Care Home: Shakespeare House

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What the care home does well We observed some good support with staff offering choices and person centred support. Staff speak calmly, encouragingly and respectfully to service users. Service users are involved in recruiting staff so they have a say about who may potentially support them. New staff complete an induction based on learning disabilities so they have underpinning knowledge about peoples needs. Staff use a person centred assessment tool to establish peoples needs and hopes for the future. This enables them to work out the support people need to achieve their goals. People are having support to achieve their personal goals and aspirations. Plans of support are produced in a way that people understand so they are meaningful and individual. Risks are identified and managed in a way that does not restrict people but enables them to take part. There are detailed plans to show what support people need with their personal and health care. Staff work closely with health professionals to make sure that peoples health needs are met. Most of the staff have a National Vocational Qualification in care. People said they have a good social life and have the support they need to access the community. People have had support to plan and book their individual holidays. What has improved since the last inspection? The requirements made at the last inspection have been met. The manager has completed the Certificate in Person Centred Support, an accredited learning disability qualification. Some communal areas have been redecorated. There is a new cooker and the garage has been cleared to create a games room, at the service users request. E learning has been introduced by the company for staff as a flexible learning tool that staff can complete at work or at home. Staff have training in subjects like person centred planning, active support, positive behaviour support and intensive interaction. This means they have the skills to give the right support. There is a new easy read complaints book. This has large pictures, photographs and symbols showing feelings, emotions and people to talk to. This means that service users can show how they are feeling without having to say anything. What the care home could do better: There are no requirements or recommendations contained in this report. The manager is working on producing an emergency and crisis plan for the home. This means that staff and service users will know what to do in an emergency. Key inspection report Care homes for adults (18-65 years) Name: Address: Shakespeare House 218 Folkestone Road Dover Kent CT17 9JF     The quality rating for this care home is:   three star excellent 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: Kim Rogers     Date: 2 7 0 7 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 28 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 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 28 Information about the care home Name of care home: Address: Shakespeare House 218 Folkestone Road Dover Kent CT17 9JF 01304202664 F/P01304202664 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: The Robinia Care Group Ltd care home 3 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum numbers of service users to be accomodated is 3. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Learning disability (LD). Date of last inspection Brief description of the care home Shakespeare House is a small home providing personal care and support for 3 people with learning disabilities. The home is owned by Robinia Care and is managed by Ms Karen Graham. Dover town centre is about one mile walk away, but locally there are small shops and pubs available. The home has its own car and there is also a regular bus service and trains from the main railway station. The house is well furnished throughout, providing comfortable living space for the service users. There is a large lounge/dining room and a kitchen, which also has space for dining. A small conservatory at the rear of the building is available as a quite area; this leads onto an enclosed courtyard garden that is accessible to all residents. Residents own rooms are on the first floor and provide good space, having been personalised. There is Care Homes for Adults (18-65 years) Page 4 of 28 Over 65 0 3 Brief description of the care home separate office and staff sleep-over accommodation. The fee for this home ranges from 1689 to 1723 pounds per week. For more information about the fee and what it includes please contact the Provider. Previous inspection reports are available from the Provider. Care Homes for Adults (18-65 years) Page 5 of 28 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: three star excellent service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This was an unannounced Key inspection of the service. This means that we assessed the Key Minimum Standards. The last Key inspection of this service was 07/08/07. We carried out an Annual Service review on 02/07/08. Copies of these reports are available from the Provider or can be viewed on our website. We spoke to people who use the service. We spoke to staff and the manager and sampled various records. We made observations and had a look around the home. We looked at the Annual Quality Assurance Assessment or AQAA. The manager completed this and it gives good information about how the home has improved and how they intend to improve further. We looked at any notifications from the home about accidents and incidents. We sent surveys to people who use the service and other stakeholders. People told us what Care Homes for Adults (18-65 years) Page 6 of 28 they think about the home. We received 3 surveys from service users and 4 from staff. All made positive comments about the service. Staff said I love working here, I look forward to coming to work. Service users said they like all of the staff and the manager is a nice lady. We found that outcomes for people in some areas are good and in other areas outcomes for people are excellent. We found that the home provides an excellent service. Care Homes for Adults (18-65 years) Page 7 of 28 What the care home does well: What has improved since the last inspection? What they could do better: Care Homes for Adults (18-65 years) Page 8 of 28 There are no requirements or recommendations contained in this report. The manager is working on producing an emergency and crisis plan for the home. This means that staff and service users will know what to do in an emergency. 