Care Home: Park Lodge

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What the care home does well Prospective residents are fully informed of the services provided at Park Lodge through the home`s literature. They are invited to view the home before making a decision about whether they wish to move to the home. The home also carries out a detailed pre-admission assessment of prospective resident`s needs, to make sure that these can be met at the home. Residents` health needs are met through the homes assessment and care planning systems. Residents are treated with respect and dignity. The home provides a range of activities within the home and the occasional outing is also arranged to meet residents recreational and social needs. Residents are able to receive visitors when they choose without restriction. Residents are provided with a good standard of food. The home is a well-publicised complaints procedure with residents feeling confident that complaints would be managed fairly. Staff have been trained in adult protection and the home has all relevant policies and procedures. Park Lodge provides a homely, comfortable and well maintained environment for residents. The home employs sufficient staffing to meet the needs of residents. Staff are recruited in line with best practice and legislation. Staff receive core mandatory training to ensure that they are competent. Generally we found that the home is well managed and run in the interests of the residents. What has improved since the last inspection? The home now has all the required storage facilities for medication and there has been an improvement through training and supervision of how medication is administered managed within the home. The home now informs the commission of all incidents and events that occur in the home that require notification under the Regulations. New carpets have been laid in communal areas and chairs replaced in the lounge. What the care home could do better: A photograph of newly admitted residents should be taken and placed at the front of their care plans and medication administration records as soon as practicable when they are admitted to the home. The home should informed that local pharmacy as soon as possible when a new resident is admitted with any known allergies, so that this information can be put on their medication administration records. The procedure for managing soiled laundry in the home should be reviewed against current guidance on how to minimise cross infection within the home. Key inspection report Care homes for older people Name: Address: Park Lodge 18 Ridgeway Broadstone Poole Dorset BH18 8EA     The quality rating for this care home is:   two star good 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: Martin Bayne     Date: 2 2 0 2 2 0 1 0 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) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. 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: Park Lodge 18 Ridgeway Broadstone Poole Dorset BH18 8EA 01202694232 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mr Kevin Arjoon Heeroo,Mrs Vimla Heeroo Name of registered manager (if applicable) Manager Post Vacant Type of registration: Number of places registered: care home 17 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is 17. The registered person may provide the following category of service only: Care home only - Code PC to service usersof either gender whose primary care needs on admission to the home are within the following category: Old age, not falling within any other category - (Code OP) Date of last inspection Brief description of the care home Park Lodge has been a residential care home for many years. Mr and Mrs Heeroo became the Registered Providers in March 2008. Mrs Heeroo is also the Registered Manager. The home is registered with the Care Quality Commission to provide personal care not nursing care for to up to 17 people. Park Lodge is a large Victorian house, Care Homes for Older People Page 4 of 27 Over 65 17 0 Brief description of the care home standing in mature grounds in the residential area of Broadstone, Poole. The home is located close to local shops, churches, doctor surgeries, the library and the Post Office. The main bus route into Poole passes the end of the road. 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: two star good 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, the Commission, carried out a key inspection of Park Lodge residential home between 8:45am and 2pm. The inspection was carried out by one inspector, but throughout the report the term we is used, to show that the report is the view of the Care Quality Commission. The last key inspection of the home was carried out in October 2009 when the home received a poor rating on account of poor outcomes, mainly focused on medication administration. Since that key inspection a random pharmacy inspection of the home was carried out at the beginning of the year, when it was found that the home had complied with requirements around medication administration. The aim of this inspection was to follow up on the remaining requirement and three recommendations that were made at the key inspection, and to evaluate the home against the National Minimum Standards for Older Persons. We were assisted throughout the day by the Registered Provider and Manager Mrs Heeroo, and the deputy manager. They provided us with records of how residents are Care Homes for Older People Page 6 of 27 supported and cared for at the home. Throughout the inspection we used a sample of two residents personal files, who had been admitted to the home since the last key inspection, to track the records and paperwork that the home is required to maintain under the Care Homes Regulations 2001. We spoke in detail with