Care Home: Stonecroft

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What the care home does well The staff are friendly. They meet each persons needs well.Care plans are detailed.Staff will help to arrange health care when this is needed.Staff are well qualified and trained. What has improved since the last inspection? Staff have had medicines training.A manager has been appointed to oversee the home. What the care home could do better: Care plans need to be kept up to date.A more accessible vehicle is needed.Staff turnover is high. This needs to improve.Records need to be stored securely. Key inspection report Care homes for adults (18-65 years) Name: Address: Stonecroft Kibblesworth Gateshead Tyne & Wear NE11 0YJ The quality rating for this care home is: one star adequate 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: Lee Bennett Date: 2 9 0 7 2 0 0 9 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should:  Be safe  Have the right outcomes, including clinical outcomes  Be a good experience for the people that use it  Help prevent illness, and promote healthy, independent living  Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home:  3 stars – excellent  2 stars – good  1 star – adequate  0 star – poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area Outcome area (for example: Choice of home) These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement Care Homes for Adults (18-65 years) Page 2 of 32 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 32 Information about the care home Name of care home: Address: Stonecroft Kibblesworth Gateshead Tyne & Wear NE11 0YJ 01914103323 P/F01914103323 ntawnt.stonecroft@nhs.net Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Northumberland, Tyne & Wear NHS Trust care home 5 Number of places (if applicable): Under 65 Over 65 5 0 learning disability Additional conditions: The maximum number of service users who can be accommodated is: 5 The registered person may provide the following category of service only: Care home only - Code PC To service users of the following gender: Either Whose primary care needs on admission to the home are within the following category: Learning disability Code LD, maximum number of places: 5 Date of last inspection 3 0 1 0 2 0 0 8 Care Homes for Adults (18-65 years) Page 4 of 32 A bit about the care home Stonecroft is a home run by the National Health Service. 5 people can live here. It is a large bungalow, set in its own garden. There level access throughout. Bathrooms and toilets are easy to get in and out of. Everyone has there own bedroom. Nobody has to share. Care Homes for Adults (18-65 years) Page 5 of 32 There is a car here for people to use. This means people can get out and about Care Homes for Adults (18-65 years) Page 6 of 32 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: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home Care Homes for Adults (18-65 years) Page 7 of 32 How we did our inspection: This is what the inspector did when they were at the care home The Inspector talked to the people who live at the home. The inspector looked documents that have to be kept. He looked at: Care plans. Staff files. Medicine records. Some of the homes policies and procedures. (Policies are rules about how to do things. Procedures tell people how to follow the rules.) Care Homes for Adults (18-65 years) Page 8 of 32 The inspector looked around the home. This was to make sure it was safe and comfortable. What the care home does well The staff are friendly. They meet each persons needs well. Care plans are detailed. Care Homes for Adults (18-65 years) Page 9 of 32 Staff will help to arrange health care when this is needed. Staff are well qualified and trained. What has got better from the last inspection Staff have had medicines training. Care Homes for Adults (18-65 years) Page 10 of 32 A manager has been appointed to oversee the home. What the care home could do better Care plans need to be kept up to date. A more accessible vehicle is needed. Care Homes for Adults (18-65 years) Page 11 of 32 Staff turnover is high. This needs to improve. Records need to be stored securely. If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact Lee Bennett St Nicholas Building St Nicholas Street Newcastle upon Tyne Tyne and Wear Care Homes for Adults (18-65 years) Page 12 of 32 NE1 1NB 01912333300 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line - 0870 240 7535. Care Homes for Adults (18-65 years) Page 13 of 32 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 14 of 32 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Each persons needs are assessed before admission and updated thereafter. This is to make sure the home and the staff team can meet peoples identified needs. Evidence: All of the people living here have done so for some time now, and nobody has moved in since the last inspection in 2008. Information about the home has been developed should someone wish to move here however, due to the local Councils review of the service it is unlikely that anyone will move here until this has been concluded. After a person moves here their needs are periodically reviewed and if necessary reassessed. This is done with the involvement of a social worker, or other care professional, as well. For example, one person has had their needs looked at by a community nurse, and a Speech and Language Therapist. This is to make