspection? The home has a new manager and everyone spoke highly of her and the changes that she has made. The provider has continued to make lots of improvements to the environment; several areas throughout the home have been completely refurbished. There are plans to completely refurbish the Moore unit; there will be additional lounge space, new flooring, decoration and furnishings. What the care home could do better: No requirements or recommendations were identified. Key inspection report CARE HOMES FOR OLDER PEOPLE Meadow Park Choppington Road Bedlington Northumberland NE22 6LA Lead Inspector Jim Lamb Key Unannounced Inspection 18th May 2009 09:00 DS0000055016.V375349.R01.S.do c Version 5.2 Page 1 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. 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. Meadow Park DS0000055016.V375349.R01.S.doc Version 5.2 Page 2 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 Meadow Park DS0000055016.V375349.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Meadow Park Address Choppington Road Bedlington Northumberland NE22 6LA Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01670 829 800 01670 829 006 meadowpark@barchester.com www.barchester.com Barchester Healthcare Homes Ltd Virginia Lowery Care Home 61 Category(ies) of Dementia - over 65 years of age (32), Old age, registration, with number not falling within any other category (29) of places Meadow Park DS0000055016.V375349.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. One named resident is under 65 years of age. Should this person leave the home the original registration condition will prevail. Date of last inspection Brief Description of the Service: Meadow Park is a purpose build home situated on the edge of Bedlington Town Centre. The home provides single accommodation with en-suite facilities for 61 older people. The accommodation is over two floors with separate units on both floors. The home is built to a good standard and the resident’s benefit from wide corridors, several lounges and a hairdressing facility. There is a large car park at the front of the home and well-tended gardens. A range of shops, community facilities and transportation links are located nearby. Fees for the home range from £444.00 to £560.00. Copies of the service user’s guide and the homes statement of purpose are available within the home. Meadow Park DS0000055016.V375349.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations - but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. The quality rating for this service is 3 stars. This means that the people who use the service experience excellent quality outcomes. How the inspection was carried out. Before the visit we looked at information we have received since the last visit, how the service dealt with any complaints and concerns since the last visit, any changes to how the home is run, the providers view of how well they care for people, and the views of people who use the service and their relatives, staff and other professionals. During the visit we talked with people who use the service, visitors, staff, the manager and relatives, looked at information about the people who use the service and how well their needs are met, looked at other records which must be kept, checked that staff had the knowledge, skills and training to meet the needs of the people they care for, looked around the building/parts of the building to make sure it was clean, safe and comfortable and checked what improvements had been made since the last visit. We told the manager/provider what we found. What the service does well: Meadow Park DS0000055016.V375349.R01.S.doc Version 5.2 Page 6 The home provides a good range of information to people thinking of coming to the home, so they can make an informed decision. The home makes a full assessment of a persons needs before deciding if it can meet all those needs. The home draws up plans to meet the care needs of its service users. Service user’s health care needs are also fully assessed and properly met. The home stores medicines safely, and administers them correctly and safely. Service users say that staff treat them well and treat them with respect. The staff are working hard to provide a stimulating atmosphere in the home, with appropriate social activities for service users. Service users are encouraged to keep in regular contact with family and friends, who say they are always made welcome in the home. One relative said, “The family are very happy with the care they provide here. We visited several other places and without doubt this place was the best and after almost two years we are still very satisfied with the care provided. Another relative said, “My relative is happy here, she struggled at home to remain independent, now with support she has her independence back and she has a new lease of life”. Service users are also encouraged to take as much control over their own lives as they are able, and make their own decisions. Without exception, the service users were very complimentary about the care that they receive, several spoke highly of the staff and all were very happy with the accommodation. Service users were very complimentary about the food, and there is a balanced diet, with service users choice included. Complaints and concerns are taken seriously and are responded to properly. The home is kept clean and hygienic and free from odours. The home has enough staff to meet the needs of service users The staff team had very good knowledge of the service users care needs. The home is very careful as to how it recruits new staff, and runs all the necessary checks on them to protect its service users. Meadow Park DS0000055016.V375349.R01.S.doc Version 5.2 Page 7 The manager is experienced and is providing positive leadership to the home. The home is being run in the best interests of the service users. Service users finances are protected by the homes policies and accounting systems. The health and safety of the service users and of the staff are protected by the homes policies and systems. What has improved since the last inspection? 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. Meadow Park DS0000055016.V375349.R01.S.doc Version 5.2 Page 8 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. Meadow Park DS0000055016.V375349.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection Meadow Park DS0000055016.V375349.