Care Home: Seathorne Court

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What the care home does well The care home offers a comfortable and homely environment. Staffing levels ensure that the identified needs of the residents can be met. Staff stated that they receive training to ensure they have the skills to help the residents. Staff members stated that they feel supported by the home’s managers. Residents were satisfied with the quality of services being offered by the home. A resident stated “I cannot fault this home for the care and attention I receive.” What has improved since the last inspection? All of the requirements made at the last inspection were found to be met at this key inspection. The registered manager has reviewed care records to ensure that they provide sufficient information to ensure residents needs can be met safely using the resources of the care home. Care records were found to have improved since the last key inspection. The detail recorded in care records has been increased for each resident. Instructions and guidance for Seathorne Court DS0000070081.V376978.R01.S.doc Version 5.2 staff to ensure residents’ needs are met were found to be recorded in individual care records seen at this visit. Risk assessments have been improved and contained detailed instructions to staff on how to manage any identified risk. There was evidence of residents being involved in the writing of their individual care records including formal reviews. What the care home could do better: The registered manager has failed to notify the Care Quality Commission of any events which could have affected the safety of the residents. This is a legal requirement for managers to keep us informed so we can monitor the safety of residents. The registered manager agreed to complete the relevant form in future. Staff recruitment records were not kept in an organised manner although the appropriate documents required before offering new staff employment were found to be kept within the home. The registered manager agreed to review the overall risk assessment for the home particularly in relation to upstairs windows to ensure that any potential risk to residents is removed. Key inspection report CARE HOMES FOR OLDER PEOPLE Seathorne Court Winthorpe Avenue Skegness Lincolnshire PE25 1RW Lead Inspector Ken Hague Key Unannounced Inspection 6th August 2009 07:45 DS0000070081.V376978.R01.S.do c Version 5.2 Page 1 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. 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. Seathorne Court DS0000070081.V376978.R01.S.doc Version 5.2 Page 2 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 Seathorne Court DS0000070081.V376978.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Seathorne Court Address Winthorpe Avenue Skegness Lincolnshire PE25 1RW Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01754 765225 Gungah Care Limited Sadesh Gungah Care Home 18 Category(ies) of Old age, not falling within any other category registration, with number (18) of places Seathorne Court DS0000070081.V376978.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following categories of service only: Care Home only - Code PC To people of the following gender: Either Whose primary needs on admission to the home are within the following categories: 2. Old age, not falling within any other category - Code OP The maximum number of people who can be accommodated is: 18 Date of last inspection 26th August 2008 Brief Description of the Service: Seathorne Court has had new owners since August 2007. It is a care home providing personal care for up to eighteen older people of both sexes. The home is situated in a side street, at the north end of Skegness, close to the beach. It is within 500 metres of pubs and amusements and within half a mile of the town centre where there are many facilities for shopping, entertainment and refreshment. The accommodation is made up of single rooms on two storeys, with a bathroom shared between each two bedrooms. Three of the baths have assistance facilities. A passenger lift gives access for residents with restricted mobility to the first floor. Communally, there is a large lounge, casually sectioned into three smaller areas to create a more relaxed, intimate atmosphere. There is one dining room. Both the lounge and the dining room are south facing so they are bright and ‘catch the sun. There is a small kitchenette on the ground floor where visitors and residents can make drinks during the day. The home has a secure garden at the rear of the property and off-road car parking at the front of the home. A large proportion of the garden is gravel but there is a small area of lawn and shrubs for residents to sit in. The home’s philosophy of care is to provide the residents with a place that they feel is their own home and makes them feel comfortable and safe. Seathorne Court DS0000070081.V376978.R01.S.doc Version 5.2 Page 5 There is a copy of the latest inspection report and the home’s statement of purpose kept in the office; this is made available to people enquiring about the possibility of coming to stay at the home. The fees range from £361 to £500 for high dependency residents. The care home does not provide an intermediate care service. Seathorne Court DS0000070081.V376978.