Care Home: The Cloisters

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What the care home does well The home is clean and has a homely atmosphere. One person told us that `they are happy` and have no complaints. Another person said `they look after us well`. A variety of comments were received about the food that was offered to the people. One person told us that `we have a good lunch and soup`. Another person pointed out and said `I like this kind of soup and we have choices`. We were told by a group of people that `we can have a cooked break fast or cereals`. It was said that the cook was very good and gave them `home cooked meals` and a real Sunday lunch`. It was said that this is `better than what you get in a restaurant`. The comments from the general practitioners were very positive about the home. Some of these include `residents happy` and `promote choice, mobility, motivation`. Positive comments were also received from the community and district nurses. Some of these comments include `staff always very pleasant and willing to help` and `residents always appear happy`. The hairdresser commented that this is `a very friendly happy home` and the `staff are always available when I need assistant`. The people told us that if they did not feel well, they would tell the staff and `they don`t hesitate to call the doctor`. One person said their husband had good care from staff when they were ill. The people told us that they like their bedrooms and the rooms seen were individualised to meet the people`s needs. One person said `I spend a lot of my time in my bedroom, I am happy here`. Compliment letters read showed that relatives were happy with the care provided at the home. The staff enjoy working at the home and it was said `I like working with the residents` The staff work very hard to meet the needs of the people. They get training to help them meet the people`s needs. They were observed talking and listening to the people and offering advice in a positive manner. They say they get good support from the manager and senior staff. What has improved since the last inspection? We were told that two bedrooms had been redecorated and new curtains and bedding was purchased. The deep fryer and several kettles were replaced. A new additional tumble dryer was replaced. The conservatory had new blinds put in to provide the people protection from the sun. The lounge was decorated with a new carpet, pictures and cushions and looked very pleasant. A new television was bought for the lounge area. The utility room was replaced. A new outside notice board was purchased. What the care home could do better: The home must ensure that all staff have Protection Of Vulnerable Adults (POVA) and criminal Record Bureau (CRB) checks before they start working at the home. This is to safe guard the people from any harm. The home should ensure all staff receives at least 6 supervisions per year to find out how they are working with the people in the home. Provide more daily activities for the people who wants to socialise and keep themselves active. Key inspection report Care homes for older people Name: Address: The Cloisters 1 The Cloisters Rectory Road Rushden Northants NN10 0HA     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: Ansuya Chudasama     Date: 1 8 0 5 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 Older People Page 2 of 26 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) 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 Older People Page 3 of 26 Information about the care home Name of care home: Address: The Cloisters 1 The Cloisters Rectory Road Rushden Northants NN10 0HA 01933356423 01933397446 mutualhomes@tiscali.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mutual Homes Limited care home 12 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The total number of beds registered in the home must not exceed 12. Date of last inspection Brief description of the care home The Cloisters is a care home providing personal care and support for up to 12 older people including one older person with mental health needs. The Cloisters Residential Care Home is owned by Mutual Homes and is managed by Mrs. Christine Chambers. The home is located in close proximity to the town centre of Rushden and its amenities. The premises consist of a listed building set in pleasant well-maintained grounds, which also accommodate retirement flats and bungalows. The retirement flats and bungalows are managed separately from the home and do not form part of the registration. The home comprises of six single bedrooms and three double bedrooms. A stair lift aids access to bedrooms on the first floor. However it is necessary to negotiate a few steps for access to four of the single bedrooms. Communal accommodation comprises a dining room, large lounge and conservatory. The manager provides, upon a request or enquiry, an information pack, which includes residents Care Homes for Older People Page 4 of 26 Over 65 12 0 Brief description of the care home guide and statement of purpose. The fees for residential care is four hundred and eighteen pound per week. Care Homes for Older People Page 5 of 26 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 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: This inspection was carried out in accordance with the Care Quality Commission (CQC) policy and methodologies which require review of key standards for the provision of a care home for older people that takes account of the peoples views and information received about the service since the last inspection. Evidence used and judgments made within the main body of the report include information from this visit. We looked at the Annual Quality Assurance Assessment (AQAA) that was sent to us by the service. The AQAA is a self-assessment tool