Care Home: The Firs, Paignton

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Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: The Firs, Paignton 60 Upper Manor Road Preston Paignton Devon TQ3 2TJ The quality rating for this care home is: two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Michelle Finniear Date: 2 0 0 4 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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 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 Commission for Social Care Inspection aims to:  Put the people who use social care first  Improve services and stamp out bad practice  Be an expert voice on social care  Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Reader Information Document Purpose Author Inspection report CSCI Page 2 of 35 Care Homes for Adults (18-65 years) Audience Further copies from Copyright General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI 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 35 Information about the care home Name of care home: Address: The Firs, Paignton 60 Upper Manor Road Preston Paignton Devon TQ3 2TJ 01803523191 01803523191 thefirs@havencare.com 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) : Havencare (Plymouth) care home 4 Number of places (if applicable): Under 65 Over 65 4 4 0 0 learning disability physical disability Additional conditions: Date of last inspection 2 4 1 0 2 0 0 8 Care Homes for Adults (18-65 years) Page 4 of 35 A bit about the care home The Firs provides care for up to four adults with learning disabilities and who may have additional physical disabilities. The Home is a detached property with level access to local shops, amenities and public transport. Each resident has a separate flatlet with its own bedroom, lounge and en-suite bathroom facilities for maximum privacy. There is a large communal lounge and dining room, which has level access into an attractive enclosed garden. Also on the ground floor are an Care Homes for Adults (18-65 years) Page 5 of 35 office, laundry and large kitchen. The Firs has rooms on the ground and first floor with stairs leading to the first floor which could be a problem for a resident with mobility problems. Fee levels were not available for this inspection. Copies of the most recent inspection report are available in the home. Care Homes for Adults (18-65 years) Page 6 of 35 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: two star good 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 35 How we did our inspection: ..\..\..\Program Files\Picture Bank 2008 VA\images\DIFFEREN This is what the inspector did when they were at the care home To find out what the home was like we asked the manager to give us some information about how they run the home and support people; we visited the home when they didnt know when we were coming; we talked to the staff and the people at the home; T_DIS_PEOPLE.GIF we looked at the records and how the home supports people; we looked at what people can do when they are living there; Care Homes for Adults (18-65 years) Page 8 of 35 and we looked round the building to make sure it was a nice place to live. What the care home does well People have lots of space of their own so they can spend time away from other people if they want. The staff have lots of training so they know how to support people well. Care Homes for Adults (18-65 years) Page 9 of 35 There are good care plans which tell staff what people like to do and about the support they need. People can do things they enjoy on their own or with other people. They can choose what they want to eat and do each day. There are holidays they can go on. The home is near shops and the sea front. Care Homes for Adults (18-65 years) Page 10 of 35 What has got better from the last inspection The staff have had training in peoples rights as well as how to support them well. There are more staff to help people. There are new sofas and some areas have been redecorated. The home has made sure the care plans are better, and that people who live at the home help write them. Care Homes for Adults (18-65 years) Page 11 of 35 What the care home could do better The manager needs to make sure that risks for First aid and the trampoline in the garden are thought about. The manager should make sure the home looks after food safely to stop people getting ill. The manager should make sure that staff are clear about when and why to give when required medication. This helps to make sure people only get medication when they need it. Care Homes for Adults (18-65 years) Page 12 of 35 The manager and deputy manager need to make sure that staff are supported to do their job well. There need to be enough staff on duty to meet peoples needs. The manager needs to make sure that things people write in questionnaires about how the home runs are listened to and are put into plans to make things better at the home for people who live there. If you want to read the full report of our inspection please ask the person in charge of the care home Care Homes for Adults (18-65 years) Page 13 of 35 If you want to speak to the inspector please contact Michelle Finniear 33 Greycoat Street London SW1P 2QF 02079792000 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 14 of 35 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 15 of 35 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 . Information is available about the home, but this could be presented in more accessible ways for people. People would receive a full assessment before a decision was made about whether the home was the right place for them. Evidence: The Firs has a statement of purpose and a service user guide available which gives information about the home for people considering moving there to live. This has been updated since the last Inspection visit to include