Care Home: The Meadows

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What the care home does well What has improved since the last inspection? This is the first inspection of this newly registered service. What the care home could do better: Key inspection report CARE HOME ADULTS 18-65 The Meadows 25-27 The Meadows Shepshed Leicestershire LE12 9QJ Lead Inspector Keith Charlton Key Unannounced Inspection 3rd June 2009 15:00 The Meadows DS0000072976.V375656.R01.S.doc Version 5.2 Page 1 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. 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 home adults 18-65 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. The Meadows DS0000072976.V375656.R01.S.doc Version 5.2 Page 2 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 The Meadows DS0000072976.V375656.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Meadows Address 25-27 The Meadows Shepshed Leicestershire LE12 9QJ 01509 821744 01509 821883 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mrs Susan Spencer Mr. Paul Spencer Mrs Susan Spencer Care Home 10 Category(ies) of Learning disability (10) registration, with number of places The Meadows DS0000072976.V375656.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 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 categories: Learning Disability - Code LD The maximum number of service users who can be accomodated is: 10 This is a newly registered service. 2. Date of last inspection Brief Description of the Service: The Meadows is registered to provide care for ten adults with learning disabilities. The home is pleasantly furnished and decorated to a high standard. There is a well-maintained garden to the rear of the property. The Meadows is situated close to Shepshed town centre and there are a number of shops nearby. Residents attend a range of different activities, including local day centres and colleges. The home has its own mini-bus. Fees typically range from £354 to £1059 per week - this information was provided by the Manager after the inspection. There are costs for extras hairdressing, toiletries, holidays, transport etc. The home provides information to residents and prospective residents in the form of a Statement of Purpose and Service Users Guide that describes the services it offers, and these and the Inspection Report will be available so as to give a view as to the quality of life for residents. The Meadows DS0000072976.V375656.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. ‘We,’ as it appears throughout the Inspection Report, refers to ‘The Care Quality Commission. The focus of the inspections undertaken by the Care Quality Commission is upon outcomes for residents and their views of the service provided. The primary method of inspection used was ‘case tracking’ which involved selecting two residents and tracking the care received through looking at their records, discussion with the residents and care staff, and observation of care practices. The inspection took place between 3.00pm and 7.00pm. Planning for this inspection included reviewing all information on our system - the Annual Quality Assurance Assessment that the management completed about the home’s services, and we will include surveys regarding the satisfaction of residents and staff about the home when we receive them if this is before the publication of the final Report. The Commission has not received any complaints since the service was registered. The Inspector spoke with six residents, two staff members and the Manager on the telephone. Surveys were received from all ten of the residents and four of the staff. They were very positive about the standard of care the home provides. Comments are made in the Report regarding specific issues. What the service does well: Residents live in a stable community. They are satisfied with all the services provided by the home as they said during the inspection. Their opinions are sought as indicated by staff talking with them and by residents meetings. They are supported and encouraged to enjoy a positive lifestyle through varied activities, contact with the local community, and contact with family. There are few rules and they have freedom to have their bedrooms the way they like. The Meadows DS0000072976.V375656.R01.S.doc Version 5.2 Page 6 Staff know about the needs of each resident and this is helped by having detailed care plans outlining residents needs. Residents are encouraged to live an independent life. An example being a resident being able to bathe himself and lock the bathroom door for privacy. A choice of foods is always available to residents and there is emphasis on healthy eating. Staff were found to be positive, friendly and helpful in their dealings with residents. There is a detailed form available to supply essential information to hospital staff if a resident is admitted, there are no set rules residents have to follow and they can have their bedrooms the way they like. Staff are properly recruited and receive a comprehensive training in order to support the residents living in the home. Health and safety systems are in place to protect residents from harm. Facilities are always kept in a clean and tidy condition with no odours and decoration is of a generally good standard. Bedrooms are personalised and homely and residents said they can accommodate their personal effects – pictures, toys, TVs, music players etc. What