Care Home: TNP House

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What the care home does well TNP is a small service that provides a warm homely atmosphere when entering the home. There is a very relaxed and friendly atmosphere between staff and people using the service. The staff employed at TNP have been at the home for between 3 years to 12 years, providing consistency for the people using the service. The home provides clean, well maintained, comfortable accommodation. People using the service we talked to told us that they were happy at the home, and that the staff were "kind and look after us". What has improved since the last inspection? Requirement regarding Criminal Records Bureau checks has been dealt with. Criminal Records Bureau and Protection of Vulnerable Adults checks for the last person employed were seen by us. Requirement regarding staff training has been dealt with training records and matrix in place. Fees are now included in the Service Users Guide and Introductory letter including transport costs and hourly rates for staff accompanying people on hospital visits. Medication is dispensed direct to the person and signed as given. Medication training has been carried out with an external training company, nine out of twelve staff attended. External trainer has visited the home to do Safeguarding Training, ten out of twelve staff attended. The provision of two wash basins in double bedroom has been explored with the plumber, and the proprietor has been told it is not a viable option. Mandatory training is now identified on the training matrix. Quality assurance questionnaires are now sent out to professionals, those that had been completed and returned were seen by us. All staff now receive supervision with the Care Manager. Weekly food intake charts are now put in place where necessary.TNP HouseDS0000005029.V377843.R01.S.docVersion 5.2 What the care home could do better: Provide a more detailed Annual Quality Assurance Assessment. Key inspection report CARE HOMES FOR OLDER PEOPLE TNP House 15 Comberford Road Tamworth Staffordshire B79 8PB Lead Inspector Kathryn Marks Key Unannounced Inspection 29th September 2009 09:00 DS0000005029.V377843.R01.S.do c Version 5.3 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 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. TNP House DS0000005029.V377843.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 TNP House DS0000005029.V377843.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service TNP House Address 15 Comberford Road Tamworth Staffordshire B79 8PB 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) 01827 316177 01827 68857 janine.owen@homecall.co.uk TNP Homecare (UK) Limited Janine Owen Care Home 12 Category(ies) of Dementia - over 65 years of age (7), Old age, registration, with number not falling within any other category (12), of places Physical disability over 65 years of age (7) TNP House DS0000005029.V377843.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: Old age, not falling within any other category (OP) 12 Dementia - over 65 years of age (DE(E)) 7 Physical disability - over 65 years of age (PD(E)) 7 The maximum number of service users who can be accommodated is: 12 9th September 2008 2. Date of last inspection Brief Description of the Service: TNP is a family run residential care home that offers a home for 12 people over the age of 65. The Home is set in a large detached house with an extension at the rear. The property is located in a pleasant area of Tamworth and has a rear garden, which has recently been improved. There is adequate car parking space at the front of the Home. The Home has two lounges and a separate dining room. There are six single bedrooms and three shared bedrooms. En-suite facilities are provided in five of the single rooms and in one of the shared rooms. There is a lift to the first floor. There are two assisted baths and a recently added assisted shower. The fees charged depend upon the room and services needed for each person. The people using the service need to pay extra for chiropody, hairdressing, toiletries, alcohol, newspapers and luxury items such as sweets and chocolates. A small charge is made for transport costs and the hourly staff costs if they accompany a person on visits, including hospital visits. Fees charged are identified in a welcoming letter, and the Service users Guide. A copy of the most recent inspection report is available upon request from the home. TNP House DS0000005029.V377843.R01.S.doc Version 5.2 Page 5 TNP House DS0000005029.V377843.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 Star. This means that people who use this service experience Good quality outcomes. This unannounced Key Inspection was carried out on Tuesday 29th September 2009 by one inspector who used the National Minimum Standards for Older People as the basis for the inspection. The last Key Inspection was carried out on the 9th September 2008. On arrival for this inspection the care manager/proprietor and one care worker were on duty. The cook and a second care worker came on duty shortly after we arrived. The care manager provided written information regarding staffing, staff training, menu and dietary provision that were observed to be in place at the home. We discussed with the care manager the arrangements for the day, to avoid disruption to people using the service, staff, and routine of the home. We spoke to all the people using the service in lounges or bedroom areas. We also spoke to a relative who was visiting a person using the service. Three peoples care records were reviewed, and the records of three members of staff, including recruitment and training records. We discussed food with people living in the home, talked to the cook, and observed lunch being served. We also looked at the Annual Quality Assurance Assessment (AQAA) this is a self assessment tool but, did not contain a lot of detail. The AQAA was sent to us prior to the inspection. Completion of the AQAA is a legal requirement and it enables the service to undertake a self assessment, which focuses on how well outcomes are being met for people using the service. Outcomes could not be assessed from the information provided in the AQAA we received. TNP House DS0000005029.V377843.R01.S.doc Version 5.2 Page 7 What the service does well: TNP is a small service that provides a warm homely atmosphere when entering the home. There is a very relaxed and friendly atmosphere between staff and people using the service. The staff employed at TNP have been at the home for between 3 years to 12 years, providing consistency for the people using the service. The home provides clean, well maintained, comfortable accommodation. People using the service we talked to told us that they were happy at the home, and that the staff were “kind and look after us”. What has improved since the last inspection? Requirement regarding Criminal Records Bureau checks has been dealt with. Criminal Records Bureau and Protection of Vulnerable Adults checks for the last person