changes in legislation. The guide is not in an easy read format at the moment, and discussion has previously been held on making this more accessible to people who may be thinking about moving in. It is felt by people at the home that the people currently living there would not currently benefit from this being made available in other formats, such as pictures or on a video. When we visited there were three people living at the home, and one vacancy. No new people have been admitted for several years, but there are policies and procedures in place to enable this to happen. These would ensure people have a full assessment undertaken before any decision was made about whether the home could meet their needs. This would also include trial visits to see how people already living at the home Care Homes for Adults (18-65 years) Page 16 of 35 Evidence: felt about the person moving in. Each person who lives at The Firs has a contract with the home. This explains what people can expect to receive for the fees paid and information about their rights. These are not written in ways that are easy to understand for people. Copies have been given to the relatives or supporters of people at the home. Care Homes for Adults (18-65 years) Page 17 of 35 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Care is well planned. People can have a say in the way they lead their lives. Evidence: Each person living at The Firs has an individual plan which shows the support they need and how they would like that support to be given. Plans for the three people living at the home were seen and discussed with observation then being made of how the plans were being implemented during the day. Plans were built around positive behavioural support in particular for one person, with support for challenging behaviours based on positive and planned, ethical principles. Plans had goals for people to aim for and develop peoples strengths rather than looking only at areas where they needed support. Plans also included communication assessments and this included explanations of in one case how the person expressed contentment or distress, as they were not able to do so verbally. This helps to make sure staff understand what the person is communicating. Plans were being reviewed regularly and included input from the person themselves and their relatives. This helps make sure that plans are based on Care Homes for Adults (18-65 years) Page 18 of 35 Evidence: what people want to do. A review meeting was being held during the site visit. The person was at the review and was able to have their say about the home and the care they received. The plans seen had areas which were written in an accessible format for example including symbols and pictures and there was a healthcare assessment, which identified peoples wishes in relation to health care needs, including screening. Peoples views on this were respected, even though it might put the person at an increased risk of ill health. Risk assessments identified areas of peoples daily lives where there were risks, and attempted to reduce them without depriving people of opportunities to develop new skills and have new experiences. A risk assessment was needed for the garden trampoline. People living at the home have opportunities to make decisions about the running of the home and in their daily lives. People were seen making choices about what and when they ate, what they did during the day and the staff they wanted to support them. As an example, during the visit one person requested some additional staff support for a trip they wanted to make later in the week, which was agreed. Care Homes for Adults (18-65 years) Page 19 of 35 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People living at The Firs have opportunities to follow their chosen lifestyles with support where needed. Evidence: People living at The Firs have very differing needs, but the home offers spacious accommodation so people do not feel like they have to mix all the time if they dont want to. Each person has their own lounge area and bedroom with en-suite facilities which means people can be completely self contained if they wish to have some private time. Activities are recorded for each individual daily. People are encouraged to take a part in the life of the home and household tasks, for example shopping for food and gardening. One persons plan showed they take their clothes to the laundry each day and how they help to make their bed. During the visit one person went to Torquay with two members of staff and another went independently into Paignton to do some shopping. The third person stayed in Care Homes for Adults (18-65 years) Page 20 of 35 Evidence: their room with music and television. At lunchtime there was a barbeque in the garden. Some people at the home are funded for 2:1 staff time, and others for individual time per day. However where there have been staffing problems this has sometimes not been easy to maintain. The home has a vehicle available to help with accessing the local community. They have also recently purchased a wheelchair for one person which has helped them while out of the home. The vehicle is paid for by Havencare ltd. The home have told us they are trying to increase the involvement of people living at the home in the local community. One person has already had a holiday this year and others are being planned. The home have told us that people can use local clubs and facilities, and visitors are welcome at any time. Arrangements for a visit were being made during the site visit. Some sensory items have been bought in particular for one person and there is a summerhouse outside where people can go and sit in fine weather. There is a garden trampoline and outdoor seating in a safe enclosed private garden. The home has a menu plan which varies