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This key visit was unannounced and any previous information held by the Commission for Social Care Inspection about the home was taken into account. Throughout this report the terms “we” and “us” refer to the Care Quality Commission. Before the visit the provider had returned an Annual Quality Assurance Assessment (AQAA). This gave us information about how the home is meeting the needs of the residents using the resources of the care home. It is normal practice to send out surveys to residents prior to visiting the home to obtain residents’ opinions regarding the service they are receiving. On this occasion there was not sufficient time available to obtain these surveys prior to our visit. However residents’ opinions were obtained by holding discussions on the day of a site visit. Their opinions are reflected within this report. The main method of inspection used is called case tracking. This involves selecting a proportion of the residents and tracking the care they receive, checking records, holding discussions with them and the staff who care for them, and observing care practice. The views of residents being case tracked and additional residents spoken to during the site visit are reflected within this report. What the service does well: The care home offers a comfortable and homely environment. Staffing levels ensure that the identified needs of the residents can be met. Staff stated that they receive training to ensure they have the skills to help the residents. Staff members stated that they feel supported by the home’s managers. Residents were satisfied with the quality of services being offered by the home. A resident stated “I cannot fault this home for the care and attention I receive.” What has improved since the last inspection? All of the requirements made at the last inspection were found to be met at this key inspection. The registered manager has reviewed care records to ensure that they provide sufficient information to ensure residents needs can be met safely using the resources of the care home. Care records were found to have improved since the last key inspection. The detail recorded in care records has been increased for each resident. Instructions and guidance for Seathorne Court DS0000070081.V376978.R01.S.doc Version 5.2 Page 7 staff to ensure residents’ needs are met were found to be recorded in individual care records seen at this visit. Risk assessments have been improved and contained detailed instructions to staff on how to manage any identified risk. There was evidence of residents being involved in the writing of their individual care records including formal reviews. 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. Seathorne Court DS0000070081.V376978.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection Seathorne Court DS0000070081.V376978.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A full assessment is completed before a new resident is admitted to the home to ensure that their needs can be met. EVIDENCE: We studied the initial assessment for four residents. Assessments were structured and identified the needs of each resident. They had been completed prior to the resident being admitted to the home. A detailed risk assessment was completed for each resident as part of the assessment. A risk strategy was in place in individual care plans where any risks were identified in order to prevent the resident from being injured. Letters are sent to new residents prior to admission confirming that their needs can be met. Seathorne Court DS0000070081.V376978.R01.S.doc Version 5.2 Page 10 Assessments described each residents wishes regarding the manner in which they wished care to be provided. They were signed and dated by the assessor and the individual resident. Risk assessments for the administration of medication were found to be in place. There was evidence found of residents consenting to medication being administered by staff where self-medication was judged to be unsafe.. Residents confirmed that they were in possession of a written contract for their stay at the home. A resident who had recently been admitted to the home stated “the home gave me all the information I needed to decide whether I wish to stay at this home. In addition they arranged for me to make a visit to see the home before I made any firm decision to stay here.” Seathorne Court DS0000070081.V376978.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the 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 have comprehensive care plans which guide staff on how to ensure all their identified needs are met. The updated medication procedure of the home is being followed which ensures the safe administration and storage of medication. EVIDENCE: The deputy manager stated that all care plans had been reviewed. They are now personalised and include detailed risk assessments, including risk management strategies when required. Seathorne Court DS0000070081.V376978.R01.S.doc Version 5.2 Page 12 The individual care plans seen contained essential information which included details of their general practitioner, community nurse, chiropodist and opticians. Details of the accommodation provided to each resident were recorded. There was a nutrition and dietary needs assessment on each resident’s file. The communication ability of each resident was assessed and recorded. The choices and wishes of individual residents in terms of diet, and choice of activities were found on their care plan. The residents’ choices about how they wished their personal care to be provided was found on all care plans seen There was evidence of residents’ families being involved in the writing of individual care plans. Staff stated that care plans are used as working documents and are regularly updated, and that they give guidance to staff around how each task should be carried out. They include