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 Adults (18-65 years) Page 9 of 28 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 10 of 28 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. There is information available about the service. Person centred assessments are carried out to establish what support people need and want. Evidence: We found that there is some information about the home. This is produced in large print with symbols and has some photographs. This means that prospective service users have some information to help them decide about moving in. The AQAA says they plan to make the information about the home more user friendly. There are currently no vacancies at the home. We found that a person centred assessment called Listen to me is used to assess peoples needs and aspirations. The manager carries out assessments with people to make sure that the home can meet the persons needs. Assessments are regularly reviewed with service users. This means that any change in needs or goals can be identified and recorded. Care Homes for Adults (18-65 years) Page 11 of 28 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have the support they need to achieve their goals. Risks are supported and managed so that people are not unnecessarily restricted. People have the support they need with communication. Evidence: We found that each person has a service user plan. This details the persons needs and aspirations for the future. We found plans to be clearly written and up to date. Plans are person centred in that people have been fully involved in their development and are involved in reviewing plans. The plans tell you about the persons background and about the life they have had and about the life they would like to have in the future. The support needed is also recorded so staff know what to do to support peoples needs and goals. We found that plans are produced in a way that is meaningful to people so they can keep track of the progress towards their goals. People told us about their goals and Care Homes for Adults (18-65 years) Page 12 of 28 Evidence: about staff supporting them to achieve. We found that potential risks are identified and assessed. This is done with the person and usually the manager and the persons key worker. We found that risk assessments do not restrict people but enable them to take part. We found that risk assessments are regularly reviewed with the service user by the manager and key worker. This means that any change in need or new risks can be identified more quickly. We found that the way people prefer to communicate is recorded in individual plans. This is detailed and clear so staff know how to communicate effectively with people. This means that people have support to make choices and decisions. We observed staff communicating effectively with service users. Staff were patient. We observed staff offering choices to people including what they would like for breakfast, what they would like to drink and how they would like to spend their day. We found that the environment supports communication. For example a board shows photographs of the staff on duty. A menu is on display and a pictorial activity planner shows what activities are on offer. This means that people can find out about things for themselves rather than having to rely on staff telling them. Care Homes for Adults (18-65 years) Page 13 of 28 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have the opportunity to take part in a range of activities and feel part of the community. People have support to keep in touch with their family and friends. Everyone is involved in planning and preparing meals. Evidence: We found that there are opportunities for people to take part in various activities, in house and in the community. This includes opportunities for employment and life long learning. People said that they have enough to do and especially enjoy trips out like playing snooker at a local club with friends. One person said they especially enjoy going to college. They said they are getting more confident at college and have made friends there. Service users have had support to plan and book their holidays that are all individual. Care Homes for Adults (18-65 years) Page 14 of 28 Evidence: One person said they cannot wait to go on holiday. We found that relationships are supported. People have the support they need to keep in touch with and visit family and friends. Some people have the support of independent advocacy services. This means that they have independent support to speak out and make decisions. We found that service users are involved in planning and preparing meals. We observed people being given a choice of what to eat and drink and being given the time they need to eat. We observed people being encouraged to do as much for them selves as possible. We found that food likes and dislikes are recorded in individual plans. We found that special diets are supported and nutrition and weight is monitored. We found that there are snacks like fruit and drinks readily available so people can help then selves when they are hungry or thirsty. We found that service users are supported to be involved in things like the housework and cooking. One person said that they like to do their own ironing. This gives people the opportunity to take part, be involved and increase their skills. Care Homes for Adults (18-65 years) Page 15 of 28 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 have the support they need with personal and health care. Medication practice is safe and person lead. Evidence: We found that the support people need with their personal care is recorded in detail. This means that staff know how people prefer to be supported. We observed staff encouraging service users with personal care in a sensitive and discreet manner. We found that the support people need with their health is recorded in individual plans. Each person has a health action plan that shows staff what they need to do to support people to remain healthy and well. We found that the home has worked closely with health professionals to make sure people have the support and aids they need to remain well and healthy. Staff have training in areas related to health so they can give people the support they need. People have the support they need to attend health related appointments. Records of the outcomes of appointments are kept and changes made to the service Care Homes for Adults (18-65 years) Page 16 of 28 Evidence: user plan when needed. There are monitoring records completed by staff that highlight any changes so staff can act quickly when necessary. We observed medication administration by staff. We found that medication administration is person centred in that the staff enabled a person to take their medication in the way they prefer in the place they prefer. We found that staff have training before they are allowed to administer medication. We found that regular competency assessments are carried out by the manager to make sure staff are still safe to administer medication to people. The AQAA says that they plan to carry out more observations of staff administering medication to ensure safe practice continues. There has been an admission to the hospital accident and emergency department recently. The person concerned is having person centred support to recover and convalesce. Care Homes for Adults (18-65 years) Page 17 of 28 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People know their complaints will be listened to and acted on. People are protected from harm and abuse. Evidence: We found that there is a complaints procedure. This has large text and some symbols to make it user friendly. This is displayed in the home. There is also a new complaints book. This has laminated pictures and symbols that people can take out and stick to a board to show how they are feeling and to help show if they have a problem. There are individual photographs of who they might talk to so people can choose and stick the photograph to the board. This means that people have the opportunity to show what the problem is and how they are feeling without having to say anything. We found that people have confidence to speak out and make complaints. People said that staff will sort out their complaints. The