according to peoples choices. For example on the day of the visit it was a warm sunny day, so the planned lunch was changed to a barbeque to fit in with peoples choice. The evening meal was Roast Beef. One person chose not to eat lunch at the home but go out and buy themselves something in a cafe. Staff on duty cook the meals, and help has been sought from the community dietician on healthy meal choices and weight management. Care Homes for Adults (18-65 years) Page 21 of 35 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People who live at the home have the support they need to maintain their health care. Evidence: The files seen for people living at the home showed assessments are undertaken of their healthcare both for now and for the future. Information is available on particular disorders and discussion was held on staff training in physical illnesses as the people living at the home are getting older and beginning to require additional support in some areas. Healthcare screening is offered to people, however some of the people living at the home dont want to take this up. Their choices and views on this are respected, and the manager said that the local general practitioners are good at helping and supporting people with a learning disability. A new wheelchair has been purchased for one person to enable them to spend more time out of the home, and we talked about making the home more suitable for people with mobility problems, such as easier bathing facilities. At the moment no-one at the home needs to be hoisted or support to move. People have access to regular reviews by consultants and these include regular medication reviews. This helps to make sure Care Homes for Adults (18-65 years) Page 22 of 35 Evidence: that people are getting the best treatment for them. We also looked at the way the home looks after peoples medication, and there is a new policy for this. The home uses a monitored dosage system, which means that medication is supplied in a series of blister packs. This helps to reduce the risk of mistakes and makes it easy to check that medication has been given out. The medication storage remains in the laundry room, which is not ideal in terms of fluctuations in temperature and humidity. The home has a homely remedies policy which is a list of medication obtained over the counter that can be given to people without a prescription. The prescribing instructions for some of the as required medications need to be made clearer by the doctor. This means a plan should be agreed for when they are to be given and how often. This helps to ensure people are given only the medication they need. Care Homes for Adults (18-65 years) Page 23 of 35 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 . The homes policies, procedures and training for staff help to protect people from abuse and abusive practices and maintain their rights. Evidence: Havencare (Plymouth) has a corporate complaints procedure which is available in each home. The procedure sets out how to make a formal complaint, and gives information on organisations outside of Havencare to whom complaints can be made. This helps to make sure that if people have concerns about the company they know who to go to who can look independently at any issues. It is understood that some people at the home would have difficulties in telling people if they were unhappy about something. However the homes staff are clear about the ways people may communicate distress or unhappiness and would try to work through a range of strategies to try to identify what the problem was. Additional support may be sought from behavioural support teams to facilitate this. Staff at the home have received training in Adult protection and safeguarding. The manager and deputy have also attended training in the Mental capacity Act and Deprivation of liberty safeguards. This training is to be rolled out to all staff. Some areas of documentation have been amended as a result of this legislation. In the last year the home made a safeguarding referral concerning a member of staff. This was investigated by the police and the local care trust. The member of staff is no Care Homes for Adults (18-65 years) Page 24 of 35 Evidence: longer working at the home. The referral shows the home acts appropriately to support and protect people. Care Homes for Adults (18-65 years) Page 25 of 35 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . The Firs is clean, comfortable and homely. People have their own spacious accommodation. Evidence: Each person living at The Firs has a suite of rooms, including a living area, bedroom and bathroom. This means people can choose to spend time on their own in comfort or mix if they wish. There is a communal lounge and dining room, sun room and a summerhouse owned by one person and used by them as a sensory room. There is an enclosed garden which is private and has a trampoline and outdoor seating. The home is close to local shops and transport services, churches and is level to the sea front. All areas of the home seen on this visit were clean and reasonably well maintained. There are plans for upgrading of some accommodation this year with a redecoration of the exterior of the home, redecoration of the hallway, lounge and dining room and the fitting of a new kitchen. In the last year the home have bought new sofas and decorated and refurbished one persons room. The laundry room was clean and the home has policies for the management and prevention of cross infection. The home is yet to implement a system for the safe Care Homes for Adults (18-65 years) Page 26 of 35 Evidence: management of food. Regular environmental audits are carried out on the premises and the company has a maintenance person who can undertake smaller renovations and repairs. Contracts are available for the maintenance of