instructions on how to ensure that the safety dignity and privacy of the residents is maintained. The home has a medication procedure for the safe administration and storage of medication. The registered manager and staff stated that only trained members of staff give out medication. Training records provided evidence that staff have received training in the administration of medication. The last pharmacy report was a positive one and contained no recommendations. A resident confirmed that they had a copy of their individual care plan and understood how much it costs them to stay in the care of home. They said “I cannot fault this home they look after us very well you get every attention you need.” A second resident said “I am a diabetic and the staff assist me to make sure I can take my insulin. My care plan tells staff what help I need and they make sure they look after me properly. I am very satisfied living in this home. I feel safe living here. ” Seathorne Court DS0000070081.V376978.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home are offered activities that are meaningful to them. People are assisted to make choices about activities and food, and to enhance their life. EVIDENCE: The activities offered to residents were set out in the Annual Quality Assurance assessment (AQAA) supplied to us by the home. Residents stated that they are happy with the range of activities offered. One resident stated “we have board games and bingo and the activity organiser makes sure that there is always something for us to do”. A second resident stated “entertainers come into the home and we go out into the community to take part in activities.” Some residents stated that they attend local churches for social events. A third resident said “we have a regular garden fete at the home and we love it when members of the public visit our home”. Seathorne Court DS0000070081.V376978.R01.S.doc Version 5.2 Page 14 Staff said the home encourages friends and relatives to visit and maintain links with residents. Relatives were seen to visit during the site visit. Residents confirmed that their families are made welcome. The company supplied a copy of the home’s menu. Residents made only positive comments regarding the food provided by the home. A resident stated, “The food is very good here”. Another resident said “The food here is excellent. We are given a second choice if we dont like the main menu for the day. A resident stated “I am happy with the menu which meets my own personal dietary needs. Staff ask us what kind of food we like. We also discuss the menu at the residents meetings. I have no complaints at all about the food.” Quality assurance questionnaires were seen and contained only positive comments regarding the food offered by the home. Seathorne Court DS0000070081.V376978.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We are have made this judgement using a range of evidence, including a visit to this service. The updated policy and procedures are in place to ensure that complaints are listened to and people are safeguarded. Staff are trained to protect residents from any potential abuse. EVIDENCE: The home has a complaints procedure which allows residents to raise any concerns which can then be managed. The registered manager stated that all residents are given a personal copy of the complaints procedure. Staff members stated that this procedure is explained to each individual resident when they are admitted to the home. Residents confirmed this statement to be correct. A member of staff stated, “There is a whistle blowing procedure in place. I feel confident that I could report any concerns about care practice”. A resident stated “we have regular residents meetings where we discuss the menu and any changes taking place within the home. I feel people listen to what we say. This makes it a lovely home to live in”. Seathorne Court DS0000070081.V376978.R01.S.doc Version 5.2 Page 16 The Annual Quality Assurance Assessment (AQAA) states all that staff have been trained in recognition of potential abuse and the protection of residents. Records and discussions with staff provided evidence that this statement was correct. The registered manager said that notifications have been completed but our records do not evidence that these have been received. It was agreed that the registered manager will review the notifications procedure of the home and ensure that notifications are sent to us appropriately. The registered manager agreed to monitor and record accidents to residents and staff more carefully. Seathorne Court DS0000070081.V376978.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home benefit from a safe, warm, comfortable and homely environment. EVIDENCE: Pre-inspection information shows that there is an ongoing maintenance programme for the home. On the day of the visit maintenance was being carried out. A number of bedrooms were being decorated. The Annual Quality Assurance assessment (AQAA) and observations provided evidence that new equipment and furniture have been purchased for residents. Seathorne Court DS0000070081.V376978.R01.S.doc Version 5.2 Page 18 A resident stated, “This home is marvellous, the new owner has decorated my bedroom and it really feels wonderful. It is bright and comfortable.” There were photographs and other personal items in lounges. Residents said that they can choose where they wish to spend their social time. Residents said that they were happy with their individual bedrooms and said that they found the home a comfortable place in which to live. Bedrooms and communal areas were found to be clean, tidy and homely in atmosphere. Information about things such as good hand washing procedures is on display around the home, and staff were seen to follow these procedures and make use of aprons and gloves where necessary. Records show that staff have been trained in infection control. There are risk assessments available for most substances that are hazardous to health. Seathorne Court DS0000070081.V376978.