five of the residents living at the home about their experience of living at the home. We also spoke with a relative who was visiting the home at the time of our visit. We were shown around the premises and were able to view some residents personal rooms. Care Homes for Older People Page 7 of 27 What the care home does well: What has improved since the last inspection? What they could do better: A photograph of newly admitted residents should be taken and placed at the front of Care Homes for Older People Page 8 of 27 their care plans and medication administration records as soon as practicable when they are admitted to the home. The home should informed that local pharmacy as soon as possible when a new resident is admitted with any known allergies, so that this information can be put on their medication administration records. The procedure for managing soiled laundry in the home should be reviewed against current guidance on how to minimise cross infection within the home. 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 9 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 10 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. Residents benefit from being fully informed of the services and facilities provided at Park Lodge and by having their needs assessed to make sure that these can be met at the home. Evidence: At the time of our inspection the home was fully occupied with new residents having being admitted to the home since the last key inspection. We identified two newly admitted residents and used their personal files to track the procedures followed for their admission to the home. One person had been admitted from hospital and we saw that they and their family had had the opportunity to visit the home in the initial stages. At this visit the home had also carried out a preadmission assessment of this persons needs to make sure that they could be catered for at Park Lodge. In the case of a second person they had been admitted from another residential home and they and their family had had the opportunity to visit Park Lodge to help them to decide whether it provided a suitable placement. Again a preadmission assessment was Care Homes for Older People Page 11 of 27 Evidence: carried out as part of this introductory visit. We found that the preadmission assessments had been recorded and were filed within the respective personal files and these assessments covered all of the topics detailed within the National Minimum Standards for Older Persons. We saw that once the decision had been made to admit residents, they were informed in writing that their needs could be met at the home with a formal offer of a trial placement. It was noted that one of these residents was found to suffer a degree of memory loss and we discussed with the provider the need to ensure that the home complies with its conditions of registration of meeting needs of people with frailty of old age, as the home is currently not registered to admit residents with dementia. At previous inspections the home was found to have an up-to-date Statement of Purpose and Service User Guide that were available to prospective residents and their relatives and we saw that these were available in the home. The home does not provide an intermediate care service. Care Homes for Older People Page 12 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from their health care needs being met through the homes risk assessment and care planning systems, by being treated with respect and dignity and by having medication administered safely. Evidence: We looked at the personal files for the two residents we tracked through the inspection and found that once they had been admitted, more in-depth assessments were carried out and these were then used to develop a care plan. We saw that the assessments were detailed and included moving and handling, skin-care, personal care needs, nutritional and social and emotional support assessments. We saw evidence that the resident or their representative were involved in drawing up care plans, by their signing these documents. We also saw that care plans were reviewed each month or when needs of residents changed, to make sure that care plans were up-to-date. We saw that photographs of residents were taken and put at the front of their care plans, so that new members of staff are able to identify residents. One of the residents we tracked through the inspection had only been admitted two weeks previously and the photograph had yet to be taken. We recommend that photographs Care Homes for Older People Page 13 of 27 Evidence: be taken as soon as possible and are put at the front of the persons care plan and medication administration records. The care plans generally reflected the needs of residents identified within the assessment processes however, in the case of one person we tracked through the inspection, their assessment informed that prior to their being admitted to the home, medication for treatment of depression had been stopped on account of a reaction to medication. The care plan should have reflected the need for staff to monitor this persons mental state for any resurgence of a depressive illness, but did not. This was discussed and it was agreed that this information would be added to the care plan. As well as looking at care plans, we looked at the daily recording notes and also spoke with both residents. Daily records informed that the care tasks had been carried out and also gave some account of how residents spent their days at the home. Overall we found that health care needs of residents were being met with appropriate referrals to GPs and other health services to meet dentistry, chiropody and optical needs. During the inspection we were able to observe interactions between staff and residents. We