has improved since the last inspection? What they could do better: It would assist with residents understanding if there were more pictures/ diagrams used for residents’ information – e.g. Quality Assurance Surveys, the Statement of Purpose and Service Users Guide that describe the services offered, the Complaints Procedure, etc., to make it easier for residents to understand this information. Residents would be able to achieve what they want to do in life if they all had person centred plans in place. The Meadows DS0000072976.V375656.R01.S.doc Version 5.2 Page 7 There needs to be evidence that all staff read care plans to ensure they are fully aware of residents individual needs. More outings have been requested by residents. The supper choices need to be made clear to residents so this choice is available. 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. The Meadows DS0000072976.V375656.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Meadows DS0000072976.V375656.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 2. People using the 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 Meadows have had their needs properly assessed before moving into the home. EVIDENCE: We case tracked a person living in the home. We checked that he had received information to help him/his relatives with the choice of home, but because the person could not recall it was not possible to check he had received this information. The Manager stated that a thorough assessment is done and that they were looking at providing more accessible information for residents who could not read. We also checked that the person now living at the home had their needs properly assessed prior to moving to The Meadows to ensure that the staff at the home could meet their needs. We found this to be the case as the Social Services assessment covered all important issues such as health, behavior, relationships, medication, sleeping, work and play, personal hygiene, safe environment etc. The Meadows DS0000072976.V375656.R01.S.doc Version 5.2 Page 10 The Meadows DS0000072976.V375656.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,9. People using the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents individual needs and choices of each person living at The Meadows are well documented and acted upon by staff. EVIDENCE: Residents could not remember having care plans though did not seem very interested in this document: We get all the care we need, one resident said. We looked at the care records of two people living at The Meadows. We found very detailed plans to support the care given to people who live at the home. There was a variety of useful information available to staff - Health Action Plans, Daily and Weekly Activities Logs, Accident and Emergency Sheets for The Meadows DS0000072976.V375656.R01.S.doc Version 5.2 Page 12 hospital visits etc, though no evidence of Person Centred Plans, which would record what residents want to achieve in the future and therefore meet their ambitions. There are also a number of risk assessments so that residents can be protected from all identified risks. Care Plans also contain detail as to how to encourage residents independence keeping their bedrooms tidy, helping in the kitchen etc. Staff said that they read Plans to ensure they can meet residents needs and keeping up to date with Plans is encouraged by management, though on the plans we saw only about half of the staff had signed to state they had read them. The Manager said that all staff read all the care plans during their first training shift and then every six months. We saw that care records were up-dated to ensure they reflected the changing care needs of people living in the homes. The Manager indicated that there had not been any accidents to residents since she took over as the owner. During our visit we observed staff being very friendly to residents and joking with them. There was some evidence that residents are able to live their own lives, e.g. going out to places in the community, choice of meal, choice of activities etc. The Meadows DS0000072976.V375656.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): This is what people staying in this care home experience: 12,13,15,16,17. People using the 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 Meadows have opportunities to have a varied lifestyle. EVIDENCE: Residents said that they were happy doing their activities: We go out and do different things and we can come home and relax when we like, one resident said. One resident said in a survey he wanted more activities at the weekend and another stated that they wanted to go out more. One staff member said in a survey that it would be useful to have smaller groups of residents going out as not everyone has the same interests. The Meadows DS0000072976.V375656.R01.S.doc Version 5.2 Page 14 We looked at the plans of people who live at The Meadows. There are weekly activity sheets in bedrooms to remind people what they are doing and daily activities are also recorded so that these can be checked and reviewed as needed to ensure residents needs are met. These showed us that residents are able to experience a varied social life. Some people go to college to learn life skills, and others have a variety of activities in the community to choose from. Residents have annual holidays and are going to Blackpool this year and residents were looking forward