Care Home: Moorgate Residential Home

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What the care home does well The providers are committed to improvements, updating and upgrading the home to a high standard. The bedroom extensions and en-suite facilities are completed to a high standard. The home has produced a format to address the assessment of people under the Mental Capacity Act and the Deprivation of Liberty Act. The home provides a wide range of social activities to entertain people. The new decking area to the front of the premises and sensory garden in the rear of the property will benefit everyone who lives in the home. The cooks employed in the home provides a excellent standard and variety of food with choice and fresh produces provided. Positive comments were recorded from visitors on the homes quality assurance surveys and included, "The continued improvement of the home is amazing" and goes onto say "Attention to detail is wonderful and makes the home a safer place for residents, more comfortable and very pleasant environment for all". What has improved since the last inspection? The home has continued to update and upgrade the environment since the last inspection. Recent upgrades have included adding en-suites to five of the bedrooms with plans to add more to other bedrooms. Everybody living at the home has benefited from a new large decking and seating areas built at the front of the house with views overlooking the surrounding countryside. A sensory garden is near completion in the rear of the property. This will have a water feature, seating area with plants and flowers and has a retractable awning in place covering the patio area. What the care home could do better: Staffing levels in the afternoon should continue to be monitored and assessed and the night staff are to be made aware that only people wishing and requesting to get up early in the morning do so. Key inspection report Care homes for older people Name: Address: Moorgate Residential Home Bedford Bridge Horrabridge Yelverton Devon PL20 7RZ     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: Kim Fowler     Date: 2 0 0 8 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 27 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 27 Information about the care home Name of care home: Address: Moorgate Residential Home Bedford Bridge Horrabridge Yelverton Devon PL20 7RZ 01822852313 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: shadrickcarehomes@hotmail.co.uk Shadrick Care Homes Limited care home 20 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is 20. The registered person may provide the following category of service only : Care home providing personal care only- Code PC to service users of either gender whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category- Code OP Dementia, aged 65 years and over on admission- Code DE(E) Date of last inspection Brief description of the care home Moorgate Care Home is a large detached property that is set in its own grounds in a rural location near the village of Horrabridge and the town of Tavistock. The property was originally built in the 1920s and was previously used as a hotel. Moorgate Residential Home accommodates 20 older people who may have dementia. Bedrooms are on the ground and first floor. The home has a passenger lift and is fitted with ramps and handrails. One bedroom is a shared room and the remainder are single Care Homes for Older People Page 4 of 27 Over 65 20 20 0 0 Brief description of the care home rooms many with en-suite facilities. The Registered Providers are Mr and Mrs Shadrick, took over the home in 2004. At the time of writing fees range from 330 pounds to 500 pounds per week but this may vary depended on individual needs. Additional charges made are for chiropody, hairdressing or papers. Care Homes for Older People Page 5 of 27 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 Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This unannounced inspection took place from 9:20am until 14:50pm on the 20th August 2009. The Registered Manager was unavailable and the homes Deputy Manager assisted throughout the inspection. The inspector made a tour of the building and spoke to many of the people living at the home and two visitors visiting at the time of the inspection as well as a District Nurse. Documentation relating to the care planning process and the management of the home were examined. Any comments are in the relevant section of the report. Care Homes for Older People Page 6 of 27 What the care home does well: 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. The report of this inspection is available from our website www.cqc.org.uk. Care Homes for Older People Page 7 of 27 You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 8 of 27 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The completion of pre-admission assessments ensures that any prospective new admissions needs are known and can ensure that the home can meet their individual needs. Evidence: The files examined for people living at the home show that the last two new admissions, and other files, had a completed pre-admission assessment carried out and that people admitted to the home have been assessed. Information recorded in the new pre-admission assessment was comprehensive in detail. This ensured that the care staff were aware of peoples needs. Several staff were spoken with during the inspection and were fully aware of the needs of each persons currently living at the home. Care Homes for Older People Page 10 of 27 Evidence: A Requirement made in the last inspection was that all files must hold a pre-admission questionnaire. Evidence showed that this