Care Home: St Marks Nursing Home

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What the care home does well The home is well managed and this is reflected in the low staff turnover. There is a long standing staff team which has created a stable environment for the residents. The manager is very effective and she and her senior nursing team are well thought of by residents, staff and relatives. The care staff and ancillary staff are very professional in the way they conduct themselves. The residents and relatives made very positive comments about the home and the staff. Staff were described as very caring, very good at their jobs and also very professional in the way they conduct themselves. Some of their comments in: "This is the best home in the area". "We are never bored. There is always something to do". "My mum is well looked after,and that is what is important". "I can`t fault the staff here, they are alright". "You will be hard pressed to find any faults with the place". The home has good admissions procedure and residents and relatives confirmed that they were given the opportunity to visit the home and to see it for themselves before they decided on coming to live there. The staff are very enthusiastic in ensuring that the residents engage in meaningful social and recreational activities. There are several indoor and outdoor fund raising activities organised by the staff to raise money towards the residents` funds. What has improved since the last inspection? Since the last key inspection the manager has reviewed the care plans and has improved on these to provide detailed information about the care needs of the individuals and how best those needs are to be met. The two minor recommendations that were made at the last inspection have been addressed. What the care home could do better: There were practices relating to the service of meals that needed to be reviewed and improved upon. The inspector observed that there were no salt or pepper on the tables, and no one was asked if they wanted any of these. The inspector observed two instances where the care staff were carrying food by hand, without a tray to residents in their rooms. The food was not covered. It was also noticed that ancillary staff who were assisting residents with their food were wearing the same tabard (protective clothing) that they wore when they were carrying out their domestic duties.Some staff have not had training in some of the statutory training areas, or needing refresher training in these areas. Key inspection report Care homes for older people Name: Address: St Marks Nursing Home 145 Hylton Road Millfield Sunderland SR4 7YQ     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: Sam Doku     Date: 2 5 0 3 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 27 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 27 Information about the care home Name of care home: Address: St Marks Nursing Home 145 Hylton Road Millfield Sunderland SR4 7YQ 01915674321 01915655834 janinevlaws@aol.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Dr Lim Wyn Name of registered manager (if applicable) Mrs Pauline Jane Laverick Type of registration: Number of places registered: care home 35 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: Date of last inspection Brief description of the care home St Marks Nursing Home is a purpose built home registered to accommodate up to 35 older people who require nursing care, including up to 4 with physical disabilities. There are 15 single bedrooms on the ground floor and 19 bedrooms on the first floor, one of which is a double room. A number of lounges and sitting areas are available including a designated smoking lounge on the first floor, and dining areas, which is situated within the lounges on the ground floor. En-suite facilities are not provided but there are adequate and accessible bathrooms and toilets situated around the Home. There are two floors that can be accessed by a passenger lift and stairs. The corridors and door widths allows easy access in and around the Home for wheelchair users. The home is situated slightly above ground level but can be easily Care Homes for Older People Page 4 of 27 Over 65 35 0 0 4 Brief description of the care home accessed via a graduated ramp path. The home is located with very easy access to shops, community facilities and public transport, and within easy reach of the city centre. It is also within relatively easy reach of the seacoast. The scale of charges for living at the home is between 408 to 513.30 Pounds per week. Care Homes for Older People Page 5 of 27 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating of this service is 3 Star. This means the people who use the service experience excellent quality outcomes. The inspection was unannounced and commenced on 23 March 2010 and completed on the same day. Before the visit the inspector looked at: Information we have received since the last inspection visit on 7 February 2007. How we dealt with any complaints and concerns since the last inspection. Any changes to how the home is run. The providers view of how well they care for people, as highlighted in the details provided in the Annual Quality Assurance Assessment (AQAA). During the visit the inspector did the following. Talked to the people who use the service, the manager and the care staff. Looked at information about the people who Care Homes for Older People Page 6 of 27 use the service and how well their needs are met. Looked at other records which must be kept. Checked that staff have the knowledge, skills and training to meet the needs of the people they care for. Looked around the home to make sure it is safe and secure. Checked what improvements have been made since the last inspection. The inspector told the manager what he found. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations - but only when it is considered that people who use the services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. Care Homes for Older People Page 7 of 27 What the care home does well: What has improved since the last inspection? What they could do better: There were practices relating to the service of meals that needed to be reviewed and improved upon. The inspector observed that there were no salt or pepper on the tables, and no one was asked if they wanted any of these. The inspector observed two instances where the care staff were carrying food by hand, without a tray to residents in their rooms. The food was not covered. It was also noticed that ancillary staff who were assisting residents with their food were wearing the same tabard (protective clothing) that they wore when they were carrying out their domestic duties. Care Homes for Older People Page 8 of 27 Some staff have not had training in some of the statutory training areas, or needing refresher training in these areas. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 27 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides good information about the home, including invitation to visit the home, which enable prospective residents to make decisions about the home. All residents are assessed before admission and on admission, to make sure that the home has the necessary skills and facilities to look after the residents thus promotes their welfare and wellbeing. Evidence: There is good information about the home and the services they provide. This information is in the form of a service user guide which is available to all prospective residents and their families. The guide is readily available and relatives who were spoke with confirmed that they have received copies of the service user guide. A copy is also available on the public notice board in the reception area. The manager explained the policy of the home regarding admission process. All Care Homes for Older People Page 11 of 27 Evidence: prospective residents and their families are offered the opportunity to visit the home and to see the place and assess it for themselves before making decisions about coming to live at St Marks Nursing Home. The inspector spoke with two visiting relatives about the admission process and they both described how they visited the home on behalf of their mother and the help that they received from the staff when they visited the home. The manager explained that most often it is the relatives who visit to view the home on behalf of their relatives. She stated that this is particularly the case when the prospective resident is very frail or suffers form dementia. The residents files show that the home always carries out a pre-admission assessment before admission is offered. The files also contain assessments carried out by social workers and nurse assessors. These assessments form the basis of care plans for looking after people. Care Homes for Older People Page 12 of 27 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The residents receive care that is consistent with their personal and healthcare needs. Furthermore, the home has good procedures in place for administration and safe handling of medication. Evidence: Each resident has a care plan that details the individuals care support needs. The plans are regularly reviewed and updated to reflect the current care needs of the residents. Staff were spoken with about the individual care plans and they indicated that the plans provide them with helpful instructions about how best to look after each resident. Staff confirmed that the care plans are easily accessible, but also the nursing staff regularly update them on the content of individual care plans. All the care plans are reviewed on monthly basis. The manager stated that where possible, relatives and residents are included in the review process. Evidence of access to healthcare facilities were documented in the residents personal files and in the daily report sheets. The records show that the residents have access to healthcare facilities including GP support and other healthcare professionals including Care Homes for Older People Page 13 of 27 Evidence: speech therapist, tissue viability specialist nurse, optician, chiropodist, dentist, occupational therapist and dietitian. Residents confirmed that the staff always call the GP when they need their service. The records also show that the residents are supported to attend outpatients appointments. Residents and relatives spoke about the excellent care that they receive at the home. A number of residents were visited in their rooms. For the residents who require intensive care, there were records in their rooms which show how their needs are being met. These records include fluid balance and positioning charts. These have been appropriately completed and were up to date. The residents who were nursed in bed were well looked after and staff regularly monitor them to make sure that all the observations and the necessary charts are filled in and are up to date. Risk assessments have been carried out to make sure that diet and food intake is adequate, and also skin integrity is maintained. The home maintains their policy on resuscitation, based on the local health care trust policies and guidance. One nurse who was spoken with stated that the resuscitation policy decision often involves a number of care agencies and crucially the resident and the relatives. The home has details policies on the storage and administration of medicines. These are followed by the nursing staff who have overall responsibility for the administration of medicines in the home. A random check of the medicines administration system was undertaken by the inspector. There were no discrepancies noted. All the drugs administration