Care Home: Reinwood Avenue

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What the care home does well People get good support from the staff with their personal care and health care needs. Staff are good at getting the right professional support for people, so that they stay healthy and they get the equipment they need. The staff know the people they support very well and know how each person communicates. Staff have good training about how to keep people safe from abuse. What has improved since the last inspection? The manager has made sure that things that we thought were wrong at the last inspection have been put right. Some work has been done in the house to make it safer from fire. There is a new bathroom with a special bath that goes higher and lower. The home has recently been redecorated and looks very nice.Some new staff have joined the team. What the care home could do better: Some of the care plans contain too much old information. This should be taken out so that staff are working with the most up to date information. It is written in the care plans what people like to do in their spare time. But staff cannot always have the time to help people do what they want to do, especially if they need two staff to support them when they go out. There often isn`t a member of staff that can drive the car. This means that people`s lifestyles are limited and may not be as enjoyable as they could be. Staff should be getting more regular supervision meetings, so that they have the support they need to carry out their roles. The service has a lot of information on a computer now. But some of the staff say they have not had enough practice or training in how to use it. Staff need to practice fire drills more often, so that they know how to keep people safe. Key inspection report Care homes for adults (18-65 years) Name: Address: Reinwood Avenue 26 Reinwood Avenue Leeds West Yorkshire LS8 3DP 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: Stevie Allerton Date: 0 8 1 0 2 0 0 9 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should:  Be safe  Have the right outcomes, including clinical outcomes  Be a good experience for the people that use it  Help prevent illness, and promote healthy, independent living  Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home:  3 stars – excellent  2 stars – good  1 star – adequate  0 star – poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area Outcome area (for example: Choice of home) These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement Care Homes for Adults (18-65 years) Page 2 of 29 Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by:  Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice  Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983  Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services.  Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 29 Information about the care home Name of care home: Address: Reinwood Avenue 26 Reinwood Avenue Leeds West Yorkshire LS8 3DP 01132730083 01132730083 reinwoodavenue@c-I-c.co.uk www.c-i-c.co.uk Community Integrated Care care home 3 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) : Number of places (if applicable): Under 65 Over 65 3 0 learning disability Additional conditions: Date of last inspection A bit about the care home The home is a large detached bungalow owned by South Yorkshire Housing Association. It is situated in a residential area close to the Oakwood area of Leeds. The house and gardens are well maintained and look like other houses on the street. The garden also suits people who use wheelchairs. Bedrooms are of a good size and there is enough space for the three people who Care Homes for Adults (18-65 years) Page 4 of 29 live there. The home has its own car and people pay towards the cost of running it. The fees at the time of this inspection are £1076.82 per week. Peoples toiletries, some leisure activities, holidays and taxis cost extra. Care Homes for Adults (18-65 years) Page 5 of 29 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 Care Homes for Adults (18-65 years) Page 6 of 29 How we did our inspection: This is what the inspector did when they were at the care home Before the visit, we looked at all the information we have about the service. This included any incidents or accidents that we were told about. The home completed a document called an Annual Quality Assurance Assessment (AQAA), which gave us lots of good information and helped us to plan the inspection. The last time we inspected this service was 31/10/2007. We didnt tell people we were coming to do this inspection. Surveys were sent out to people living at the home, some staff and other professionals, like nurses and Social Workers, who also support people. We hadnt had any back by the time we wrote this report. Three people were case tracked. Case tracking is how we decide whether people who use services receive good quality care that meets their individual needs. We spent time with people living at the home and spoke to members of the staff team who provide support to them. We also looked round the building and looked at written records in the office. We were able to look at all of the standards that the law says services like Care Homes for Adults (18-65 years) Page 7 of 29 this must meet. What the care home does well What has got better from the last inspection The manager has made sure that things that we thought were wrong at the last inspection have been put right. Some work has been done in the house to make it safer from fire. There is a new bathroom with a special bath that goes higher and lower. The home has recently been redecorated and looks very nice. Care