Requirement has now been met and discussion with the deputy manager confirmed the new process in place on the homes admission procedure included a visit to the person interested in moving in, if possible, and the completion of the pre-admission questionnaire. Two visitors were spoken with and both were able to confirm that they had visited the home before their relative had been admitted and one was able to confirm that they thought they had assisted in the completion off a pre-admission assessment. One person living at the home, when asked, stated that they thought a relative had been to the home with them before being admitted. The Deputy Manager believed that the second Requirement, which the Statement of Purpose and Service Users Guide were to be sent to the Commission, had been carried out by the provider. The homes AQAA returned to the Commission stated, We actively promote independent living and ensure that any assistance required is delivered in a caring and dignified approach by our dedicated staff. Moorgate Residential Home does not provide Intermediate care. Care Homes for Older People Page 11 of 27 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The staff and manager provide good personal support to people who live at the home. Ensuring the promotion of privacy and dignity at all times. Evidence: Four files for people living in the home were examined and each was found to hold a updated care plan. The care plans completed with the involvement of the health care professional were comprehensive in the detail held. These care plans were based on individual needs of people living in the home and some were supported by other assessments from professionals involved in the individuals care. One care plan showed a recent update due to the changing needs of one person living in the home. The daily care plans are easy assessable for staff on duty and risk assessments are held on individual files for the protection of all people living at the home. These care plans give detailed instructions to all staff as well as information to new staff to ensure intimate personal care is being provided in a manner that meets with the approval of people receiving the care. This is particularly important where people Care Homes for Older People Page 12 of 27 Evidence: are unable to express themselves verbally. Each file also hold information on a persons Life History to enable staff to have a understanding of a person previous life and is important if people now have dementia. The deputy manager stated that the risk assessments are reviewed regularly and updated as and when needed. Information on several files showed that a risk assessment had been completed for people who may be at risk of falls and these were updated and reviewed regularly. The home has produced a format to look at and assess people under the Mental Capacity Act and the Deprivation of Liberty Act and each person has an individual assessment completed by the deputy manager on peoples ability. All people living at the home have access to all health care services and information was recorded onto care plans in each persons file that there was input from other professionals including GPs, chiropodist and consultants based at the local hospital. All care plans give full details and instructions to staff on what health care needs are to be carried out and by whom. The home holds a Hospital Admission form that is completed with up to date information should an emergency happen and can accompany the person to hospital. Some people living in the home were spoken with and some were able to confirm that their health care needs were met and a relative stated that their relative had, Received excellent support when they had been unwell recently and one person living in the home said I see the District Nurse. The District Nurse was spoken with during this inspection and confirmed that they visit the home regularly and all treatments are carried out in private and the home continue with any treatments the District Nurse team request of them. The medication system was examined and showed that the home uses the blister pack system to dispense medication and staff were observed administering medication. The medication system was checked and found to be well recorded and documented. The home does not currently hold any controlled medication. The deputy manager confirmed that only staff trained, via the local pharmacist, administer medication and one staff member spoken with confirmed that had received medication training. One person at times receives their medication covertly, this has been agreed with the Care Homes for Older People Page 13 of 27 Evidence: person concerned, the family member and GP with a document signed by all parties agreeing this procedure. Some of the people living at the home were spoken with during this inspection and some were able to confirm that the staff respects their privacy and dignity at all times. Observed during the inspection were staff knocking on peoples doors to promote privacy and shutting the bedroom door when attending to a person personal care needs. One person living in the home said, my door is shut and a relative stated that when they are visiting their relatives personal care is always carried out in private. The homes AQAA returned under what we have improved over the last 12 months states, Our documentation has greatly improved. Care Homes for Older People Page 14 of 27 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Meals and mealtimes are not rushed making them an enjoyable, social occasion for people. The home welcomes and encourages families and friends to visit. Evidence: People were observed moving freely around the