that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service. We also looked at the information from the last key inspection and the records of any other visits that we have made to the home in the last 12 months. Information we have about how the home has managed any complaints and things that have Care Homes for Older People Page 6 of 26 happened in the home, which are reported under notifications and are a legal requirement are also looked at. The report refers to we this is because the report is written on behalf of the Care Quality Commission. We last inspected this service on the 5th of June 2007. This key inspection was carried out on the 18th of May 09. The registered manager was not working on the day of the inspection. The deputy manager helped out with the inspection process. During this inspection we tracked the care of two people who use this service. This involved reading their care records and also talking to them wherever possible to obtain their views on the service. We also spoke to most of the other people who live in the home. Documentation relating to staff recruitment, training and supervision, medication administration, complaints and health and safety were also examined. We had the opportunity to talk to some of the staff who were on duty and a tour of the home was also conducted. The current weekly fees range from four hundred and eighteen pounds per week for residential care. Additional charges are required to pay for hairdressing, news papers, magazines, and chiropody. Information on the cost for these services can be obtained from the home. Care Homes for Older People Page 7 of 26 What the care home does well: What has improved since the last inspection? What they could do better: The home must ensure that all staff have Protection Of Vulnerable Adults (POVA) and criminal Record Bureau (CRB) checks before they start working at the home. This is to safe guard the people from any harm. The home should ensure all staff receives at least 6 supervisions per year to find out how they are working with the people in the home. Provide more daily activities for the people who wants to socialise and keep themselves active. Care Homes for Older People Page 8 of 26 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 26 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 26 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. Needs assessments and visits are encouraged for all the people admitted to the home to ensure that their needs will be met. Evidence: The home has a statement of purpose and a service user guide which is kept near the foyer at the front so the people and their relatives can view this. The people spoken to tell us that their family had chosen the home for them to live in. It was also said that they were given information about the home when they visited the place. One person told us that we visited the home and liked it and came to the home. Another person said it looked clean and every one every one was nice and friendly and the bedroom seen was nice. Some people knew about the home because they used to come and have lunch and knew the staff. One person told us that they knew about the home prior to their admission and they had lived nearby. The peoples files looked at showed that there were assessment admission details of Care Homes for Older People Page 11 of 26 Evidence: the person being admitted to the home. All the people in the home have contracts and the people or their representative had signed this document. Care Homes for Older People Page 12 of 26 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The peoples personal and health care needs are met by the home. Evidence: We looked at two peoples care plans in detail and discussed their care needs with staff on duty. The staff showed that they had very good understanding of the care needs of the people. Evidence showed that these plans were being reviewed on a monthly basis and most of them had been signed by the people. The people were also able to see their plans when they asked for this. The care plans we saw clearly set out peoples support needs and preferences in receiving personal care. We observed staff interaction and noticed that they talked to people in a respectful manner and were careful to preserve their dignity. The people we spoke to informed us that the staff knocked on their doors and maintained their privacy and dignity when doing personal care. Examples of this were given when they were supported to have a bath. Care Homes for Older People Page 13 of 26 Evidence: Evidence in the care records showed that people are offered support for their physical and emotional health needs. There were records of district nurses, general practitioner, and hospital appointments, and people have access to the opticians, dentists, and other health care professionals. The people told us that if they did not feel well, they would tell the staff and they don t hesitate to call the doctor. One person said their husband had good care from staff when they were ill. The staff told us that the district nurse comes when they are needed and they are very good. Comments read from a district nurse stated that in my opinion the residents are well cared for in a dignified appropriate manner. We also spoke to a district who was visiting the home and it was said that this was a beautiful home and they had no worries about the people. The senior staff gave out medication and had received the accredited training. We observed staff giving out medication and this was done by talking to the people. There were medication profiles for each person. The medication records looked at showed that there were no gaps in the record. The home had a controlled drugs cupboard but no one in the home was having any controlled drugs. The records and medication checked was satisfactory. The staff told us that they have done