records were appropriately maintained. The inspector spent sometime on the floor observing care practices. The staff treat the residents with respect and dignity. The interaction between the staff and and the residents was good. Staff were courteous, friendly and professional in the way they interacted with the residents. Staff were observed to knock on bedroom doors before entering. Care Homes for Older People Page 14 of 27 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The residents have meaningful activities which enhances the wellbeing. Furthermore, the spiritual needs of the residents are promoted by suitable arrangements for pastoral visits to the home. The residents are provided with good variety of wholesome and nutritious meals, which promotes their health and wellbeing. However, the food safety and hygiene practices were not always up to the required standards. Evidence: Residents and visitors commented positively on the activities that are organised for them. The notice board provides details of weekly activities that the residents engage in. These include weekly church services on Wednesdays, music, singing, bingo and quiz games. Care plans identify people recreational, social and spiritual needs. There are regular residents meetings and the minutes from the meetings show that the staff take these meetings seriously. Residents are able to express their views on issues relating to their care and also on social activities. One resident said that she finds it useful and said that the staff always act on the outcome of the meetings. Care Homes for Older People Page 15 of 27 Evidence: The dinning areas are pleasantly decorated and furnished. Some residents have their meals in places that they prefer. For example, on the day of the inspection, a number of residents decided to have lunch either in the their rooms or in the lounge where they feel more comfortable. The dinning tables were appropriately set and residents had their meals in pleasant and comfortable environment. Examination of past menus show that the home provides choice of menu for the residents. Those residents with special dietary needs are catered for. The presentation of liquidised meal for one resident was good. There were however, practices relating to the service of meals that needed to be reviewed. The inspector observed that there were no salt or pepper on the table, and no one was asked if they wanted any of these. The inspector observed two instances where the care staff were carrying food by hand, without a tray to residents in their rooms. The food was not covered. It was also noticed that ancillary staff who were assisting residents with their food were wearing the same tabard (protective clothing) that they wore when they were carrying out their domestic duties. Care Homes for Older People Page 16 of 27 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents and relatives have information about how to make a complaint and are confident that any concerns raised would be acted on by the home, thus promoting their right to express their views about the service. Staff are aware of safeguarding adults procedures and have received suitable training which safeguard the safety and welfare of the residents. However, training in Deprivation of Liberty Safeguards should be provided to all staff to safeguard the rights of the residents. Evidence: The complaints procedure is posted in the reception area and a summary of the procedure is in the service user guide. The inspector had a look at the complaints book and it was evident that the home takes complaints seriously. The record show details of two complaints that were received in 2009/2010. These were thoroughly investigated, including details of witness statements. Relatives were spoken with about the homes complaints procedure and they all said that they are aware of the procedure and would know what to do if they have any concerns. The majority of that staff have had had training in safeguarding adults. The training record shows that although the vast majority of that staff have had this training, a Care Homes for Older People Page 17 of 27 Evidence: significant number of staff need need this training and others need a refresher training. Staff who were spoken with were familiar with the homes policy on safeguarding vulnerable people. However, the training in Mental Capacity Act Deprivation of Liberty Safeguards should be extended to all staff to provider a greater awareness and to ensure that the staff are aware of their duty to safeguard the rights of the residents. Care Homes for Older People Page 18 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides safe, secure, clean, warm and pleasant environment for the residents to live in. Evidence: The home is clean and maintained to good standard. The bedrooms that were visited were clean and personalised, reflecting individual tastes and preferences. People have been encouraged to furnish their rooms with personal items which enhanced the homeliness of their rooms. There are good arrangements in place for regular maintenance work in the home. The maintenance book shows that the handyman has kept on top of any safety work that is needed to maintain a safe environment. These include fire safety checks hot water temperatures and drills. The home has suitable infection control policies in place. Staff have had training in infection control and records show that the home has adhered to effective infection control procedures. The central kitchen was noted to be clean and maintained to very high standard. There is a cleaning rota showing how the domestic staff keep up with the cleaning activities in the kitchen. Records relating to food temperatures and other food hygiene Care Homes for Older People Page 19 of 27 Evidence: measures are maintained. The laundry