sure Stonecroft remains the right place for people to live, and that staff have clear information to guide their care. It is from these reviews and reassessments that plans of care are developed. We found that these are not always up to date, reflecting changing needs, or signed as read by staff. Social Workers have reassessed each service users needs, as the Council is reviewing this care home as a whole. Copies of these assessments have been passed on Care Homes for Adults (18-65 years) Page 15 of 32 Evidence: to the manager of the home for reference. Care Homes for Adults (18-65 years) Page 16 of 32 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people living here benefit from clearly planned care, but care plans are not always up to date. Up to date information is important for service users and staff to be well informed about what care and support is to be offered. Evidence: To help guide the care that staff offer to the people living here, a care plan file is compiled. All of the people living here have had one developed. These are all written up, evaluated and reviewed by the manager and a key worker; a member of staff who works with a named service user and takes a lead on the planning and delivery of care. Due to the high levels of staff turnover, there has been little consistency in key worker allocations, and therefore care plans have not always been kept up to date. Some work is currently ongoing to update care plans, and Northumberland, Tyne and Wear NHS Trust plan to introduce a new care plan format across its community services. The care files contain extensive and detailed information on each persons needs, and are written in a person centred way. The care practice that we observed generally reflected the guidance in the care plans, but some aspects such as eating meals is not accurate. Care plans are signed by staff to evidence their having read the content, but many current staff have not Care Homes for Adults (18-65 years) Page 17 of 32 Evidence: signed these off. Closely linked to care planning arrangements are risk assessments. Again, these are written up by a key worker when there is an identified area of risk, either to the service user, or to others by that persons behaviour or needs. They follow a standardised format, and detail the area of risk, consider the benefits of certain risks being present, and outline how unnecessary risks are to be managed. We found that areas of risk were being documented for relevant aspects, such as eating, behaviours that challenge the service, activities and manual handling. Again, the read and sign arrangements are only partially completed, making it unclear if staff have familiarised themselves with key areas of risk. By developing care plans and risk assessments staff are documenting important decisions about how people lead their lives and are supported. Due to the communication needs of the people living here, the staff team have to be mindful and observant of the way in which peoples views are expressed and the way these are communicated. Care Homes for Adults (18-65 years) Page 18 of 32 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people living here are assisted to spend their time in an active and fulfilling way. This can help promote each persons sense of wellbeing. Evidence: On the day of the inspection, some of the people living here were spending their time at home, relaxing or watching TV. Other people were out with the support of staff. The people living here lead a lifestyle reflective of their age, interests and preferences. They have opportunities to meet up with family and friends and also have their own vehicle to help get further afield. This vehicle is not fully accessible for everyone (the previous minibus having not been renewed). The current vehicle is due to be returned to the lease company soon, and no replacement is currently planned. We were told about the activities people enjoy, and some people receive the help of an Enabler, a member of staff specifically employed to help people to participate in activities. There is now only one Enabler employed across Gateshead, with no plans to recruit to the vacant posts. Staff have nevertheless tried to maintain regular activities, but for more Dependant people this may mean they only get out the house once or twice a week. Care Homes for Adults (18-65 years) Page 19 of 32 Evidence: As well as going out and about or being occupied whilst in the home, contact with friends and relatives can affect the quality of life enjoyed by people. The people living here have variable family contact, but staff help arrange visits and for people to keep in touch. As well as having rights to keep up family contacts and to lead a varied and fulfilling lifestyle, the people here retain rights around how they are helped, and what staff do when they put themselves at risk of harm. To help meet these rights there is some guidance in care plans and risk assessments. The information in these is largely up to date (although read and sign arrangements are not consistently used). Nevertheless, long serving staff were able to explain to us clearly the individual needs of each person living here, any risks they may face, and how these are managed. Meals form an important part of peoples daily routine and lifestyle, and arrangements are made to ensure this is a relaxing time and people dont disrupt one anothers meal. The