Commission has had no complaints about the home since the last inspection. We found that there are policies about how people are safeguarded from harm and abuse. Staff and the manager have training in how to recognise and respond to abuse. The AQAA says that they plan to organise training for service user about abuse Care Homes for Adults (18-65 years) Page 18 of 28 Evidence: awareness. We found that staff have training in how to support problem behavior in a positive way. We found that people have positive behavior support plans showing things like triggers and distraction techniques. This means that staff have the guidance they need to support people in a positive way. People said they feel safe living at Shakespeare House. Care Homes for Adults (18-65 years) Page 19 of 28 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 is clean and well maintained. Evidence: We found that the home is clean and smells fresh. Service users confirmed this in the surveys we received. We found that each person has their own room which are personalised so look individual. One person showed us their bedroom and said they are happy with their room. A bathroom with WC is close to bedrooms. There is also a separate WC on the ground floor. There is a large lounge diner and separate kitchen with a dining area. Some parts of the home have been redecorated since the last inspection. The AQAA says that more redecoration is planned as well as some new carpets and furniture. The garage has been cleared as service users said they would like a games room. There is a dart board in the garage and plans for a games table. People can access all parts of the home as there are no restrictions. This means that people can go out into the garden and get fresh air and get drinks and snacks from Care Homes for Adults (18-65 years) Page 20 of 28 Evidence: the kitchen when they want to. Everyone has a key to their room. Service users said that they are supported to take part in the housework including the laundry and cleaning. This means that people have the support they need to be involved. Care Homes for Adults (18-65 years) Page 21 of 28 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. There are enough trained staff to meet peoples needs. Recruitment checks are robust protecting service users. Evidence: We found that there are enough staff to meet peoples needs. The manager said that extra staff can be called on when needed. The manager said that all staff are up to date with the required mandatory training and most of the staff have an National Vocational Qualification in care. Staff have training related to peoples needs including person centred planning, active support and positive behavior support. The company has introduced e learning for staff. This requires staff to use a computer to read about a topic and answer some questions about it to check they understand. The manager said that they will be getting a computer so staff can complete modules while at work or staff can work on this at home. The manager can keep track on which staff might need refresher training or more support. New staff complete an induction based on learning disabilities. This means they cover the underpinning knowledge they need. Care Homes for Adults (18-65 years) Page 22 of 28 Evidence: Staff said in the surveys we received that they have the training and support they need to do a good job. We observed staff encouraging people to do things for them selves and supporting people in a positive way. A service user said they like all of the staff and that the manager is a nice lady. Recruitment checks are carried out on new staff before they start work at the home. The AQAA and staff surveys confirm this. This protects service users. Service users are involved in meeting and interviewing prospective staff so they have a say about who may potentially support them. The home is currently fully staffed with some long standing staff who know service users well. We found that staff have one to one meetings regularly with a line manager. There is opportunity for staff to attend regular staff meetings. This means that staff can have discussions about the service and have some coaching and mentoring. The manager plans to have more frequent staff meetings. Care Homes for Adults (18-65 years) Page 23 of 28 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well managed and peoples health and safety is protected. People know that their views and opinions will be listened to and acted on. Evidence: We found that the management of the home is stable as the same manager is in post. The manager has several years experience and has been managing the home for just over two years. The manager is registered with us. This means that she has passed the fit person process. The manager has the qualifications required by the Minimum Standards and has an accredited qualification in learning disabilities, the Certificate in Person Centred Support gained after a year long course. The manager spoke with understanding and knowledge of peoples needs. There are plans to recruit an assistant manager to give more support to the manager and staff. The four staff surveys we received said that the manager is supportive. Care Homes for Adults (18-65 years) Page 24 of 28 Evidence: The manager completed the Annual Quality Assurance Assessment, AQAA. The AQAA is well completed and gives detailed information about how the home has improved and how they intend to improve further. The AQAA gives good information about how they promote and support issues relating to equality and diversity and how the home is good value for money. The AQAA shows that the manager has identified barriers to improvement and has plans of how to overcome these barriers so that the service still improves. The AQAA shows that the required health and safety checks are carried out on the premises and equipment. Staff have training in areas relating to health and safety which protects service users. The AQAA says that training is planned for service users so they have knowledge about food safety, fire awareness, infection control and health and safety. This means that service users will have the knowledge to take more responsibility in these areas. The AQAA shows that they use of range of ways to seek peoples views about the service. Service users have recently requested that they meet monthly instead of weekly to air their views about the service. This has been supported by the staff. People have advocates to support them to speak out and make informed choices and decisions. Surveys are sent out to people like care managers and relatives. This means they have the opportunity to give their views about the service. There are systems in place to check the quality of service including monthly visits by an area manager. Changes have been made based on peoples views including the clearing of the garage to create a games room. Service users now have the opportunity to attend staff meetings and have made changes to the menu and to the environment. Individual holiday choices and other goals like living more independently have been supported. Care Homes for Adults (18-65 years) Page 25 of 28 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 26 of 28 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 Care Homes for Adults (18-65 years) Page 27 of 28 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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