Care Home: Oak Residential Home for the Elderly

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What the care home does well This is a service , registered in August 2007, which has just recently become operational. The home presents as having a pleasant and homely feel. The home has a fairly comprehensive Statement of Purpose and Service User Guide. These documents do, however, need to be reviewed and updated. What has improved since the last inspection? First key inspection. What the care home could do better: There are a number of requirements relating to health and safety which must be met, together with a number of other requirements and recommendations that relate to staffing, training and health care arrangements. Key inspection report Care homes for older people Name: Address: Oak Residential Home for the Elderly 33 Marlow Road Penge London SE20 7XX     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Peter stanley     Date: 0 3 1 2 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: Oak Residential Home for the Elderly 33 Marlow Road Penge London SE20 7XX 07508028060 TBA Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Grace Chika Akinpelu care home 4 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: 4 The Registered Person may provide the following category of service only: Care home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old Age, not falling within any other category - Code OP Dementia - Code DE Date of last inspection Brief description of the care home Dormant Service. 1 9 0 1 2 0 0 9 4 0 Over 65 0 4 Care Homes for Older People 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: one star adequate 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: We visited the service and completed a site inspection. We met with the one recently admitted resident, and case-tracked the admission, assessment and care planning process. We looked at staff and service user files, and other documentation relating to the day to day management of the home. We met with the manager, and discussed issues relating to the home and the relevant standards and regulations that apply. Care Homes for Older People 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 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 Older People Page 6 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 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 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is providing the information required with which to assist prospective residents and relatives to make an informed choice as to where to live. The Statement of Purpose and the Service User Guide are, however, out of date and need to be be reviewed and updated. The home has a contract in place which was issued prior to the resident moving into the home. This provides information regarding the homes terms and conditions. The registered person has been able to demonstrate that full referral information, regarding the homes recent first admission, has been obtained, and that the needs of the resident have been approprately assessed. The home has been able to demonstrate that it has the capacity to meet the residents care needs. However, it is too early in the placement to make any definitive longerterm judgement in this regard. Care Homes for Older People Page 8 of 27 Evidence: The home has a Statement of Purpose and a Service User Guide which date from 2007. The Statement of Purpose and the Service User Guide must, however, be reviewed and updated, and include up to date contact details for the CQC. The home currently has one resident. Inspection of the residents file evidenced that full referral and assessment information had been obtained from the referring social services department, and that the home had completed its own pre-admission assessment. Inspection of the assessment and care plan, for the one resident so far admitted, indicated that the registered person had identified the range of needs to be met, and had been able to demonstrate the capacity of the home to meet the assessed needs of an older person with dementia. However, given that this is the homes first admission, and that the home is still in the process of recruiting care staff, it is too early to make a definitive judgement in this regard. The resident did, however, present as being happy and settled in her new environment. A service user contract had been drawn up, stating the terms and conditions of the placement. Care Homes for Older People Page 9 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The one resident so far admitted has a care plan in place, which sets out her health, personal and social care needs, and the actions required to meet these. For residents to feel assured that their health care needs will be met, the manager must review the homes present health care arrangements, and take whatever actions are required, so as to ensure that residents are able to access local primary health care assessments and treatment whenever these are required. The homes medication policy, procedures and practice are providing protection for the one resident. However, for there to be fuller protection, accredited medication training will need, as a priority, to be extended to all care staff who work in the home. The privacy and dignity of the one resident is being respected. Evidence: The home has recently admitted its first resident. Inspection of the care plan, for this individual, indicates that there has been a full assessment of her needs and a care Care Homes for Older People Page 10 of 27 Evidence: plan, which details how the persons care and support needs are being addressed. The resident presented as having settled in well, and as being content with her environment. The home has a log and documentation in place which evidence that the residents health and welfare are being routinely monitored. The manager advised, however, that there have been difficulties in accessing reliable local health cover, and that requests for a health care assessment from a local GP practice had not so far proved successful. The manager must, therefore, review her present health care arrangements, and take whatever actions are required, so as to ensure that residents are able to access local primary health care assessments and treatment whenever these are required. The home has a medication policy and procedures in place. Medication records, including MAR sheets, were examined for the recently admitted resident. These were being appropriately maintained. There are appropiate storage arrangements in place. The registered provider and manager is a qualified State Registered Nurse and has had many years of experience in the nursing profession. However, for there to be fuller protection in terms of medication practice, it will be necessary for all new care staff, who are recruited, to be provided with accredited medication training by an accredited training provider. The recently