home. Some people remained in their individual bedrooms and a relative stated that their relative sometimes likes to stay in their own room. The staff were seen interacting with people and discussing everyday topics and included assisting individuals when needed showing staff were aware of the needs of people living in the home. The main entrance hall has a notice showing this month activities and visiting entertainment professionals. This included a Singing Sweetheart production due and other activities included a film show, tea dances and exercise sessions. The deputy manager stated that staff member also arrange in house sessions and some people spoken with were able to confirm that activities are available and offered. Care Homes for Older People Page 15 of 27 Evidence: Visitors are welcome at any reasonable time and can visit their friend/family in the privacy of their own room. Two visiting relatives were spoken with during this inspection and both were able to confirm they were able to visit at any reasonable time. Also one visitor confirmed that they were able to see their visitor in private if they wished. The homes AQAA records how they have improved in the last 12 months states, Researched into how to give the best dementia care and put this into daily activities. All bedrooms visited contained personal possessions and items and one person living at the home said that the home encouraged them to bring in items from home. All people who were able to made positive comments about the food provided. The home employs two cooks and one was spoken with and confirmed that the home has all the required fresh ingredients needed and has a 4 weekly menus available and displayed for all to see and this showed a varied and nutritional diet. It was evident from the food seen served at lunch time, Pasty pie, mash potatoes and fresh vegetable and a choice dessert of rice pudding and fresh fruit salad that the food was home cooked using fresh products. The meal was well presented and freshly prepared. Staff were observed serving meals individually and asking each person in turn what they would like. Homemade soup and fresh cakes are available each day. During discussion with people about food they said it was very good and another said, I like it. Care Homes for Older People Page 16 of 27 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the home can be confident that any complaints or concerns raised will be listened to, acted upon and managed by the home, which protects the welfare of all. Evidence: The home has a complaints procedure displayed on the homes notice board and those people who were able to stated that they would approach the manager or owner if they had any concerns or complaints. The home has not received any complaints and neither has the Commission. A few of the people living at the home were able to confirm that they were aware the home had a complaints procedure but have never needed it. One person said they would talk to their family if they had any concerns. One relative also confirmed they were aware the home had a complaints procedure but had not needed to use it and also said the owners were available most day to discuss any concerns. The deputy manager confirmed that some staff have received safeguarding training and other still need to do so. One staff confirmed they had not received Safeguarding training but would raise any concerns with the providers or deputy manager. Care Homes for Older People Page 17 of 27 Evidence: The deputy manager confirmed that the providers are in the home most days and would deal with any issue raised straight away. The homes AQAA records that, Our management team have had training in MCA (Mental Capacity Act) and DOLS (Deprivation of Liberty Act) and we continue to keep ourselves updated with these changes as they happen. Care Homes for Older People Page 18 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Moorgate continues to maintain a clean and suitable environment for its stated purpose and the people who live at the home can be assured that they will live in comfortable home that is regularly maintained. Evidence: The home is safe and well maintained and suitable for its stated purpose. All areas of the home were found to be comfortable, warm and light. The home was very clean, hygienic and free from offensive odours and the process for the removal of clinical waste was discussed and was satisfactory dealt with. The manager and several staff members confirmed they had completed infection control training and the home also provides gloves, aprons and hand gel to protect people from infection. Since the last inspection several areas of the home have been upgraded and included a large patio/decking area to the front of the home with seating and excellent views over the country side. The rear of the garden had a sensory garden near completion that included seating areas, sun shade, a water feature and plants and flowers. Care Homes for Older People Page 19 of 27 Evidence: The deputy manager confirmed that some bedrooms have now been fitted with ensuite facilities with plans to fit other rooms with en-suites. All other areas that required attention have been updated where needed. And the home employs a maintenance person to assist with day to day issues. The homes AQAA records under, how we have improved in the last 12 months, Improvements with addition of new en-suites is well underway now, our aim is to complete this stage within the next 12 months. Care Homes for Older People Page 20 of 27 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The homes recruitment procedures protect people living at the home from being placed at risk of harm or abuse. Regular