Care Home: Oak Lodge

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What the care home does well People who use the service praise the treatment programme, saying that they feel safe and get good support from knowledgeable staff. This demonstrates that the people are well supported and their needs are well met by the home. What has improved since the last inspection? At the previous inspection there had been two recommendations for the service to improve. The home has taken action on these areas, demonstrating positive developments to the service. In particular, the service has installed an appropriate cabinet for the storage of medication at the home. What the care home could do better: Areas where the home could be doing better are highlighted in the report and were discussed with the manager during the inspection. These include ensuring that appropriate recording is carried out on medication received into the home and records maintained of electrical checks carried out. The service must also ensure that a record of the recruitment and training of staff is held at the service at all times. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Oak Lodge 136 West Hill Putney London SW15 2UF     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Louise Phillips     Date: 2 9 0 4 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. 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. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 27 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 27 Information about the care home Name of care home: Address: Oak Lodge 136 West Hill Putney London SW15 2UF 02087881648 02087800286 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) : Cranstoun Drug Services care home 14 Number of places (if applicable): Under 65 Over 65 0 0 past or present alcohol dependence past or present drug dependence Additional conditions: 14 14 The maximum number of service users who can be accommodated is: 14 The registered person may provide the following category of service only: Care Home Only (CRH - PC) to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Past or present drug dependence - Code D Past or present alcohol dependence - Code A Date of last inspection Brief description of the care home Oak Lodge provides care for up to 14 clients on a short-term programme for the treatment and rehabilitation of drug and alcohol problems. The home is a large detached house on a main road in the West Hill area of Wandsworth. It is located near local shops, transport and community facilities. Information about the home is provided in a written guide. The current fee is £620 per week. Care Homes for Adults (18-65 years) Page 4 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: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This inspection took place over one day by a Regulation Inspector. A tour of the premises was carried out and care records were inspected along with other relevant paperwork. Time was spent talking to the manager, two staff and two people who use the service. Care Homes for Adults (18-65 years) Page 5 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 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 6 of 27 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 7 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, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are appropriately assessed to ensure the service is the right place for them. Evidence: The manager described that the service takes referrals from care managers, and these could be for people who are currently in detox or maybe in prison. Referrals for people not yet in detox are added to a waiting list and the care manager is expected to initiate contact with the service once the person commences their detox. In cases where people wanting to use the service contact the home directly, they are asked to contact Wandsworth drugs team, to access the service via the care management process. The manager described that the process of people moving to the service is initiated by a care manager making a referral to Cranstoun referral and assessment team. The person is then invited to Oak Lodge for the assessment to take place and to enable them to have a look around and meet people who currently use the service. If the Care Homes for Adults (18-65 years) Page 8 of 27 Evidence: person is in prison then the team would carry out the assessment at the prison. We saw the assessments that had been carried out on two people who use the service. These are very detailed and record relevant information such as previous treatment they have received, history of the person, any safety needs, leisure interests and information about significant others. People in detox who are accepted move straight from their detox placement to Oak Lodge. People who use the service must be drug free when they arrive. The service takes people with drug or alcohol rehabilitation needs, and of any gender, though no couples. When people arrive to start their rehabilitation a small search of their belongings is carried out, so that any items such as knives, syringes or any drug paraphernalia can be removed. They sign a consent form to say that they agree to this search taking place. The first key-work session takes place as soon as possible so that the person can receive an induction to the service, where they are told about the programme, how to make a complaint, confidentiality issues, etc. They are also given a Welcome Pack that describes these policies. Care Homes for Adults (18-65 years) Page 9 of 27 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are involving in identifying what they want from the service and personal