Homes for Adults (18-65 years) Page 8 of 29 Some new staff have joined the team. What the care home could do better Some of the care plans contain too much old information. This should be taken out so that staff are working with the most up to date information. It is written in the care plans what people like to do in their spare time. But staff cannot always have the time to help people do what they want to do, especially if they need two staff to support them when they go out. There often isnt a member of staff that can drive the car. This means that peoples lifestyles are limited and may not be as enjoyable as they could be. Staff should be getting more regular supervision meetings, so that they have the support they need to carry out their roles. The service has a lot of information on a computer now. But some of the staff say they have not had enough practice or training in how to use it. Staff need to practice fire drills more often, so that they know how to keep people safe. Care Homes for Adults (18-65 years) Page 9 of 29 If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact Stevie Allerton St Nicholas Building St Nicholas Street Newcastle upon Tyne Tyne and Wear NE1 1NB 01912333300 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 10 of 29 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 11 of 29 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 are carefully assessed, so that staff at the service are sure they can continue to meet their needs. The information about the service is presented in a way that is easy for people with a learning disability to understand, so they know what the service is about. Evidence: During the site visit we looked at the information available to people that tells them about the service. We also looked at the environment to see whether peoples physical care needs were being met and we had discussions with the manager and other staff. The Statement of Purpose and Service User Guide is presented in an easy-read format, with pictures to support the text. Peoples support plans showed that risk assessments had been carried out and individual support needs identified to minimise the risks. The information about the service states that it can accommodate people with complex multiple disabilities and high support needs, including specialised mobility needs and behaviour that can challenge services. It is intensively staffed, including two to one support for certain activities. Everyone currently living there has support needs that are being met within the stated Care Homes for Adults (18-65 years) Page 12 of 29 Evidence: aims of the service. There have been no new admissions, so we were unable to track the admission process. Care Homes for Adults (18-65 years) Page 13 of 29 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. Support plans guide staff so that they provide the right support for each person, ensuring that their assessed needs are met. Some of the care files contain a lot of historic information that could be archived, so that staff have access to the most up to date information. The Communication Passports could also be further expanded and developed, to give staff a clearer description of how people communicate their wishes and feelings. Evidence: During the site visit we looked at care records and case-tracked all three people living there, looked at the environment to make sure that things identified in the care plans were in place, spent time with people and spoke to staff about how they support them. Support plans are in place, developed following continuous assessment and review of peoples changing care needs. There was some good practice seen in how the Life Book is developed for each person. Where these had been written in the first person, eg, I like to.... they had much more impact than the He likes to... style. There were Care Homes for Adults (18-65 years) Page 14 of 29 Evidence: inconsistencies seen with how these are being written. Some support plans had been agreed & signed by relatives. It was observed that staff were working to peoples expressed wishes and preferences, supporting them in the way they prefer and that have been agreed. Risks are assessed and appropriate plans put in place, including a risk assessment & plan for each individual if ever a night-time evacuation has to be carried out. The service is getting up to speed with the Mental Capacity Act Deprivation of Liberty implications; the manager is currently completing a Deprivation of Liberty Indicator Tool in respect of someone who has a comfortable chair that is correct for their posture, but which they cannot get out of without staff assistance. Staff were observed to have a good rapport with the people they support and to try and encourage their participation in everyday life in the home. Care Homes for Adults (18-65 years) Page 15 of 29 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have their social and leisure needs identified, but there is currently a gap between what they want to do and what the staff can support them to do. This means that peoples lifestyles are limited and they may not be fulfilling. People have a good diet and enjoy the food. Evidence: Records showed that peoples social and leisure needs have been identified and are incorporated into their support plans. Staff told us about the day services and other activities that people are engaged in, but their daily diaries did not reflect these, mainly concentrating on the recording of personal care. One person now has his own car and there is also a house vehicle. However, the manager told us that there is a shortage of staff that can drive these vehicles, so there are limits on