staff training ensures that only suitable qualified, competent and experienced staff are working in the home. Evidence: The homes rotas, deputy and most staff on duty confirmed that there is sufficient staff employed to care for the number of people currently living at the home. On the day of the inspection on duty were the deputy manager, 3 care assistants, one cook, one cleaner and a laundry assistant due in the afternoon. However a staff member interviewed felt that the night staff start to get people out of bed very early as often 10 or more people are up when day staff come on duty at 7.30am. The staff handover book examined confirmed that the night staff had recorded that most days 10 or more people were up and dressed before they went off duty. This was discussed with the deputy manager and the deputy felt that many people chose to get up early. Another staff member felt that in the evening there were only 2 staff on duty to assist people living in the home and this could be difficult at times if one person required additional support. Care Homes for Older People Page 21 of 27 Evidence: The Registered Manager Mrs Shadrick, in response to the draft report, stated that the night staff only help residents to wash and dress if they are already up and about as they are often wandering around and require attention. Mrs Shadrick also stated that the evening staffing levels are constantly reviewed and increased when needed. The inspector would recommend that the evening staffing levels require re- assessing to ensure sufficient staff on duty to care for people with dementia and the night staff to ensure only people who wish to rise early do so. Some of the staff on duty during the inspection were spoken with and some confirmed that they hold a NVQ qualification. The manager confirmed 5 of the eleven staff employed at the home hold an NVQ qualification and one staff member is doing the NVQ Assessors training. Examination of staff files showed that all staff had the required pre-employment checks, including CRB (Criminal Record Bureau Disclosure) in place ensuring as far as possible unsuitable staff are not employed. The homes AQAA states, Staffing levels are reviewed on a regular basis to ensure that all care needs are being met enabling us to have a high level of trained staff on duty at all times. The staff-training files provided evidence that some training was routinely carried out. Most staff has completed updates in Manual Handling training. Fire Safety training and Dementia training. Other training completed included Dementia Care and Insulin training provided by the District nurse team. One staff said they had been encouraged to complete their NVQ training and other training was offered. One staff member said I am happy working here. And one person living in the home said of the staff team, they are nice with two relatives speaking very highly of the staff team. And one said, Staff lovely and very welcoming. Care Homes for Older People Page 22 of 27 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The owners and their staff team strive to provide a homely, stimulating environment that respects people who live at the home. Evidence: The Registered Manager was not available during this inspection and the deputy manager assisted throughout the inspection. Previous inspection reports showed that the Registered Manager, Mrs.Shadrick, has qualifications in care, and is experienced at running a care home. Information received from the people living in the home, staff members and visitors confirmed that the owners are approachable with Mrs. Shadrick available most days. The home continues to have a worksheet highlighting each staff members duties and each person assigned individual people to work with each day. The deputy manager Care Homes for Older People Page 23 of 27 Evidence: felt that this task provided information for all the staff on each days duties requiring completion and included any appointments that day. The deputy manager confirmed that they had send out Quality Assurance surveys and information recorded onto these showed positive comments. This included one person saying, The staff are very helpful and very kind and a relative recording, We call at all times of the day and always find the home the same, very happy. The money of two people living in the home was checked and one was a small amount short and the other a small amount over. The records held showed a audit trail of income, expenditure with receipts kept. The deputy manager stated that they would recheck the records for the money held. Sampling of records indicated equipment is serviced regularly and maintained in good order. Health and Safety is a priority in the home and records examined showed fire safety training and fire protection is in place and up to date. The accident records were accurate and files examined showed that information is recorded onto accident forms and also written into peoples daily records with appropriate action taken when needed. Good health and safety practices reduce any unreasonable risk, affecting people living at the home, to an acceptable level. The AQAA returned to the Commission states, Ensuring that the DOLS (Deprivation of Liberty) system is introduced. Care Homes for Older People Page 24 of 27 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 25 of 27 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 27 The home should review the staffing numbers of 2 staff members on duty for the afternoon shift for the currently number of people living in the home. Care Homes for Older People Page 26 of 27 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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