Care Home: Merrimore House

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What the care home does well People have very good care plans which explain how they like to live and be supported.The people living at Merrimore House have lots of things to do during the day.There are lots of things to do in the evenings and at weekends.The people living at Merrimore House have nice holidays.People have their own bedrooms, which they say they like.The food is really nice and people take it turns choosing the menu.Everybody says they know who to talk to if they are not happy.Merrimore House is clean, comfortable and very homely. What has improved since the last inspection? The cellar has been changed into another room for people to use. What the care home could do better: Merrimore House does everything it needs to and there is nothing CQC think it can do better at this time. Key inspection report Care homes for adults (18-65 years) Name: Address: Merrimore House 39 Avenue Road Hunstanton Norfolk PE36 5HW The quality rating for this care home is: three star excellent service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Debby Ames Date: 1 6 0 9 2 0 0 9 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 35 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 © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 35 Information about the care home Name of care home: Address: Merrimore House 39 Avenue Road Hunstanton Norfolk PE36 5HW 01485535299 01485535299 merrimorebband@tiscali.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) : Mrs Elizabeth Turner,Mr John Turner care home 4 Number of places (if applicable): Under 65 Over 65 4 0 learning disability Additional conditions: None Stated Date of last inspection 0 4 1 0 2 0 0 6 Care Homes for Adults (18-65 years) Page 4 of 35 A bit about the care home Merrimore House is a care home for four adults with learning difficulties. It is a large terraced house situated in a small road near to the shops and the sea front in Hunstanton. The owners are Mr and Mrs Turner who live and run the business as a family home. The bedrooms are single occupancy and are located on each floor. There is a lounge on the ground floor, for all to share and meals are eaten around a large farmhouse type table in the kitchen. The weekly fees levels vary Care Homes for Adults (18-65 years) Page 5 of 35 according to individual support needs. Care Homes for Adults (18-65 years) Page 6 of 35 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home 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 7 of 35 How we did our inspection: This is what the inspector did when they were at the care home The visit to Merrimore House lasted about four and a half hours. During the visit, everybody living at Merrimore House was met and spoken with. We looked around the home and saw the bedrooms of the people living there. We also spoke to the two owners/managers. We looked at lots of information, including peoples care and support plans, police checks for staff and other information to do with health and safety. Page 8 of 35 Care Homes for Adults (18-65 years) The Annual Quality Assurance Assessment (AQAA) was returned to the Commission (CQC), as we asked, before we did this inspection. Three surveys were completed and returned to CQC by the people living at Merrimore House. Care Homes for Adults (18-65 years) Page 9 of 35 What the care home does well People have very good care plans which explain how they like to live and be supported. The people living at Merrimore House have lots of things to do during the day. There are lots of things to do in the evenings and at weekends. Care Homes for Adults (18-65 years) Page 10 of 35 The people living at Merrimore House have nice holidays. People have their own bedrooms, which they say they like. The food is really nice and people take it turns choosing the menu. Everybody says they know who to talk to if they are not happy. Care Homes for Adults (18-65 years) Page 11 of 35 Merrimore House is clean, comfortable and very homely. What has got better from the last inspection The cellar has been changed into another room for people to use. Care Homes for Adults (18-65 years) Page 12 of 35 What the care home could do better 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 13 of 35 If you want to speak to the inspector please contact: Debby Ames CQC Eastern Citygate Gallowgate Newcastle upon Tyne NE1 4PA 03000 616161 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 14 of 35 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 15 of 35 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective residents have their needs assessed before moving in to Merrimore House and individual needs and aspirations continue to be assessed on an ongoing basis, which helps ensure the service continues to meet their needs. Evidence: Information provided in the Annual Quality Assurance Assessment (AQAA) confirmed that an up to date assessment and care plan is received from the person making the referral, before anyone moves in and that people thinking about moving to Merrimore House are given a book, with information and pictures, about the home and the area. Following this, people are able to visit, have a meal and stay over-night, by way of a gradual introduction. It was also stated in the AQAA and confirmed in the records looked at during this inspection that the proprietor/manager carries out a full needs assessment, to make sure the service will be suitable, before anyone moves in. Meanwhile, all three people, living at Merrimore House, who returned surveys confirmed Care Homes for Adults (18-65 years) Page 16 of 35 Evidence: that they were asked if they wanted to live there and two responded that they received enough information about the home before they moved in. Care Homes for Adults (18-65 years) Page 17 of 35 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 excellent 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 Merrimore House have their changing needs and personal goals reflected in an individual plan of care, they are able to make decisions about their lives and are supported to take risks as part of an independent lifestyle. Evidence: All three care plans were looked at in detail and time was spent with all three people on return from their daily activities, which helped to confirm that the contents of the plans were accurate. The care plans were seen to be extremely well organised and informative, covering areas such as: * Resident Information - this was seen to include a photograph (plus the date the photograph was taken), name, date of birth, clothing measurements, weight, eyes, hair, complexion, distinguishing marks and oral facts - i.e. dentures etc. * Personal Details - Information regarding the doctor, dentist, psychiatrist and next of Care Homes for Adults (18-65 years) Page 18 of 35 Evidence: kin. * Special Dates - i.e. family birthdays. * Care Plan Reviews - these were seen to be detailed and personal and carried out on a regular basis. * Cognition - good explanations were seen here - i.e. can take things very literally. * Violence - appropriate information was seen to be recorded in respect of individuals behaviour, trends and patterns. * Interests and needs - such as computers and enjoys going out etc. * Culture and Religion * Independence - covering areas such as going out, washing, managing own money, catching the bus and making snacks. * Risk Assessments - these were detailed and informative, plus written in an enabling manner, which confirmed people are supported in, and not stopped from, taking risks. * Wishes Upon Death * Finances * Other People Involved in compiling the Care Plan - this confirmed the inclusion of the individual concerned plus parents, social worker and behavioural nurse, where relevant. Meanwhile, all three surveys contained responses of always to confirm that people make decisions about what they do each day. The risk assessments included areas such as being in the sun without protection or drinks, personal hygiene/care, being unwell, sexual activity, fire risks, crossing the road, going out alone, using public transport, cooking or making snacks alone etc. It was noted that any limitations or potential deprivation of liberty were recorded appropriately, with full reasons, explanations and protocols in place. Very good Quality Assessments were also seen for each person, which were easy to follow, to ensure people could be supported in a positive and enabling fashion. For example, the questions were such as: Can you use the following: Kettle/Microwave etc. or Do you Like: pets, children, going on holiday etc. The answers were logged under headings of 1. No 2. With Help 3. Yes. Assistive and supporting comments were also seen Care Homes for Adults (18-65 years) Page 19 of 35 Evidence: such as can rush or does need guidance. Care Homes for Adults (18-65 years) Page 20 of 35 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 excellent 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 Merrimore House are able to take part in activities that suit them, be part of the local community, enjoy leisure activities as they wish and have good relationships with their family and friends. The people living at Merrimore House are offered a healthy diet and enjoy their food. Evidence: Through the information seen in the care plans and discussions with the people living at Merrimore House, it was confirmed that people have opportunities for personal development and attend day services or work placements during the week. It was also noted that all three people have access to and undertake a variety of hobbies and activities during the evenings and weekends such as: pub visits, going to dances, playing snooker, bike rides, X-Box computer games, watching films, watching football, roller-blading and listening to music. It was particularly noted in the care plans, areas where people have expressed a personal Care Homes for Adults (18-65 years) Page 21 of 35 Evidence: wish for support in particular areas such as learning to cook, budgeting and looking after own finances, giving up smoking and self medicating. In all three care plans, individual Choice assessments were also seen. These assessments describe to what degree each person is able to understand and make their own choices in areas such as: What to wear, what to eat, what to spend money on, whether to have an advocate, what to do during the day/evening, how to make a complaint and where to live. The responses were headed as: Never, sometimes and always and, where necessary, supporting explanations were also recorded. However, most responses were seen to be mostly always or sometimes. The menus were seen to be very nicely presented, the meals sounded very appetising and had a restaurant quality to the descriptions. It was noted that each person has a chosen menu for each week and it was also confirmed that the newest person living at Merrimore House has kept a previous persons choice, as they liked the food on the list and couldnt decide on anything else. Some of the additional comments, written by the residents in the surveys included: ...I really like the food, it is very nice... ...we have a lot of fun... ...I had a lovely holiday... ...the best home I have been in my whole life... ...good food... ...variety of activities and holidays... ...helped me to change day services when I wanted because I wasnt happy there... ...the carers understand me and allow me to go out when I want to... ...I like going on holidays, days out and walking... ...I like the meals, theyre really nice... ...I look after my own money and the staff help me manage my money... ...I like living here better than other places Ive been... Care Homes for Adults (18-65 years) Page 22 of 35 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 excellent 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 Merrimore House receive personal support in the way they prefer, their physical and emotional health needs are met and they are protected by the homes medication policies and procedures. Evidence: All the information seen in the care plans, together with discussions with all three people living at Merrimore House, confirmed that they are able to genuinely make choices in all areas of their lives, including what level of personal and healthcare support they receive. As mentioned in the previous section (Lifestyle), individual Choice assessments were also seen. These assessments describe to what degree each person is able to understand and make their own choices in areas such as: What to wear, what to eat, what to spend money on, whether to have an advocate, what to do during the day/evening, how to make a complaint and where to live. The responses were headed as: Never, sometimes and always and, where necessary, supporting explanations were also recorded. However, most responses were seen to be mostly always or sometimes. Additionally, in a previous section (Individual Needs and Choices), Very good Quality Assessments were seen, which were easy to follow, to ensure people could be supported in a positive and enabling fashion. The answers are logged under headings of 1. No 2. Care Homes for Adults (18-65 years) Page 23 of 35 Evidence: With Help 3. Yes. Assistive and supporting comments were also seen such as can rush or does need guidance. Each person also has an individual My Health book, in which all health issues are recorded, including health problems, appointments and