how often they can be used. Proper arrangements are in place to provide people who need intensive support with the agreed numbers of staff, ie, two to one for activities outside the house. Again, the manager said that these opportunities have been limited Care Homes for Adults (18-65 years) Page 16 of 29 Evidence: because of staff shortages. We had lunch with people living at the home and the staff who support them. People were being helped discreetly and the practice observed matched that which was outlined in the support plans. Staff showed that they understand how the individuals they work with communicate their needs. One person was supported to eat in his room, as in his plan. Nutritional risk assessments are now being carried out, an improvement on the previous inspection. Care Homes for Adults (18-65 years) Page 17 of 29 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 get good support with their personal care and health care needs. Staff are proactive in getting the right professional support for people, so that their health needs are met and they get the equipment they need. Medication is safely managed and people get the treatment they have been prescribed at the right times. Evidence: At the site visit we looked at documents and records relating to peoples health and personal care and had discussions with the staff on duty. There was evidence that peoples health is monitored regularly and specific action plans are in place to support their health. Health professionals are consulted appropriately and are currently providing quite a lot of input to make sure that people have the correct equipment, treatment or medication to meet their needs. Staff have been proactive in getting health care professionals on board to achieve better outcomes for people. Medication is looked after and administered safely, although an area was identified where practice could be improved (the record of staff that have been trained to administer medication should include a sample of their initials alongside their signature). Support plans note how people want to be supported with their personal care, and whether they prefer someone of the same gender to deliver their care. They also outline Care Homes for Adults (18-65 years) Page 18 of 29 Evidence: how individuals without verbal communication indicate pain or discomfort and there are established protocols in place that describe in what circumstances homely remedies, such as Paracetamol, can be administered. Care Homes for Adults (18-65 years) Page 19 of 29 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. Complaints and safeguarding issues are taken seriously. People and their families know that there are the right procedures and the right staff training in place to deal with issues properly, to keep people safe. Evidence: Staff have been trained in safeguarding and the manager said that the new staff member would be receiving this training during induction. The complaints procedure is produced in an easy-read format so that it is more accessible to people without good literacy skills. Staff spoken to appear to know the people they support very well and know how each person communicates ill-being and well-being, so can pick up on problems. There was evidence that people had had advocacy support in the past. Records showed that keyworkers meet with their clients regularly; they complete review sheets that have symbols to enable people to understand them more easily. The manager said that the people living at the service are encouraged to come into the relevant parts of the staff meetings, if they wish. Care Homes for Adults (18-65 years) Page 20 of 29 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides a safe, clean and comfortably furnished environment to live in, where people have the equipment they require to meet their needs. Evidence: Fire safety work has been carried out in recent months and they had had a new bathroom with height-adjustable bath installed. The home had recently been redecorated and it provided a very bright and airy environment. The building is owned by a Housing Association, who provide an on-call maintenance team if repairs are needed and also do the garden. The manager said that there were plans to make more of the outside space, including a sensory garden. General cleanliness was good and protective hygiene equipment was to hand where it was needed. No health and safety issues were noted. Bedrooms were personalised and reflected the preferences and interests of the individual. One person has specialist equipment for seating and for mobility, which was seen in place in his bedroom. Care Homes for Adults (18-65 years) Page 21 of 29 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. People are protected by the providers strong recruitment practice, making sure that only those deemed suitable to work with vulnerable people are offered employment. Staff have a good level of training, but need a more structured programme of supervision to make sure that they are translating the training into good practice. Evidence: Staff rotas show that there are three staff on duty from 7.00 - 2.30, two staff from 2.00 9.30pm, one waking night staff from 9.15 - 7.15 and one person sleeping over on call. We spoke to a new support worker, had been in post for one week. He said he was having a good induction so far - he said that he had read the care plans, been shown basic fire evacuation drill and was shadowing the staff giving personal care to people. He would also be starting the providers e-learning induction programme. He said he was worried about using the hoist, but knew that he would not be expected to unless he had been trained. He