development needs. Any areas of risk are managed through appropriate risk assessment and risk management planning. Evidence: The aims of Oak lodge is to encourage people who use the service to look at their self, their behaviours and reasons for their substance misuse. They are encouraged to do this through the therapeutic community, group work and individual sessions with their key-worker. People who use the service praise the programme at the home, with one saying that ..its just what I need to help me move on.., whilst another said ..the staff are great, they really help you look at yourself and help you develop ways of coping other than what Im used to... People said that they find the process of rehabilitation hard, Care Homes for Adults (18-65 years) Page 10 of 27 Evidence: but understand it is necessary to help them live their life. Each person has a key-worker who they meet with once a week for a formal one-toone support session, and to discuss their care plan. They are also able to approach other staff if they need to have a chat at any time. There are care plans for each person based around their substance misuse, health, legal issues, relationships, personal development, cultural needs and plans for moveon. The care plans are detailed, giving a background to the issue, eg drug use, current issues and goals to achieve at different stages throughout their stay at the service, eg getting help in dealing with different feelings. The format of the care plan also allows for a review at different stages of their being at the service, whether this be during their settling-in period, midway through their treatment or prior to their moving on. People who use the service are involved in developing and reviewing the care plans, and this is evidenced in the care plan agreement sheet, that is signed at different stages by them and their key-worker. There are detailed risk assessments that identify any particular safety needs around areas such as self harming, exploitation, risks to others and relapse. Any areas identified are developed into a comprehensive risk management plan. Care Homes for Adults (18-65 years) Page 11 of 27 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. People who use the service are supported with personal development to enable them to lead a more fulfilling life. They are fully involved in all aspects of their lifestyle choices and in planning meals, purchasing and cooking the food provided by the service. People who use the service are also involved in co-ordinating the running of the house and taking on areas of responsibility within this. Evidence: The service provided by Oak Lodge is specifically designed to support people to develop, take on personal responsibility and lead a drug/alcohol free life. Support for this is provided through group sessions and one-to-one key-working. The programme is structured from Monday through to Friday. Care Homes for Adults (18-65 years) Page 12 of 27 Evidence: The programme is currently based on a 6 month programme, though the manager said that this is currently under review, where they are looking at changing this to a 3 monthly programme, due to issues in funding. For the first five days people are not able to leave the service, and after this time only if they are escorted by a senior person who has been using the service for longer or with staff, and then only to the local area. If any person breaks the rules of the programme they undergo a 21 day (though under review at time of inspection) assessment where they receive more intensive support and work on looking at the reasons why they breached the rules, and at the end of the period present their work to the community. One of these was seen in the care file for a person who uses the service, this demonstrated the work they do in looking at their thoughts and feelings around the incident, experiences in the past and identifying different coping strategies. The work of the service is based on a therapeutic community approach to coping, where people who use the service live as a community, develop a working relationship with staff and work their personal development and increasing their self esteem. The aim is to create a safe environment where people are able to open up about themselves, look at the triggers for their using drugs/ alcohol, and learn life-skills to cope with this and help them develop personally. The service also offers an aftercare group once a week for people who have completed their rehabilitation programme and have moved on. Each day there is a community meeting where the staff meet with people who use the service and plan the day around the groups, and any key-work sessions or appointments that people may have. People who use the service also have their own business meeting where they decide who is responsible for different jobs around the house, such as cooking, cleaning or shopping. One person is also allocated to ensure everyone is woken up by 7am so that they can be ready to join everyone for a community breakfast. The group sessions that take place at the service include those around relapse prevention, gender and house maintenance. At the weekends there is minimal structure to the programme, and people are able to have visitors or spend time with family or friends. This has to be planned in advance and people who use the service have to complete a visit request, which informs a risk assessment. This is is discussed within the community as to whether it is safe for Care Homes for Adults (18-65 years) Page 13 of 27 Evidence: them to spend time with certain people, as it could trigger a relapse. The manager said that where people have children, they work with childrens services