to this. We saw that staff are sensitive to the needs of people living at the homes. They were aware of the preferences of people in their daily activities. We saw staff talk to and interact well with people who live at each home. Residents said that they kept in contact with their friends and relatives and staff said they reminded residents to do this at times. There were some comments that more outings would improve residents quality of life. The Manager has stated that outings are offered but residents sometimes change their minds about going on them. We saw evidence of residents meetings to inform management how residents would like to see how the home is run. All residents said they enjoyed the homes food. We saw tea being served and people living at the home having a choice of meal of pasta with vegetables or chicken nuggets with chips and beans / tomatoes, which residents said they enjoyed. Menus were in place and had sufficient variety. There was reference in the homes staff meeting minutes to try to encourage healthy eating. A suggestion was made for residents to be able to enjoy a ‘summer’ and ‘winter’ menu so they are not getting the same choices all the year round. The Manager stated that menus are usually changed twice a year with residents input. There was also a comment that residents can only now have biscuits for supper, not toast and that male residents have more biscuits that female residents. The Manager said this was not the case and agreed to tell residents and staff of the proper choice that exists. The Meadows DS0000072976.V375656.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20. People using the 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 Meadows receive good support to meet their personal and healthcare needs. EVIDENCE: Resident said that staff call in the GP if they are not well. We looked at the personal and healthcare records of people who live at The Meadows. We saw that they have good access to healthcare services to meet their personal and healthcare needs as described in individual Care and Health Action Plans. There is a personal health booklet for hospital staff to be aware of a residents needs if an admission takes place. On talking to staff as well as looking at the records, we found that staff act quickly on concerns they have about peoples needs, and these prompt actions have resulted in a better quality of life for those concerned. The Meadows DS0000072976.V375656.R01.S.doc Version 5.2 Page 16 We looked at medication management and found that staff are administering medication appropriately to people who live at The Meadows, with no instances where medication was not signed as given. We saw staff records and these showed us that staff have undertaken training in the administration of medication. We were informed that new carers are given permission to administer medication when they are assessed as being competent and they attend an appropriate training course. The Meadows DS0000072976.V375656.R01.S.doc Version 5.2 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 22,23. People using the 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 at The Meadows can be confident that their concerns are noted and acted upon, and they are protected from abuse. EVIDENCE: Residents said that if they had a problem they were sure that staff would sort it out for them. There were some comments that a staff member had been curt with a specific resident on occasion though they thought it had been sorted out by the Manager. We spoke to the Manager about this and she confirmed that this was followed up as it was completely unacceptable behavior. We looked at the complaints procedure which was set out in detail though not written in a format which is not helpful for people living at The Meadows to understand, though the Manager said this is being looked at and will be done in an easy read format. One resident said in a survey that they did not know how to make a complaint. This needs to be explained at a Residents Meeting or similar. We saw good interaction between people who live in the home, and staff who support them. The Meadows DS0000072976.V375656.R01.S.doc Version 5.2 Page 18 The procedure gives the complainant the choice to go directly to the Lead Agency if they wish, instead of the home. The Manager said that there have been no complaints since she took over as the owner of the home. We saw by looking at staff training records, and by talking to staff that staff have a good understanding of safeguarding policies and procedures. Staff know what to do if they suspect that a person who lives in the home is being abused in any way. People who live in the home have their own bank accounts. Staff support people living at The Meadows in dealing with their money. We checked the financial records of two people living at the home, and found good recording of money transactions. The Meadows DS0000072976.V375656.