admitted resident presented as being settled and content with her environment, and indicated that she is being well cared for. Observation of the managers interaction with her demonstrated both sensitivity and respect. The manager advised that the lady receives regular weekly visits from her family in the privacy of her own room, and that she is encouraged to regard her new residence as being her home. This was very much the impression gained during the inspection. Care Homes for Older People Page 11 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. It is too early to assess standards 12, 13 and 14, and not possible, therefore, to assess this area as being other than adequate. The food prepared is home cooked, varied and nutritious, and takes account of the residents personal and cultural tastes. Evidence: It is too early to assess standards 12, 13 and 14, and not possible, therefore, to assess this area as being other than adequate. The home has recently admitted its first resident. The resident was observed playing a word board game with the manager. The ladys religious and spiritual needs have been identified, and it is hoped to enable her to attend church services. There are regular weekly visits from the residents family and relatives, whom she is able to see in the privacy of her own room. There has not, as yet, been any more structured development of activities, or of any planned outings into the community. The food is homecooked, meals being prepared on the premises and provided either in Care Homes for Older People Page 12 of 27 Evidence: the residents own room, or in the dining room on the ground floor. The resident indicated that she enjoys the food which is provided. The manager stated that she tries to provide food which meets this ladys personal and cultural tastes. Care Homes for Older People Page 13 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has an appropiate complaints policy and procedure in place. This does, however, need to be updated so as to include the correct contact details for the CQC. The home has an appropriate safeguarding policy in place. All staff will, however, need to raise their awareness of safeguarding issues, and attend statutory safeguarding training. Evidence: The home has a satisfactory complaints policy and procedure. The home has only recently admitted its first resident. No complaints have been received. The home has a policy covering the protection of adults, and the prevention of abuse. There is a need for the manager and staff to undertake statutory safeguarding training with social services. Care Homes for Older People Page 14 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides a homely, well maintained environment, with access to safe and comfortable communal facilities.The home is not, however, suitable for service users with mobility difficulties, and needs, as a priority, to be assessed for aids and adaptations. Residents rooms present as being safe, comfortable and pleasantly decorated. The one room so far occupied reflects the individuals personal identity, and includes some of her possessions and photographs. Residents are living in a home that presents as being clean, pleasant and hygienic. Evidence: The home is registered to provide care for up to 4 older persons with dementia and/or physical frailty. It is not purpose built and is not therefore suitable for anyone who has mobility difficulties. There are no adaptations that would enable older persons with physical disabilities, to be able to access the 3 upstairs rooms. The one resident so far admitted has mobility problems, but is located in an en suite room on the ground floor. The home should, as a priority, be assessed by an occupational therapist (or other qualified person) for any aids, equipment or adaptations that would improve safety for Care Homes for Older People Page 15 of 27 Evidence: service users. This should include the assessment of the staircase and the small step in the upstairs corridor. Given the difficulties involved in being able to safely access the upstairs floor, no service users, with mobility difficulties, should be admitted to the home, for any of the upstairs rooms. The home has radiators throughout the home. Apart from one low-level radiator in the ground floor bedroom, all radiators in the home must, in the interests of safety, have protective covers put on. This must be prioritised for urgent action. A requirement applies. The home presents as having a pleasant homely feel. There is a dining room and a small lounge on the first floor, both of which are well decorated and furnished in a domestic style. The lounge would, however, benefit from a table lamp or wall-fitted lighting, so as to provide better lighting, and to give the room a warmer feel. The dining room has one large dining table, and leads into a small kitchen. This is well fitted and has appropriate cooking facilities, fridge/freezer and storage facilities. The home generally presents as being clean and hygienic. Cleaning fluids and agents are kept in the upstairs laundry room. This must be kept locked at all times when not in use and unattended. All cleaning fluids must be securely stored in a lockable cabinet or cupboard within the laundry room.A requirement applies under standard 38. The home has two ensuite bedrooms, one of which is occupied on the ground floor. There is a communal bathroom, with a bath, and a toilet on the first floor, and another separate toilet on the ground floor. There is a garden at the back which has been tidied up and grass laid, and which is securely fenced. Care Homes for Older People Page 16 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. For the health and welfare needs of residents to be fully met, the home must ensure that there are a sufficient number of qualified, competent and experienced care staff available at all times. The home aims to provide staff with an induction and NVQ training. For the safety and welfare of service users to be assured, the home needs to ensure that training in medication, safeguarding, dementia, manual handling, food hygiene, fire safety and health and safety, is prioritised, and that a training programme is put in place. Evidence: The registered provider and manager, Grace Akinpelu, presently lives in and provides a full-time caring role.There is, however, an urgent need for more staff support, in being able to fully meet the residents needs. The manager has confirmed that there will be a minimum of two staff on duty during weekday daytime shifts, one to two staff during the day at weekends, and one waking staff member at night. Since the site visit, it has been confirmed that three qualified care staff have had their CRB checks completed. The files have been inspected, evidencing that all the other necessary identity and recruitment checks had been processed. The manager confirmed that newly recruited staff will be undertaking an induction Care