saw that residents were spoken to respectfully and offered assistance appropriately. The residents and the visiting relative we spoke with during the inspection told us that the staff were very kind, courteous and respectful of privacy and dignity. Generally there was much praise of the staff with comments such as, they cant do enough for me. At the last key inspection a requirement was made that medication administration records must accurately reflect medicines administered to residents. This requirement was followed up through a random pharmacy inspection carried out by the Commission earlier in the year and it was found at that time that the home had complied with the requirement. At this inspection we again looked at the medication administration. We found that since the last key inspection all of the staff at the home had had refresher training in safe medication administration. We looked at the medication administration records for all of the residents and found that the records were completed in full, with no gaps in the recording. We saw good practice of a photograph of the resident concerned at the front of their administration records, a second person checking and signing records where hand entries had been made to the records and a record of any medication allergies concerning particular residents. In the case of one of the newly admitted residents, the assessment from hospital informed that they had an allergy to a particular medication and this had yet to be included on their medication administration records. It was agreed that the manager would contact the pharmacy to pass on this information and have it included on their Care Homes for Older People Page 14 of 27 Evidence: medication administration records. The home has suitable storage facilities for storing medication, a locked trolley that can be chained to the wall being provided as well as a controlled drugs cabinet that meets the new Regulations. We saw that medicines were being stored correctly. Care Homes for Older People Page 15 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from their social, religious and recreational needs being met; through being able to maintain contact with friends and family and from being provided with a good standard of food. Evidence: We saw on the residents notice board information about events and activities to take place in the home that month as well as photographs of various activities that had taken place within the home. The planned activities included visiting entertainers, regular exercise groups, craft, celebration of birthdays and other activity sessions. On the day of our inspection one resident went out from walk, another was involved in painting and a small group of residents together with a member of staff were involved in a quiz. Within the lounge area the home has a piano. We were told that one of the residents sometimes plays the piano to other residents. We saw that daily newspapers were provided to those residents wanting to have a daily paper and that the library regularly visited the home. Residents we spoke with told us that generally they were satisfied with the activities and stimulation provided in the home. Residents religious and spiritual needs are assessed when they are admitted to the home and care planning supports residents with any unmet needs. A holy communion Care Homes for Older People Page 16 of 27 Evidence: service is held in the home each month. Another resident told us that they attended a church service in the community. On the day of our visit three residents received visitors. We spoke with one of the visiting relatives who told us that they were free to visit the home at any time and were always made welcome at the home. All of the residents we spoke with told us that the food was of a good standard, and we saw within the residents personal files that likes and dislikes were known. We saw that the menu for that day was displayed on residents notice board with the choice of salmon or pork casserole. We were able to observe some of the lunchtime period and saw that residents were provided with ample portions and the meal looked appetising. We also saw that residents were supported appropriately. We found within residents records that a nutritional assessment had been carried out and that residents were regularly weighed. Care Homes for Older People Page 17 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. Residents benefit from a well-publicised complaints procedure and through the staff being trained in the protection of vulnerable adults. Evidence: The homes complaints procedure is well publicised, being detailed within the Service User Guide and the Terms and Conditions of Residence. Information about how to complain was also displayed on the residents notice board together with a copy of the last inspection report. We also saw that there was a suggestions box in the reception area. Since the last key inspection there have been no formal complaints made to the management of the home and none had been brought to the attention of the Commission. The home has full policies and procedures relating to the protection of vulnerable adults and all of the staff had received training in the prevention of adult abuse. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from a clean, homely and well maintained environment. Evidence: Park Lodge provides a homely, comfortable and well maintained environment for residents. The home provides communal areas of a large lounge/dining room and conservatory. Leading from the conservatory, residents can access the garden and patio area. On the day of our visit the home was very clean with an absence of any odours. We found that furniture and fittings were in a good state of repair. Since the last key inspection all the carpets within the communal areas have been replaced and all of the chairs in the livingroom also replaced. During the inspection we were able to see some of the residents within their bedrooms and we saw that they were able to bring their own possessions to personalise their rooms. The home provides a range of disability equipment with grab rails sited around the home, a passenger lift providing access to bedrooms on the first floor, a walk-in shower and a hoist. One of the bathrooms has a swivel seat to assist residents in and out of the bath safely. We tested the hot water temperature in one of the communal bathrooms and found this to be within safe limits. We also saw that staff kept a record of bath temperatures. Liquid soap, and paper towels were provided in communal bathrooms to minimise the risk of cross infection. Care Homes for Older People Page 19 of 27 Evidence: As reported at the last inspection the home is still seeking planning permission to improve the laundry and other facilities of the home. The current laundry area is very small but provides a sink and machines suitable to meet the laundry needs of the home. Walls and floor surfaces are impermeable so that they could be cleaned easily and we saw that there were supplies of protective aprons and gloves for use by the staff. On the staff notice board we saw a procedure for managing soiled laundry. We recommend and it was agreed that the home review the procedure with reference to current guidance concerning infection control, as the sink in the laundry room was not being solely used for hand washing. Adjacent to the laundry room is the staff toilet where there is another sink used exclusively for hand washing that could be used as part of the laundry procedures. 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. Residents benefit from staff being deployed in sufficient numbers to meet their needs, through the staff being well-trained and recruited in line with the Regulations. Evidence: We were told that between 8 a.m. and 2 p.m. there were three care staff and the deputy manager on duty and that from 2 p.m. until 8 p.m. there were three care staff on duty. In addition to the care staff, the deputy manager works from 9 a.m. to 3 p.m., the home also employs a cook and the Mrs Heeroo works in the home on most days. During the night-time period there is one member of staff on an awake night duty with another person who carries out a sleep in duty. The residents and the relative we spoke with told us that this level of staffing met the needs of the residents living at the home. We were told that since the last key inspection no new members of staff have been recruited to the staff team. As we looked at the staff recruitment records at the last key inspection and found that these were in order, we did not look at any recruitment files at this inspection. At the last inspection we recommended that the staff application form be changed to request a reference from the persons last employment when working with children or vulnerable adults of not less than three months. Mrs Heeroo told us that staff application form had been changed as recommended. Care Homes for Older People Page 21 of 27 Evidence: We saw that new members of staff are provided with induction training that meets the common induction standards of Skills for Care. We were provided with a staff training matrix that showed us that staff are provided in core mandatory training and that the systems in place to monitor staffs development and need for refresher training. 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. Residents benefit by the home being well managed and run in their interests. Evidence: Mrs Heeroo is currently studying for an NVQ level 4 and we found that the home was being well managed and run in the interests of the residents. The home carries out quality assurance surveys, the results of which are used to plan for further developments of the home. The surveys last year just involved staff and residents. We were told that the survey to be carried out within this year would also involve relatives. We were told that the results of the last surveys were discussed with residents at a staff meeting, which is good practice. At the last key inspection a requirement was made concerning notifications of incidents and events that should be reported to the Commission. We looked at the homes accident book and saw that all incidents requiring notification to the Commission had been actioned appropriately. We also saw that the home carries out Care Homes for Older People Page 23 of 27 Evidence: an analysis of accidents to look for trends and patterns where action could be taken to reduce the risk is accidents occurring. We also saw good practice within the care records of body maps being used to record any marks where injuries are sustained by residents. We were told that the home does not safekeep monies on behalf of residents. We looked at the fire logbook and saw that the home had carried out a fire risk assessment. We also saw that tests and inspections of the fire safety system were taking place to the required timescales. We saw that the home had a current employers liability insurance certificate displayed and that other safety checks such as the annual servicing of boilers were taking place as required. 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 7 We recommend that photographs of residents be taken as soon as possible atfer admission to the home and are put at the front of their care plan and medication administration records. We recommend that the home review the procedures for managing laundry with reference to current guidance concerning infection control. 2 26 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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