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 24,30. People using the 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 Meadows live in a homely, comfortable environment. EVIDENCE: Residents said they liked the homes facilities particularly their bedrooms - We can use our bedrooms at any time and we can have them the way we like, one resident said. We looked at the communal areas of the homes and some of the bedrooms of people who live there. We found the communal areas to be satisfactorily decorated and homely. The bedrooms were decorated to reflect the personalities and preferences of the people using them. The Meadows DS0000072976.V375656.R01.S.doc Version 5.2 Page 20 We saw that the home was well maintained in general though there were some comments that the decor in some areas was shabby and that tiling in some bathrooms was odd as tiles had been laid on tiles without regard to design. The Manager said that these issues were to be addressed and three residents bedrooms decorated in the middle of June 2009. One resident said he was really pleased with his bedroom as he had come back off holiday last year to find he had a toilet/shower en suite which he really likes. The Manager may wish to consider having a sensory garden installed to provide added stimulation for residents, particularly those with dementia. The Meadows DS0000072976.V375656.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 32,34,35,36. People using the 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 in the home have satisfactory staffing levels and support from a motivated staff team. EVIDENCE: Residents said they liked the staff and saw them as their friends, Staff are nice and help us, one resident said. Staff and residents thought the home was properly staffed. Residents did not say it was a problem being able to speak to staff at any time. The staff rota indicated that when all residents were in the home, there were a minimum of two care staff on duty with an awake staff member at night. The Meadows DS0000072976.V375656.R01.S.doc Version 5.2 Page 22 We talked to staff and saw them supporting people who live in the home. We saw good interaction between staff and people who live in the home, and staff demonstrated a very good understanding of the needs of people living there. Staff said they were supported to do their job by management, and there is detailed induction training and on going training relating to the job they do, though no regular supervision, which is only offered to staff after staff meetings so they can choose to refuse this. This is a National Standard to ensure that staff are managed and supported in the delivery of quality care to residents so it is recommended. The Manager stated that staff are seen at least weekly and discussions take place then as needed. We found that over 50 of staff have National Vocational Qualification in Care to be able to provide skilled care. We looked at a sample of staff records, and saw that all the necessary checks were made to safeguard people who live at the home. We looked at training records and this confirmed that staff have undertaken relevant training to help them in their roles. Training included health and safety, medication management, food hygiene, first aid, epilepsy, communication, hand hygiene, MRSA, etc and there was a training plan in place to try to ensure that all appropriate training was in place for staff to have appropriate skills. The Meadows DS0000072976.V375656.R01.S.doc Version 5.2 Page 23 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 37,39,42. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Health and safety systems are in place to protect residents welfare. EVIDENCE: Sue Spencer is the Manager and Co owner of the Home. Sue has completed her management qualification in care to assist her in having the skills to run a home in the best interests of residents. Staff said they were supported in their work. There are staff meetings so that relevant issues can be discussed as to the proper running of the home. The Meadows DS0000072976.V375656.R01.S.doc Version 5.2 Page 24 There are quality assurance and monitoring systems in place, and we saw the questionaires that go out to all relevant parties to ascertain peoples views of the service so that improvements can be made if needed. The temperatures of water were seen to be regularly checked to ensure residents are protected from scalding water, although when we checked the water it was of a higher temperature than recommended. The Manager said that a new boiler system had been installed and this had affected the valves though they had now been adjusted to bring into line with the National Standard. Risk assessments are in place for safe working practices and fire risks were seen to be covered by regular testing and a fire risk assessment and proper fire records in place. The Meadows DS0000072976.V375656.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 4 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 3 X 3 X LIFESTYLES Standard No Score 11 X 12 4 13 3 14 2 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 4 X 3 X X 3 x Version 5.2 Page 26 The Meadows DS0000072976.V375656.R01.S.doc Are there any outstanding requirements from the last inspection? N/A STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA36 Good Practice Recommendations That staff receive regular one to one supervision to enable management to discuss work performance and any issues that are preventing a quality service being supplied to residents. That the frequency of outings is reviewed with residents involvement and increased accordingly. 2. YA14 The Meadows DS0000072976.V375656.R01.S.doc Version 5.2 Page 27 Care Quality Commission East Midlands Region Citygate Gallowgate Newcastle upon Tyne NE1 4PA National Enquiry Line: 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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