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home receive good care from staff that are appropriately recruited and trained. Staffing levels in the home allow staff to be deployed to meet the emerging needs of residents. EVIDENCE: Duty rotas show that there are 3 staff on each day shift with 2 waking night staff each night. There are also domestic and kitchen staff to support carers. The registered manager works in the home on Monday to Friday each week. Residents made comments such as “staff are well trained and know what they’re doing”, and “they know how best to help me and will do whatever I ask”. Staff records contain recruitment information such as application forms and criminal record bureau checks. Personal files contained proof of identity and including a photograph of the person. The registered manager demonstrated through the records that staff are being recruited safely. Seathorne Court DS0000070081.V376978.R01.S.doc Version 5.2 Page 20 Records show that staff are studying for, or have achieved nationally recognised care qualifications at various levels, and this was confirmed during discussions with staff. Training records demonstrate that 88 of care staff hold an NVQ two in care or an equivalent qualification. Records and preinspection information also shows that update training for subjects such as moving and handling, food hygiene, have taken place. Specialised training in dementia care has been given to some members of staff. Induction records show that staff are made aware of equality and diversity issues and staff demonstrated their understanding of these issues throughout the visit. There are also records of staff meetings, which show that they have opportunity to discuss things like training needs and rotas. Seathorne Court DS0000070081.V376978.R01.S.doc Version 5.2 Page 21 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the 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 is managed in the best interests of the residents, and there are good quality assurance systems enabling residents to contribute to the development of the service. EVIDENCE: Staff stated that all members of management are supportive and approachable, and they feel confident to go to them with any issues or Seathorne Court DS0000070081.V376978.R01.S.doc Version 5.2 Page 22 concerns. Residents said that staff are always around for them to speak to and always help them when they need anything. Pre-inspection information shows that regular residents meetings are held and quality assurance surveys are carried out. The deputy manager stated that minutes of residents meetings are recorded and distributed to all residents to enable them to be able to express their views about things like activities, entertainment and improving the general environment. The residents said they are very happy with the services that they receive and the activities provided. At the time of this inspection residents’ finances were being managed by the individual resident or a member of their family. The deputy manager stated they have procedures in place which instruct staff how to manage safely resident’s finances if they choose not to manage their own. The deputy manager said staff have annual appraisals. Staff confirmed this statement to be correct. All staff receive regular formal supervision. Staff said that the registered manager supports them in their work and helps them to develop their skills. There is a fire risk assessment in place, and a full and detailed risk assessment for the building. The registered manager has agreed to review this to ensure that all steps have been taken to protect residents from potential risk. Pre-inspection information shows that electrical equipment has recently been tested, and the heating and hot water system has been serviced. There are risk assessments in place for substances that are hazardous to health; and that there are policies for issues such as quality assurance, emergencies and crises, fire safety, health and safety, residents’ finances and record keeping. Seathorne Court DS0000070081.V376978.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x 3 x x n/a HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 X X X X X x 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Seathorne Court DS0000070081.V376978.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? N0 STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP37 Regulation 38.7 Requirement The Care Quality Commission (CQC) must be informed of any incident that affects the safety of residents. This is to ensure that CQC can satisfactorily monitor events in the home. Timescale for action 01/09/09 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP38 Good Practice Recommendations It is recommended that the registered manager reviews the risk assessment for the building to ensure any identified risk to residents is removed. Seathorne Court DS0000070081.V376978.R01.S.doc Version 5.2 Page 25 Care Quality Commission East Midlands Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: 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). 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. 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