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1 2 3 People using the 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 service users are provided with enough information about the service to enable them to make an informed choice about whether this is where they want to live. EVIDENCE: The care records for four service users were looked at. These showed that the manager makes sure that a full assessment of a new service user’s needs is carried out by the persons social worker before they come into the home. The manager also carries out her own assessment, to be doubly sure that the home can meet all of the new persons needs. Meadow Park DS0000055016.V375349.R01.S.doc Version 5.2 Page 11 More detailed assessments are carried out once the new service user has come into the home. These include assessments of risk, of nutritional needs, social needs, moving and handling needs and of behavioural needs. A dependency rating scale is also completed. Skin care assessments are also carried for those at risk of developing pressure sores. As a result of all these levels of assessment, the manager can clearly demonstrate that all the service users are in a home that can give them the care that they need. The homes service user’s guide is available, and information is available in a range of formats... All are provided with a contract explaining the homes terms and conditions, and fees. Meadow Park DS0000055016.V375349.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7 8 9 10 People using the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The care planning system is clear enough to ensure that staff has the information they need to meet the assessed needs of the service users. EVIDENCE: Each service user has his or her assessed needs met by an individual care plan. A basic care plan, based on the initial assessment is drawn up so as to be in place when the person is admitted. This is good practice, as is the fact that the staff then draw up more detailed care plans on the day of admission. There was a good match between identified needs (including risk assessments) and corresponding care plans. Care plans are comprehensive, detailed and holistic, in that they cover social, spiritual and emotional needs, as well as Meadow Park DS0000055016.V375349.R01.S.doc Version 5.2 Page 13 their physical needs. In one example seen, staff had accurately identified that an individuals interests included reading, dancing and cooking, and the care plan included helping the service user to access all three. Each service user has a monthly re-evaluation of the care plans; to make sure they are still up to date and relevant. A thorough assessment of the physical health needs of each person takes place before/on admission, and monthly, thereafter. Care plans cover all assessed needs, including each person’s health care needs. Mental health needs are assessed as part of the overall dependency assessments; more detailed assessments would be carried out by mental health workers, where necessary. All visits from health care professionals are clearly recorded in the care record. There was evidence of the full range of community health professionals, as well as specialist referrals, as needed. Each service user’s weight is recorded monthly, and action taken where there is significant weight loss/gain. Waterlow assessments are completed for those at risk of pressure sores, and special equipment is available to promote skin viability. The home uses the monitored dosage system for its medications. The Medication Administration Records (MAR) was properly completed, with no blank entries. Each resident’s section in the MAR has a photograph of the person, to make sure that the right medicines are being given out. Medicines are properly stored in a locked and secured cabinet. Service users confirmed that they are treated with respect at all times and have their privacy respected by the staff. Staff were seen to treat service users with respect and kindness. Meadow Park DS0000055016.V375349.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12 13 14 15 People using the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service users are offered a good quality lifestyle, which includes varied social contact and activities. EVIDENCE: Each person has an assessment of their social needs that gives details of his/her background, lifestyle, routines and interests. The information is used to implement individual social care plans. Wherever possible staff supports individual needs and requests for one-to-one activities and outings. The home has a well thought out activities programme, and service users are supported and encouraged to participate. The home has an open visiting policy. Visitors are welcomed and can take refreshments and meals. Service users choose whom they wish to see and Meadow Park DS0000055016.V375349.R01.S.doc Version 5.2 Page 15 where to receive visitors. Contact with friends and family is supported through visits, telephone calls and letters/cards. Two visitors said they are always kept up to date with important issues affecting their relative. Some service users continue to manage their financial affairs. Where this is not possible they are assisted by relatives/representatives. The homes management does not take responsibility for finances, other than holding cash for personal spending in the safe. Service user’s nutritional needs are assessed and care planned where necessary, and weights are monitored. Special diets are catered for. These currently include low fat, diabetic and soft diets. Independent eating is encouraged, with use of aids if needed. At mealtimes the catering staff serves the meals, and all other staff eats with the service users, in doing so they are able to provide support and encouragement to service users. Mealtimes are a very sociable and enjoyable occasion. The current menus showed that there is a choice of meals available. All the service users were very complimentary about the meals. The inspector observed lunch. The tables were nicely set with cloths, placemats and full range of condiments. Hot and cold drinks were available. The meal was served at a leisurely pace, and staff were on hand to offer discreet help if needed. Meadow Park DS0000055016.V375349.