dietary needs of each person are detailed in their care plans, and there is a record kept of meals planned and provided. Each person is also weighed, although, again this is not always up to date. Where help and prompting is needed staff were able to explain the help they offer, with guidance also being available in each persons care plan file. This is so staff follow good practice guidelines, as this can often have important health implications for the people living here. Care Homes for Adults (18-65 years) Page 20 of 32 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. Each individuals personal care and healthcare needs are supported by systems that ensure privacy is respected and that health and welfare is monitored and maintained. Medication is safely handled. Evidence: The people living here have their personal and healthcare needs explained within their case files. This is so staff are clear about what support they need to offer. Each persons needs are supported and met, where appropriate, in private. Specialist support and input has been sought and obtained where necessary, and multi-disciplinary input (such as that from the Community Learning Disability team) is made available. As well as making sure healthcare advice is sought, the acting manager, and other staff in the team, help the people living here to access healthcare treatment. This is so people get the help and healthcare they need to keep well. The results of healthcare visits and routine monitoring is recorded within each persons care file. This can help ensure that staff follow any advice and guidance that has been made by the healthcare professional. Linked to these health and personal care arrangements is the support given with medication. Due to their levels of need, service users are not able to administer their own medicines, and designated staff will help in this area. The staff we spoke to told us they Care Homes for Adults (18-65 years) Page 21 of 32 Evidence: have received relevant medication administration training (the safer handling of medication course and training on the use of specialist medicines). This has been supplemented by in-house guidance and competency testing. The medicines themselves are stored in a locked cupboard to keep them safe. There is only a small amount of loose stock, the rest being held in a monitored dosage system. This is where tablets are placed into a blister pack system by the pharmacist. Once given out staff write down who has had what medicine on printed administration records. A brief check of the medicines used here was carried out by us. The medicines we looked at were properly accounted for, records were clear and guidance in place for special forms of medication. Care Homes for Adults (18-65 years) Page 22 of 32 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Clear systems help protect people from neglect, abuse and self-harm. Evidence: A clear, written complaints procedure is available at the home. There have been no complaints reported to us since the last inspection. Because of peoples communication needs it is not always possible for people to make direct comments on the quality of care they receive. Staff have therefore to be mindful of each persons behaviour, gestures, and body language to gauge how they feel. The staff here have also received training on adult safeguarding and abuse awareness matters. More training on adult safeguarding is planned. Both the care providers and the local councils adult protection procedures are available here for staff to refer to. Care Homes for Adults (18-65 years) Page 23 of 32 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Stonecroft provides a homely and comfortable environment that meets peoples current and changing needs. Evidence: Stonecroft is an adapted care home. It is a bungalow, and has various adaptation (such as accessible baths and lifting aids) to help ensure it is suitable for the people living here. There is an enclosed and accessible garden, and private car parking space. Overall the home is domestic in style, and each persons bedroom has been personalised to suite their individual tastes. There is a large main lounge, a small, quite lounge and kitchen / diner. This means people can have a choice of who they spend their time with, or be able to spend time on their own. The home is clean throughout and there is good odour control. The home was being decorated at the time of this inspection to keep it clean and fresh looking. Stonecroft is a comfortable home, and the people living here appear relaxed and at ease in their surroundings. Care Homes for Adults (18-65 years) Page 24 of 32 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. The people living here are supported by a well trained and qualified staff team, but consistency has been affected by high levels of turnover. Evidence: There has been substantial turnover at this home over the past year, with only 3 out of the 10 staff employed here a year ago still working at the home. For new staff recruited here care providers have to carry out robust pre employment checks. This is to ensure unsuitable people are not employed here. We were not able to see the staffing recruitment records as these are held elsewhere, however this has been agreed with us, and are periodically checked on a random basis. These checks have found that Northumberland, Tyne and Wear NHS Trust has robust pre-employment