to facilitate parents seeing their children during the week. The manager described that there is a no sex rule at the service, and intimate relationships between people who use the service is discouraged, as this can have a negative effect their treatment. In the evenings and at weekends people are able to relax in the lounge which has a large television, DVDs and books for use. There is also computer which has internet access, and with a block on this to prevent any inappropriate use. A pay-phone is also available. Breakfast, lunch and dinner is very much a community activity, with people who use the service involved in choosing, purchasing and preparing the food as part of their life-skills development. A lot of fresh fruit and vegetables were seen in the kitchen areas, as well as fresh bread, meats and a variety of foods lots of fresh fruit and veg in kitchen, fresh bread. People who use the service spoke highly about the programme, the work that is involved and the skills they feel they are developing. They said that they feel well supported in their rehabilitation, yet also feel they are gaining a greater awareness of their self, their strengths and coping for when they move on from the home. Care Homes for Adults (18-65 years) Page 14 of 27 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are encouraged to attend to their own health and social care needs, and relevant support is provided by the service for this. Some improvements need to be made to the management of medication to ensure this is recorded appropriately. Evidence: People who use the service at Oak Lodge attend to their own personal care needs. Each morning the staff and people who use the service have a Community Meeting to remind people of relevant appointments and key-work sessions that they have, to ensure that people are getting the right support to meet their health needs The service benefits from the professional knowledge of a staff team, most of whom have worked at the home for a number of years. The team consists of a qualified psychotherapist, trained counsellors and a psychologist. Care Homes for Adults (18-65 years) Page 15 of 27 Evidence: The home does not usually accommodate people who also have an existing mental health problem, and the manager said that if a referral was made for a person with dual diagnosis needs of a mental health issues and drug/ alcohol use problems, they would liaise with the local community mental health team to carry out a psychiatric assessment, to ensure that they service is able to offer the person the right support. Since the last inspection the service has obtained an appropriate medication cabinet. At the time of inspection only one person who uses the service was being administered medication by staff. The manager said that some people administer their own medication, and this is based upon a risk assessment around the medication that they are taking. We looked at the records for the medication held. This had not been recorded as being received at the service. It had been recorded on the Medication Administration Record (MAR) chart, yet the staff member who completed this chart had not signed to say they had done this. They had also not entered on the chart whether the person who uses the service has any allergies. Requirements have been made for the service to address this. Care Homes for Adults (18-65 years) Page 16 of 27 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are confident to raise issues of concern with relevant people. Evidence: Oak Lodge has a clear complaints procedure that details how to make a complaint and how this will be managed. The admission procedure for new people includes a verbal explanation of the process for investigating any complaints, and this is also provided in their welcome pack. People who use the service spoke about the Community Meeting as a safe environment for them to challenge other people and raise issues with staff about anything they are unhappy with. They also said that they would raise any concerns with their key-worker, manager or care manager if they were unhappy. The manager explained that training for staff in safeguarding adults is carried out through the organisation. He also confirmed that all staff have been booked to attend this training through the local authority within the next month. Care Homes for Adults (18-65 years) Page 17 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, 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The environment is modern, homely, clean and well maintained throughout. People who use the service are able to live in an attractive and relaxing environment that they feel is safe. Evidence: People who use the service told us that the environment is calm, relaxing and a safe place for them. Throughout the inspection a friendly, respectful rapport was observed between staff and people who use the service. The people who use the service are responsible for maintaining the cleanliness of the environment, and this is carried out on a rota basis, with each taking in turns to clean different area of the home, empty bins, etc. All the bedrooms are double with single beds, accommodating same gender people in each. The layout of the home also allows for one floor to accommodate males only, and the other floor for females only. However, at the time of inspection one male was living on the female floor, though in a separate area. Care Homes for Adults (18-65 years) Page 18 of 27 Evidence: Due to the therapeutic nature of the home the bedrooms are not lockable, and people do not have a key to the front door, instead they have the keypad code that they can use to enter the home. The furnishings of the home are of a