the training on dying and death. We were told that there was information on burial arrangements. One person stated that the home had provided good care for their family member when they had passed away. A range of risk assessments are in place that enables the people to take risks as part of an independent lifestyle. Care Homes for Older People Page 14 of 26 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. Meals served are nutritious and plentiful with a menu, which changes each week so that the people have a balanced diet with choices to meet their needs. Evidence: We sat and observed the people having their lunch. This was eaten in a relaxed atmosphere with staff talking to the people and helping them in a kind manner. They were also observed calling people by their names. This was good practice. All the people spoken to said that the food cooked on the day was lovely. The food was presented nicely on a plate. A variety of comments were received about the food that was offered to the people. One person told us that we have a good lunch and soup. Another person pointed out and said I like this kind of soup and we have choices. We were told by a group of people that we can have a cooked break fast or cereals. It was also said that they are able to have meals in their own rooms. We were told that the cook was very good and gave them home cooked meals and a real Sunday lunch. It was said that this is better than what you get in a restaurant. We observed the cook talking to the people to ask them of their views of the food they had eaten, and if they wanted extras. The cook was also observed asking what they wanted for pudding from a variety of choices. We sampled the home cooked pudding Care Homes for Older People Page 15 of 26 Evidence: and this was delicious. One person went to the bathroom and the cook put their food in the kitchen to warn it up. We were told when families visited and they had lunch with their relative, this was offered in the conservatory so they had time together. The people told us that they liked their bedroom, and each persons bedroom seen was individualised to their taste. Some people enjoyed spending time in their rooms as they preferred this. We were also told that if they want any thing, staff will help me. The people and visitors to the home say that the staff are always warm caring and very helpful. Most of the people in the home maintain contact with their families and friends. The home had coffee mornings, church service and holly communion once a month. Some people went shopping with staff, or by themselves. They had quizzes and bingo twice a week. On Monday afternoons they had exercise to music. Some people told staff that they wanted a few more daily activities provided and this was also confirmed by talking to some people. The home did not have a peoples meeting but the people were spoken to individually by a staff member once a month. This was to find out if they were happy with their room, staff, food, and activities. They were also asked if they had any concerns or requests they needed to make. The out come was recorded and this was very good at getting the peoples views about living at the home. The garden was beautiful with lots of different flowers and plants. We were told that the people enjoyed sitting in the garden when the weather is warm. Care Homes for Older People Page 16 of 26 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. The staff have good understanding of the peoples behaviours to ensure they are protected from any abuse Evidence: The home has a complaints policy, and the procedures for making a complaint is recorded in the statement of Purpose and service user guide. The home has not received any complaints since the last inspection. The staff spoken to informed us that they had completed the safe guarding of vulnerable adults procedures training. They had good understanding of this and understood the peoples behaviours to know if they were unhappy or not feeling well. The home has not made any referrals to the safe guarding team of social services. Most of the people spoken to were capable of informing staff if they had any concerns. They told us that they would tell the manager or staff if they had any concerns. A member of staff also had one to one sessions with the people living in the home to find out if they had any concerns. The information read in the minutes showed that no one had any concerns or complaints to make. The home does not manage the peoples finances, this is managed by the people or their families. Care Homes for Older People Page 17 of 26 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 is clean and has a homely atmosphere to meet the peoples needs Evidence: A tour of the home showed that the place is clean and homely. The bedrooms seen were indivualised to the people and those spoken to tell us that they like their rooms and enjoyed spending time in them. One person said that they were very happy with their room and had bought some of their own furniture to make the place feel homely. The bedrooms in the home get decorated when they become vacant. We were told that six months ago the blinds in the conservatory were put in to provide shade in the room. The laundry and the kitchen were pleasant, clean and domestic in character. The down stairs and hall way carpet was replaced and the walls painted with a new boarder. The down stairs toilet with wet room was decorated. The lounge was decorated and a new carpet was put in. The room looked very pleasant with new pictures and new cushions. The people also told us that they liked the decoration in the lounge. The dining room was also very pleasant. The home has a stair lift and some people are able to use this independently and staff support those who need this help. We were told that the people like to sit outside in the