gas and electrical systems and the appliances in use at the home are tested for electrical safety. The home has had a recent rewiring check. Radiators are covered to prevent people coming into contact with hot surfaces and hot water is regulated to ensure people cannot be accidentally scalded. Care Homes for Adults (18-65 years) Page 27 of 35 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . The staffing levels need some clarification to ensure they meet the identified needs of people living at the home. Staff are well trained. Staff supervision needs to be given consistently. Evidence: On the site visit time was spent looking at the staffing arrangements at the home. Staff have job descriptions and the file for the most recently appointed person was seen. This showed that the home follows through a full recruitment programme when people come to work at the home. This includes criminal records bureau checks and should help make sure that people at the home are cared for by people who are suitable to be working with potentially vulnerable people. At the time of the visit staffing levels were under review. People who live at the home are funded for some hours when they have staff to themselves, but this had not always been happening due to staffing problems. The home has recently increased their staffing hours and has a package of benefits for staff, which they hope will help them find more new staff. The home can for example offer flexible hours to meet caring responsibilities. New staff have a probationary period and follow an Induction programme to make sure they understand their role and the way people at the home like their care to be given. Care Homes for Adults (18-65 years) Page 28 of 35 Evidence: They have access to a full training programme and core training updates in areas such as care of medication, Autism and managing challenging behaviours. The home has a programme for supervision of staff which is a system of 1:1 interviews with staff and management looking at how the person carries out their role and whether they need any additional support. This programme has fallen behind the recommended level of six times a year, but has a good system for support. Staff routines each day are decided upon and recorded on the daily co-ordination sheet. This helps make sure people are aware of their duties that day and who is responsible for which tasks. The manager of the home is involved in auditing other homes owned by Havencare Ltd. and managers of other homes come to look at The Firs. This helps to make sure the companys policies and procedures are being applied in the same way. The staff seen on duty supporting the people living at the home were clear about their roles and were consistent in the way they were managing peoples needs. Care Homes for Adults (18-65 years) Page 29 of 35 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 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 being well managed. Evidence: The home manager has worked for Havencare for 11 years, and has been the registered manager of The Firs for over five years, having previously been the deputy manager. She is well trained and experienced, and has started the new leadership and management qualification, as has the deputy manager. The home has a system for involving people in having a say about the quality of the services provided, through a series of questionnaires. These needs to be bought together into an annual development plan for the home, so that people can see what has changed as a result of their comments. The home is currently subject to regular audit from within their organisation and last year a full review of the service against the National Minimum Standards was undertaken. This will also help the home make sure they know what is working well and what can be improved. Health and safety seen at the home was being managed well, and staff have training in working safely. We talked about checking how often the Legionella assessment Care Homes for Adults (18-65 years) Page 30 of 35 Evidence: needs to be undertaken, which is done to make sure the water is safe from bacteria. The home has a Fire Risk assessment and regular infection control audits. These help to make sure the home is safe from fire and risks of infection. Information is available on chemicals and cleaning materials in use at the home. A First aid risk assessment is still needed. Care Homes for Adults (18-65 years) Page 31 of 35 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 Care Homes for Adults (18-65 years) Page 32 of 35 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 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 9 20 A risk assessment should be undertaken for the garden trampoline. Protocols need to be agreed for as required medication. This is so that people are clear why and when the medication is to be given, and how often. Staffing levels should meet the assessed needs of the people being cared for. Staff should receive supervision six times a year. This is to ensure they are working to their full potential and in the same way to support people. Information gathered from the homes questionnaires, internal and external audit systems should be incorporated into an annual development plan for the home. This will help ensure that the management is aware of peoples views on what is working well and what could be improved about the home. The home should ensure that First aid risks are assessed 3 4 32 36 5 39 6 42 Care Homes for Adults (18-65 years) Page 33 of 35 and appropriate measures put in place to control them. This would include staff training and equipment. Care Homes for Adults (18-65 years) Page 34 of 35 Helpline: Telephone: 03000 616161 or Textphone : 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. 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