good standard throughout, with an attractive modernly furnished lounge, large garden, homely kitchen and individually decorated bedrooms that people can personalise with their own belongings. The bathroom areas are also of a high standard. The only areas that were seen to need attention were cleaning of the stained carpets in the office area and on the stairs, and the marks on the walls in the dining room. The manager said that he is in the process of addressing these areas. Care Homes for Adults (18-65 years) Page 19 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, 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. The staff are supported in their work at the home and people who use the service are confident of their abilities. The recruitment practices and training could not be appropriately assessed at this time due to lack of information held at the service. Evidence: We spoke to two staff during the inspection. Both commented positively about the work that they do, and the service delivered by Oak Lodge. They said that there is good teamwork and they feel they are appropriately trained for their role. All staff receive monthly supervision from the manager, and there are daily team meetings to discuss the work with people who use the service and any issues. A consultant visits the home once a month to carry out group supervision with staff. The staff said they have undertaken different training courses to develop their professionalism, with one being a qualified psychotherapist, one a psychologist and others having done counselling training. One staff spoke about having done a National Vocational Qualification (NVQ) in drug and alcohol work. The manager said that staff are trained in first health, basic food hygiene, fire safety and that some had done an NVQ in social care. The staff records are not held at the service, and so evidence that the staff training is current could not be confirmed at this time. The staff recruitment Care Homes for Adults (18-65 years) Page 20 of 27 Evidence: records are also held at the head office of the organisation, and so this area could not be assessed on this occasion. People who use the service said that they are confident of the knowledge and professionalism of the staff, with such comments being: ..the staff really know what they are talking about.., ..they say it like it is.. and ..they have a good understanding of issues... The home is staffed throughout the twenty four hour period, with staff doing overnight and weekend cover on rota basis. The manager said that a relief bank of experienced drug workers is used to cover Sunday shifts and any staff sickness or leave. Care Homes for Adults (18-65 years) Page 21 of 27 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Oak Lodge is a well managed home that works in the interests of the people who use the service. Evidence: ..the manager is spot-on, he really knows what he is talking about.., ..I have nothing but respect for the manager... These were comments received from two people who use the service, who said that they feel it is well-run and committed to supporting them. The manager has worked at the service for over twenty years and said he is a qualified counsellor. He said that he has also obtained the Registered Managers Award (RMA) and NVQ level four in Management. He conveys a competent and professional approach to his work, which is demonstrated by the structure of the service and commitment of the staff team. During the inspection he spoke about different factors that are having an affect on the service provision, and ways that he is adapting the service to cope with these. Care Homes for Adults (18-65 years) Page 22 of 27 Evidence: The manager said that quality monitoring takes place through daily meetings with people who use the service, monthly visits from his line manager and an annual survey with people who use the service. There are systems for checking fire equipment, alarms, calls bells and carrying out fire drills. Up-to-date gas safety and Portable Appliance checks are in place, though there is no evidence to demonstrate that a recent electrical installation check has been carried out. Care Homes for Adults (18-65 years) Page 23 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 Adults (18-65 years) Page 24 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 1 20 13 Receipt of all medication held at the service must recorded. To assure people who use the service that medication is being managed appropriately. 11/05/2009 2 20 13 Any allergies of people who use the service must be recorded. A record of this must also be put onto the MAR chart. To ensure that risks to people who use the service are minimised. 11/05/2009 3 32 17 A record of staff training in NVQ must be held at the service. So that people who use the service can be assured that staff have received all training appropriate to their role. 29/05/2009 Care Homes for Adults (18-65 years) Page 25 of 27 4 34 17 A record of the recruitment of staff must be held at the service. So that the service can evidence that appropriate recruitment checks have been carried out. 29/05/2009 5 35 17 A record of the training of staff must be held at the service. So that people who use the service can be assured that staff have received all relevant training to their role. 29/05/2009 6 42 23 the service must hold evidence to demonstrate that the electrical installation check has been carried out. So that people who use the service can be assured that the home is safe. 29/05/2009 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 26 of 27 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). 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