checks in place, including checks for criminal convictions, against the Protection of Vulnerable Adults List, and reference checks from previous employers. Overall staffing levels remained unchanged, however there is now only one Enabler employed across the whole the Gateshead area, which has impacted the level of support available for planned activities. At the time of the inspection, 7 out of the 10 support staff were qualified to NVQ level 2 in care [or higher]. The staff here also undertake periodic training on topics relating to safety and care. We found that all staff had received a one day mandatory course, covering topics such as first aid, health and safety, fire safety and moving and handling. Other topics have included equality and diversity, epilepsy and Care Homes for Adults (18-65 years) Page 25 of 32 Evidence: mental health awareness training. Training is one of the topics discussed at each staff members supervision session. These are one to one meetings that are held between a staff member and manager to discuss their performance, training needs, personnel and personal matters. Actions are agreed where necessary. These occur on a regular basis, to allow staff to feel supported and informed about developments at the home. Care Homes for Adults (18-65 years) Page 26 of 32 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users benefit from a generally well managed home, where quality and health and safety matters are regularly checked, but where records need to be more carefully stored. Effective management can help ensure the service remains focused on the needs and safety of the people who live here. Evidence: Stonecroft is overseen, on a full time basis, by a temporary manager. She is supported by a deputy manager. The registered manager is a registered nurse and qualified to NVQ level 4 in management. She also attends periodic training to keep abreast of current good practice. As well as ensuring her own knowledge and practice remains up to date, the manager undertakes a number of quality checks and audits to ensure the standard of care is up to current good practice levels. More senior managers also carry out periodic inspections, although these are not always carried out on a monthly basis. The views of the people living here are sought on a formal basis at house meetings. This gives people an opportunity to discuss matters affecting the running of the home, menus and planned activities. Over time a large amount of records can build up, these will include Care Homes for Adults (18-65 years) Page 27 of 32 Evidence: confidential records relating to service users and staff. We found that a large quantity of such records were being stored in the garage in unlocked cabinets, and also a shopping trolley. During the period of the inspection these were fully accessible to people on site, potentially including the contractors who working on site at the time. Just as the quality of the care provided is checked, so are matters affecting health and safety. Therefore regular checks on the building are carried out, water and fridge / freezer temperatures are monitored, and working practices that could present a risk are looked at, and safe ways of working (for instance by the use of lifting aids) introduced. There were no hazards to health and safety observed. Care Homes for Adults (18-65 years) Page 28 of 32 Are there any outstanding requirements from the last inspection? Yes  No  Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No Standard Regulation Requirement Timescale for action 1 6 15 Service user plans must be reviewed to take account of changes in circumstances. 30/01/2009 This will support people through a period of transition in their lives. Care Homes for Adults (18-65 years) Page 29 of 32 Requirements and recommendations from this inspection Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No Standard Regulation Description Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set No Standard Regulation Description Timescale for action 1 17 13 Where practical service users 25/09/2009 must be weighed regularly. This is to ensure that their health and wellbeing is being regularly monitored. 2 33 18 Enabler staffing hours need to be reviewed. 21/09/2009 This is so there is sufficient staff time devoted to supporting service users with planned activities. 3 39 26 The registered person (or person delegated by him) must ensure the home is inspected on a monthly basis. 21/09/2009 This is to ensure that the quality of the service here is subject to regular checks and Care Homes for Adults (18-65 years) Page 30 of 32 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set No Standard Regulation Description Timescale for action scrutiny. 4 41 17 Confidential records must be 21/09/2009 stored in a safe and secure manner. This is to ensure that peoples confidences are protected. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 6 Staff working in the home should use the read and sign arrangements for care plans and risk assessments to evidence that they aware of what each service users needs are and that they know how to meet these. The vehicle used by service users should be fully accessible for all of the people living here. 2 13 Care Homes for Adults (18-65 years) Page 31 of 32 Helpline: Telephone: 03000 616161 or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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