lovely garden in the summer months. Staff spoken to said that the people love the garden and they take a few Care Homes for Older People Page 18 of 26 Evidence: people out for a walk around the garden. The people who are able to go by themselves do this independently. Care Homes for Older People Page 19 of 26 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The homes recruitment procedures are not robust, so there fore the people are not being safeguarded from potential harm. Evidence: The staff recruitment files were looked at in detail. Evidence showed that the home was not obtaining all the relevant information required to safe guard the people in the home from any harm. One new staff file looked at showed that the organisation had not undertaken a POVA or a new CRB check for working at this home. The home was using their criminal record bureau (CRB) check from their last employment. This was undertaken on February 09. The member of staff was suspended during the inspection process. The deputy manager got the CRB guidance from the computer and reassured us that no staff would be employed at the home until the proper checks have been received. New staff spoken to said that they received an induction at the home. This lasted 4 days and they shadowed a few members of staff. We were told that this was good. The staff told us that this training was very good and most of the staff had NVQ level 2 or 3 training. They received good in house and out side training. This was evidenced when looking at staff files. The deputy manager told us that the home was looking at doing the Mental Capacity Act training soon. Staff spoken to informed us that they were getting supervision but this was not happening at least six times a year. The Care Homes for Older People Page 20 of 26 Evidence: home did not use agency staff and we were told that there was enough staff on duty. We were also told that the home retains a lot of their staff and this provides continuity to the people. The staff say that they enjoy working at the home, and it was said that they looked after the peoples needs well. There was always drinks available for them all the time. One staff said they make you laugh and put a smile on your face and enjoyed coming to work. We were told that the home has staff meetings and these are good but more was needed. It was said that they all get on well as a team and one staff said that they are a lovely bunch. We were told that the staff have good training and they get involved in care planning. Care Homes for Older People Page 21 of 26 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is run in the best interest of the people and management is aware of the areas they need to make improvements to meet the needs of the people. Evidence: The manager of the home is qualified and has many years experience of running a home. The staff tell us that support from management and senior staff is fantastic and they listen to them. One of the district nurse told us that this is a beautiful home and they say to the manager that we want this doing, and she does it. Discussion with the manager after the inspection stated that the recruitment procedures will be followed (see section on staffing) and this was an oversight from them. Discussion with staff showed that they were receiving supervision but this needs to happen at least six times per year. The accident and incident records show that these were being recorded appropriately. It also showed when a person has a fall, a review of this takes place and the action to Care Homes for Older People Page 22 of 26 Evidence: be taken is carried out. The home had sent out questionnaires to the peoples families in March 08. The information from these questionnaires had not been analysed for other people to view. We read the feedback received from the general practitioners. The comments were very positive and some of these include residents happy and promote choice, mobility, motivation. Positive comments were also received from the nurses who visit the home. Some of these comments include staff always very pleasant and willing to help and residents always appear happy. The hairdresser commented that this is a very friendly happy home and the staff are always available when I need assistant. We were told that this years surveys were going to be sent out to the relevant people. We are aware that staff have one to one with the people but they should be sent questionaires to complete to find out their views on how the home is meeting their needs. The home has a newsletter and this is sent out to the relatives and the people to keep them informed of what is happening in the home. Some of the information include social events taking place, useful numbers of organisations, and new staff starting employment at the home . The fire alarm system was being tested on a weekly basis. The emergency lighting was done on a monthly basis. We were told that fire drill practice was also happening on a weekly basis. The Environmental health officer had visited in March 09 and awarded the home five stars which is very good. Care Homes for Older People Page 23 of 26 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 24 of 26 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 29 13 The POVA first check and CRB checks must be obtained prior to staff working at the home. This is to protect the people from any harm. 22/06/2009 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 12 36 Provide more daily activities for the people to socialise in the home. Provide staff at least six supervisions per year. this is to mointor how they are meeting the needs of the people. Care Homes for Older People Page 25 of 26 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. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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