said that he felt comfortable about asking any of the staff if he was unsure about things. He was learning how the individual people communicate and gave examples of this. The manager said that there was another new support worker waiting to start, as soon as their references and Criminal Records Bureau check had been returned, then the service would be fully staffed. Care Homes for Adults (18-65 years) Page 22 of 29 Evidence: Personnel & recruitment records were seen for two staff. These contained all of the required checks and documents that have to be present. One file showed that the staff member had had supervision within the past month, but the previous one had been 6 months before that. People were not able to give an opinion about the staff supporting them. However, during the course of the inspection, where we spent half of the time in the communal areas, staff were observed to have a good rapport with the people they support and appear to know them very well. Care Homes for Adults (18-65 years) Page 23 of 29 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. Appropriate arrangements are in place for the effective management of the service and it demonstrates that it is run in the best interests of the people living there. There may be a skills gap with the introduction of computer-based information and procedures, which could mean that peoples rights and best interests are not safeguarded. The manager needs to ensure safe working practices, so that peoples health and safety is not compromised. Evidence: We received the homes Annual Quality Assurance Assessment. It contained information about the home and the services that are provided, the improvements they have made and their plans for the coming twelve months. The managers time is split between two sites and she works 19 hours per week at each service. One of the seniors is at this service full-time, the other senior is split between two sites. All three work set days. Staff also have the support of a manager from the oncall rota at any time. The provider meets regularly with the local authority that commissions their service, to Care Homes for Adults (18-65 years) Page 24 of 29 Evidence: ensure quality. Meetings also take place with relatives and advocates. The homes line manager also carries out monthly service reviews (Regulation 26 visits). People with an interest in the service had recently been sent quality questionnaires, but the results of these were not yet available. During our visit we looked at some records, including: care plans and daily records, medication records, menus, kitchen hygiene records, fire safety records, staff files, staff rotas and records relating to the management of peoples money. Policies and procedures are now on the providers intranet system. However, not all of the staff are confident about being able to access this yet. Accident recording is also now computerised. There is a good emergency procedure file, which contains evacuation plans for each person, along with their personal details. Fire safety records showed that the last fire drills for staff had taken place during April and May 2009. The manager felt certain that this had been done since, but there was no record to confirm this. This is now due & needs to be recorded. At present there are no people living at the home who are subject to a deprivation of their liberty authorisation, under the Mental Capacity Act 2005. Care Homes for Adults (18-65 years) Page 25 of 29 Are there any outstanding requirements from the last inspection? Yes  No  Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 26 of 29 Requirements and recommendations from this inspection Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No Standard Regulation Description Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set No Standard Regulation Description Timescale for action 1 13 16 The home must support people to engage in local, social and community activities, where a need has been identified. 31/03/2010 This is so that people can enjoy being part of the community they live in. 2 14 16 The home must provide people with access to facilities for recreation, where a need has been identified. 31/03/2010 This is so that people can lead interesting and fulfilling lives. 3 42 23 Fire drills and practice must 01/12/2009 be carried out for all staff on a regular basis, and such drills recorded. Care Homes for Adults (18-65 years) Page 27 of 29 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set No Standard Regulation Description Timescale for action This is so that the vulnerable people living at the service are kept safe in the event of a fire. 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 6 The care plan files would benefit from old material being archived, so that staff are working with the most up to date information. It would be good practice if staff were to initial alongside their name on the list of those trained to give medication. This would then make it easy to identify each member of staff on the medication administration record (MAR) charts. Staff should receive regular supervision at least 6 times a year, so that they have the support they need to carry out their roles. The provider should support staff with training in the use of the intranet system they have introduced. This would ensure that records are completed correctly and that all staff have access to information and procedures. 2 20 3 36 4 40 Care Homes for Adults (18-65 years) Page 28 of 29 Helpline: Telephone: 03000 616161 or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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. 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