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 18 People using the 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 complaints management is effective, and this results in the service users being protected from harm and abuse. EVIDENCE: There is a complaints procedure. It contains details of how to contact the CSCI to make a complaint, if complainants are not happy with the homes investigation and response. The procedure is written in a way that ensures service users fully understand its contents. Copies are available in service user’s bedrooms. Three service users said that they had been given copies of the procedure and that staff listened to their concerns and always dealt with them fairly. The home keeps a record of complaints. During the last twelve months there has been four complaints received, all were appropriately investigated and resolved. The home has a Whistle Blowing policy, a copy of the Local Authorities Vulnerable Adults procedures, and a copy of the Department of Healths Meadow Park DS0000055016.V375349.R01.S.doc Version 5.2 Page 17 document, NO SECRETS. Staff are aware of these procedures and have easy access to them. Safeguarding adults training is ongoing for all staff. Service users can deposit cash for safe keeping, and records are kept of accounts. A sample of personal finances records was examined. Currently cash is being held for only one service user. Transactions were appropriately recorded. Meadow Park DS0000055016.V375349.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19 20 21 22 23 24 25 26 People using the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides a very comfortable and safe environment for those living there. EVIDENCE: The home was clean, well decorated and well maintained. The grounds were tidy, safe, attractive and accessible. The home has an appropriate amount of sitting, recreational and dining space. There are enough rooms for a variety of activities to take place. Meadow Park DS0000055016.V375349.R01.S.doc Version 5.2 Page 19 During the last year, there has been some improvements made to the environment, there are new carpets in the corridors, several bedrooms have been refurbished and decorated, and communal areas have been decorated. Service users can see visitors in private in their own rooms. Furnishings and fittings were domestic in design and in good condition. All bedrooms have got en-suite facilities. Lighting was bright and domestic in design. All doors have privacy locks and room sizes exceed the required standards. There is space on either side of beds when necessary, to enable access for carers and specialist equipment. Service users bedrooms have opening windows and restrictors are in place where needed. The rooms were centrally heated and the heating level could be controlled within each bedroom. Radiators and pipes were guarded. There was emergency lighting throughout the home. The kitchen was spotlessly clean and well organised. Water is stored at over 60°C. Valves at water outlets ensure water is provided close to 43°C to prevent scalding. The home was clean and free from offensive odours. The laundry facilities are very well organised. The washing machines have the specified programme to meet disinfection standards. Meadow Park DS0000055016.V375349.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27 28 29 30 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is a good match of well-qualified staff, who are appropriately recruited and supervised. EVIDENCE: The personnel records of three staff were examined. All three had completed application forms, and there was a clear employment ‘audit trail’. All had the required two work references, documentary and photographic evidence of identity, induction and training and development information. Criminal Record Bureau (CRB) checks are always carried out prior to commencing employment. An annual training matrix is drawn up, covering all mandatory training needs, and other core training needs, such as Dementia Awareness and Adult Protection. Individual staff members have his or her individual training needs Meadow Park DS0000055016.V375349.R01.S.doc Version 5.2 Page 21 analysis on their personal file. These have recently been revised to cover developmental as well as mandatory and core training. 70 of staff have achieved NVQ level 2/3. There are appropriate numbers of staff employed to meet the needs of the service users. Meadow Park DS0000055016.V375349.R01.S.doc Version 5.2 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31 33 35 38 People using the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager is supported by the organisation in providing good leadership throughout the home, with staff demonstrating an awareness of their roles and responsibilities. EVIDENCE: The registered manager has the required qualifications and experience to run the home. There is a range of quality systems in the home. Meadow Park DS0000055016.V375349.R01.S.doc Version 5.2 Page 23 There is an annual survey of the views of the residents and their families. The findings are collated and an ‘action plan’ drawn up to address any areas of concern. There are also regular meetings held with both the service user groups and with the staff group. These are minuted in good detail and action points listed. Both individual and central supervision records were studied. These records show an appropriate bi-monthly pattern of supervision, with an annual work performance appraisal. All staff receives annual health and safety training. This is good practice. Checks of the fire log book showed that all the required checks and tests of equipment and systems take place at the proper intervals, as does fire safety training. The home’s accident book is kept up to date and information is fully recorded. Each accident is reviewed after 24 hours to check the outcomes of the accident and any treatment given. There is a monthly audit of accidents, and a detailed audit of all falls. Servicing and maintenance records are comprehensive and well maintained. Meadow Park DS0000055016.V375349.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 4 8 4 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 4 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 4 4 4 4 4 4 4 4 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 X 4 X 3 X X 4 Meadow Park DS0000055016.V375349.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Meadow Park DS0000055016.V375349.R01.S.doc Version 5.2 Page 26 Care Quality Commission North Eastern Region St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB National Enquiry Line: 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. 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