vaccinations. It was confirmed in the AQAA that residents are encouraged and supported to selfmedicate, where possible, and full risk assessments are carried out in this respect. There is a lockable cabinet for the storage of medication and Merrimore House has very clear policies, procedures and protocols in place to ensure staff and residents are protected. Evidence was seen of individuals having access to healthcare professionals such as doctor, dentist, optician, psychiatrist and behavioural nurse. The care plans also contained details of peoples wishes upon their death. In certain cases, these were seen to be very specific in respect of organ donation, burial or cremation, location of ashes to be scattered and where belongings should go. Care Homes for Adults (18-65 years) Page 24 of 35 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 excellent 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 Merrimore House feel safe, know who to talk to if they have any problems or concerns and they are protected from abuse, neglect and self-harm, as much as is possible. Evidence: No formal complaints have been received since the last inspection, although the residents are encouraged to raise any concerns or issues on a regular and informal basis. The complaints procedure was seen to be available, in clear and easy to understand formats and all three people responded yes, in the surveys, that they know how to make a complaint and who to speak to if they are not happy. Information in the AQAA and a discussion with the proprietors confirmed that all staff have received training on Adult Abuse, the Mental Capacity Act, Safeguarding Vulnerable Adults, Deprivation of Liberty and Challenging Behaviour. It was also stated that people are able to talk regularly on a one-to-one basis with the proprietors and are also encouraged to talk to day service staff, if they feel they cant approach the staff or management at Merrimore house. Although the people living at Merrimore House are encouraged to manage their own finances, any money that doe need to be managed by the Home is recorded appropriately. Care Homes for Adults (18-65 years) Page 25 of 35 Evidence: One person was noted to have been supported to keep a log of all their spending on their computer, which has helped to increase their independence in managing their own money. One of the surveys stated: ...I manage my own money... Care Homes for Adults (18-65 years) Page 26 of 35 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. Merrimore House is a very homely, comfortable and safe environment, which is clean and hygienic and peoples bedrooms suit their needs and lifestyles and promote their independence. Evidence: A tour of the premises was carried out and all areas of the home were found to be clean and hygienic. Decor and furnishings were of a very high standard and the whole atmosphere was very comfortable and homely. Each person has their own bedroom, which has been personalised and each room was seen very much to reflect peoples individual preferences, hobbies and characters. All three surveys had responses of Yes that the home is fresh and clean. Additional comments included: ...I really like my bedroom... ...I like my room (new carpet and the sea views)... The communal areas comprise of a lounge, kitchen/dining area and the cellar has recently been refurbished to a very high standard and creates a further area for office work and/or relaxation. Care Homes for Adults (18-65 years) Page 27 of 35 Evidence: Overall, Merrimore House was found to be safe and free from hazards. Care Homes for Adults (18-65 years) Page 28 of 35 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. Everybody living at Merrimore House is competently supported by the proprietors and the occasional member of staff, who have all undergone full recruitment checks, which ensures the residents are protected. Evidence: Generally the home is run by the proprietors, Mr and Mrs Turner although one member of staff has been recruited on a casual basis. Good pre-recruitment records were seen for this staff member, which included Enhanced Disclosure from the Criminal Records Bureau (CRB), two professional references plus one character reference. and appropriate identification. It was also noted that the staff member has NVQ2 in Care. A staff file is also in place, which was seen to contain information such as copy of application form, terms and conditions, wages, job description, regular one-to-one support and supervision sessions and an Induction/Training record. Additional comments received in the surveys include: ...the staff are very nice and I can talk to them... ...the carers understand me... Care Homes for Adults (18-65 years) Page 29 of 35 Evidence: ...the staff help me to manage my money... Care Homes for Adults (18-65 years) Page 30 of 35 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. All the people living at Merrimore continue to benefit from a home, which is well run by very competent proprietors. Policies, procedures and record keeping continue to safeguard each persons rights and best interests and their health and safety is promoted and protected. Evidence: The proprietors have run Merrimore House for a number of years and Mrs Turner has achieved the Registered Managers Award and NVQ4 in Health and Social Care. It was also noted that Mrs Turner has recently acquired a Health and Safety award, which will help to improve the safety standards even further for everybody living at Merrimore House. A very good Annual Quality Assurance process is in place at Merrimore House and input and feedback is positively encouraged from residents, relatives, advocates and relevant healthcare professionals. A good quality Summary of Feedback was seen to be compiled and action plans drawn up. Care Homes for Adults (18-65 years) Page 31 of 35 Evidence: Records were looked at in respect of health and safety, such as: Infection control, accidents and incidents, fire, gas, portable appliance tests and the boiler. All of these were seen to be up to date and reviewed regularly. A Fire Risk Assessment was also seen and records confirmed that tests are carried out regularly on the fire alarms and emergency lighting. Fire drills were noted to be carried out on a regular basis and included details of the times - i.e. morning/afternoon/evening/night and response times - i.e. good or slow. Care Homes for Adults (18-65 years) Page 32 of 35 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 33 of 35 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 Care Homes for Adults (18-65 years) Page 34 of 35 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 © (2009) Care Quality Commission (CQC). 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