was found to be well ordered, and appropriate COSSH notices are in place. The laundry machines are suitable for cleaning foul linen. Care Homes for Older People Page 20 of 27 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The staffing numbers are satisfactory and promote the safety and welfare of the residents. Furthermore, the manager adheres to good recruitment practices, which safeguards the welfare of the residents Evidence: The inspector examined the staff rotas for the past four weeks and noticed that the home employs sufficient number of staff to meet the needs of the residents. The staff, residents and relatives that were spoken with stated that there is always sufficient staff on duty to meet the needs of the residents. The staff have had appropriate training to equip them for their roles. The manager confirmed that the staff have received training in moving and handling, first aid, protection of vulnerable adults, fire safety, food hygiene and health and safety training. This was confirmed in the staff training log that was available in the home which shows the percentage of staff with relevant training. However, some staff are due for refresher training in some areas, including moving and handling, food hygiene, infection control and fire safety. Four files belonging to recently appointed staff were examined to check on the recruitment process by the registered manager. The files show that the home has been following their policy on recruitment. All the files contain completed job Care Homes for Older People Page 21 of 27 Evidence: applications, copy of job description, appropriate references, evidence of CRB checks and record of training. The manager confirmed that all staff have received enhanced CRB check. Care Homes for Older People Page 22 of 27 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience 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 managed by a qualified and experienced person who runs the home for the benefit of the residents. There are suitable arrangements in place for ensurung that the staff receive regular supervision. This promotes the quality of the service that the residents receive. The safety and welfare of residents is protected fully by the regular servicing and safety arrangements that are in place. Evidence: The registered manager has a long experience of managing a nursing home. She is supported by a deputy manager manager who is also a registered nurse. the managers style of management was praised by staff, residents and relatives. she was described as an excellent manager, competent manager, very caring, good at her job. One staff member commented that it is the managers manner and her respect for staff of grade that resulted in such high moral amongst the staff team. One Care Homes for Older People Page 23 of 27 Evidence: other staff member said that most staff like working at the home and have been there for a long time because of the way she and her senior staff manage the home and the staff. There is a quality assurance system in place for seeking the views of the residents and visitors to the home. The registered manager described the procedure for ensuring that the service is under constant review taking into consideration the views of the owner, residents and relatives. The weekly audit checks include medication system, accidents and general health and safety measures. There are suitable arrangements for staff to receive one-to-one supervision from the registered manager. Staff records show that the manager has provided individual supervision to staff on regular basis. Staff commented that they find the supervision sessions useful. There are Health and Safety policies remain in place. These cover policy areas such as fire prevention and Care of Substances Hazardous to Health (COSHH). These polices have been adapted from the Croners standards policies. There is evidence that staff adhere to the policies as set by the company. Servicing records confirm that all portable appliances have been tested. A record is maintained of regular water temperature tests are maintained in the home. Regular servicing of fire equipment, passenger lift, bath lifts and hoists, gas and electrical appliances have been carried out by the contracted companies. All the servicing records that were examined were up to date. These included servicing of passenger lift, hoists, water treatment, electrical installation and gas servicing. Records examined indicate that fire precautions relating to weekly fire alarm testing and record of inspection takes place. There are records in the home indicating fire drills and fire instructions with staff. Residents and relatives commented that the unit manager and the manager run the home for the benefit of the residents. Care Homes for Older People Page 24 of 27 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 25 of 27 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 15 12 The manager must provide training to staff in safe food handling to safeguard the health and welfare of the residents. Staff were carrying food to residents without covering the food. Also domestic staff were assisting residents with their food whiles wearing the same protective clothing they had on while they were undertaking domestic duties that morning. 01/06/2010 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 2 17 30 Training in Deprivation of Liberty Safeguards should be provided to all staff to safeguard the rights of the residents. An up to date statutory training should be provided to all staff. These include moving and handling, Fire safety, food hygiene and infection control. Care Homes for Older People Page 26 of 27 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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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