Homes for Older People Page 17 of 27 Evidence: programme based on Skills For Care. And that all staff will be required to undertake training for an an NVQ Level 2 qualification. The manager also confirmed that she will be providing training in Fire Safety and Health and Safety. As yet, the manager has not put in place a training programme. This will need to include dementia awareness training, accredited medication training, food hygiene training and statutory safeguarding training. Given the physical frailty of the ground floor resident, training for staff in manual handling is also required. Care Homes for Older People Page 18 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. It is too early to assess standards 31 to 36 and not possible, therefore, to assess this area as being anything other than adequate. Records examined are being appropriately maintained, and present as being up-todate and accurate. A number of health and safety measures, identified under Standard 38, (and under Standards 19 to 23 relating to the home environment) must be taken if the health, safety and welfare of service users and staff is to be assured. Evidence: The home has only recently admitted its first resident and become operational. It is not possible, therefore, to assess standards 32 to 36. Standard 31. The manager, Grace Akinpelu, presents as a caring and responsible individual. Her background is in nursing, being an SRN (State Registered Nurse) with Care Homes for Older People Page 19 of 27 Evidence: over 30 years of experience in general and paediatric nursing. She confirms that she has, within recent years, had experience, as a care worker, of working with older people with dementia. Ms Akinpelu confirmed that she intends to register to study for an NVQ Level 4 management qualification. Standard 37 The records inspected included the residents personal care file and staff recruitment files. These presented as being maintained in a reasonably good order. Standard 38. There are three requirements relating to health and safety. Cleaning fluids and agents were observed as being stored in the upstairs laundry room. This room must be kept locked at all times when not in use and unattended, as this would otherwise present a safety risk for service users. All cleaning fluids must be securely stored in a lockable cabinet or cupboard within the laundry room. The manager confirmed that no records are presently being maintained regarding the monitoring of hot water and fridge freezer temperatures. These must, in the interests of safety, be monitored on a regular weekly basis. The homes Fire Risk Assessment dates was last reviewed in 2007, and must, as a priority, be reviewed and updated. Care Homes for Older People Page 20 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 21 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 1 6 The Statement of Purpose and the Service User Guide must be reviewed and updated, and include up to date contact details for the CQC. To provide up to date information about the home 31/03/2010 2 8 8 The manager must review 31/12/2009 the homes present primary health care arrangements, and take whatever actions are required, so as to ensure that residents are able to access local health care assessments and treatment whenever these are required. To ensure that the health care needs of residents are being met. Care Homes for Older People Page 22 of 27 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 3 16 22 The home needs to update the complaints policy and procedures so as to include the up-to-date contact details for the CQC. To ensure that service users have correct information as to whom to refer if their complaint is not resolved. 30/04/2010 4 19 13 All radiators in the home 31/03/2010 (apart from one low level radiator) must have radiators covers put on. This must be prioritised for urgent action. To help ensure the safety of service users. 5 22 13 The home must, as a priority, be assessed by an occupational therapist (or other qualified person) for any aids, equipment or adaptations that would improve safety for service users. This should include the assessment of the staircase and the small step in the upstairs corridor. Given the difficulties involved in accessing the upstairs floor, no service users, with mobility difficulties, should be 31/03/2010 Care Homes for Older People Page 23 of 27 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 admitted to use any of the upstairs rooms. To ensure the safety of service users. 6 23 13 Magnetic self-closing door stops must be fitted to the doors of all residents bedrooms and to the door that opens out from the lounge into the downstairs hall. To help ensure the safety of service users in the event of fire. 7 27 18 The manager must ensure that, at all times, the home is staffed by sufficient numbers of qualified, competent and experienced staff, and that there is adequate back-up staff cover available. To ensure that the health and welfare needs of residents are being fully met. 8 38 23 The homes Fire Risk Assessment must be reviewed and updated. To ensure the safety of service users. 9 38 13 The laundry room, must have a door lock, and be 31/12/2009 31/03/2010 31/12/2009 30/03/2010 Care Homes for Older People Page 24 of 27 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 kept locked at all times when not in use and attended by staff. The hazardous cleaning fluids kept within the laundry room must be stored within a securely locked container or cupboard within the laundry room. To ensure the safety of service users. 10 38 13 The home must maintain regular weely monitoring record of hot water and fridge freezer temperatures. Hot water temperatures must not exceed 43 degrees centigrade. To ensure the safety of service users. 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 31/12/2009 1 9 All staff, once recruited, should, as a priority, undertake accredited medication training with an accredited training provider.. The manager and staff shouild, as a priority, undertake statutory safeguarding training with social services. The lounge would benefit from a table lamp or wall-fitted Page 25 of 27 2 3 18 20 Care Homes for Older People 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 lighting, so as to provide better lighting, and give the room a warmer feel. 4 30 The home needs to ensure that training in medication, safeguarding, dementia, manual handling, food hygiene, fire safety and health and safety, is prioritised, and that a staff training programme is put in place. The registered manager should aim to undertake studies leading to an NVQ Level 4 management qualification. The home must arrange fire drills on at least a 3 monthly basis, and keep a record of these. The home should, as a priority, arrange fire safety training for all staff. 5 6 7 31 38 38 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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