employed were seen by us. Requirement regarding staff training has been dealt with training records and matrix in place. Fees are now included in the Service Users Guide and Introductory letter including transport costs and hourly rates for staff accompanying people on hospital visits. Medication is dispensed direct to the person and signed as given. Medication training has been carried out with an external training company, nine out of twelve staff attended. External trainer has visited the home to do Safeguarding Training, ten out of twelve staff attended. The provision of two wash basins in double bedroom has been explored with the plumber, and the proprietor has been told it is not a viable option. Mandatory training is now identified on the training matrix. Quality assurance questionnaires are now sent out to professionals, those that had been completed and returned were seen by us. All staff now receive supervision with the Care Manager. Weekly food intake charts are now put in place where necessary. TNP House DS0000005029.V377843.R01.S.doc Version 5.2 Page 8 What they could do better: 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. TNP House DS0000005029.V377843.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection TNP House DS0000005029.V377843.R01.S.doc Version 5.3 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 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): 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 wish to use the service have the information they need to make an informed choice about living at the home. EVIDENCE: The AQAA we received prior to the inspection told us that “the service provides a friendly, homely, safe and comfortable home to people using the service. The service retains its staff and has had one new starter in two years, (this person has now left the home). Staff are familiar with the work environment; they are trained to a high standard and knowledgeable about the needs of the elderly. TNP House DS0000005029.V377843.R01.S.doc Version 5.3 Page 11 The service provides people with a written statement of purpose and statement of terms and conditions”. We saw the homes Statement of Purpose and Service Users Guide that provide detailed information for people who may wish to use the service. We saw records that told us that people and their relatives had visited the home prior to admission. There were two relatives visiting at the time of this inspection. We saw the care records of three people and examined them in detail. People’s records contained information collected by the care manager, who carried out the assessment. We saw that risk assessments were in place on peoples care records including manual handling, fire, health and safety and nutritional assessments where required. This means that people’s needs had been assessed and the home was satisfied it could meet those needs. The manager was reminded of the need to review risk assessments on a regular basis. The home does not provide intermediate care. TNP House DS0000005029.V377843.R01.S.doc Version 5.3 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 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): 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. The health and personal care needs of people using the service are met; personal care is delivered in the way the individual wishes. EVIDENCE: The AQAA we received prior to the inspection told us that “the service ensure people are well cared for, involve outside professionals when required. Staff have experience, knowledge, qualification, up to date training and confidence. Caring nature is essential. Have respect and support from families, friends and outside agencies. Maintain good staffing levels, very few staff changes ensures continuity of care”. TNP House DS0000005029.V377843.R01.S.doc Version 5.3 Page 13 We received completed surveys from three health care practices including district nursing teams that told us that: “Excellent standard of care provided in a friendly homely atmosphere” “Good team work high standard delivered” “Always contact the team for advice and support” “The care manager is very approachable” “Excellent ability to recognise the diverse needs of people using their service, individual holistic approach” “Treat everyone with dignity and respect” We saw a letter from one health care practice thanking the staff of TNP house for the kindness and care they showed in looking after a person using the service. We checked the care records of three people during this inspection. We saw that records contained information regarding health care, personal care and socialisation. Records are regularly reviewed but could contain more detail. We saw health care records that identified people are registered with the local health care practice. Appropriate referrals are made to professionals as necessary. We saw that medication is administered from a blister pack monitored dosage system, with the exception of medication not compatible with the system. We saw throughout this inspection courtesy being shown to individuals, with privacy and dignity being promoted. TNP House DS0000005029.V377843.R01.S.doc Version 5.3 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above 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): 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 using the service make choices about their daily lifestyle. The food provided is of a high standard, with a varied and nutritional diet being offered. EVIDENCE: The AQAA we received prior to the inspection told us that “The service ensures that the people using the service feel that TNP is their home. Activities include entertainment/parties, autumn fare, games and activities, craft sessions, outings in the mini bus, knit and natter, music and dancing.” We looked at the care records of three people using the service, some social activities are recorded, along with relative’s visits. One person went out with their relative during this inspection. We observed that people’s privacy was promoted with staff telling people what they were doing, and knocking doors before entering people’s rooms. TNP House DS0000005029.V377843.R01.S.doc Version 5.3 Page 15 Discussions with people using the service identified a relaxed atmosphere where the needs of individuals were respected. We saw that people had brought favourite items with them to personalise their bedrooms, including some furniture. There were lots of pictures, photographs and familiar possessions. We saw a varied traditional menu in place that people told us is discussed with them. We observed lunch being served with alternative choices available. We observed fresh produce was used and tasted the cottage pie; this was hot, flavoursome and served with fresh vegetables. We talked to one person who has a bedroom with French window and small patio over the garden. This person likes to have their meals in the bedroom and told us the food is always hot when it arrives. We talked to a relative who had lunch at the home today, and they told us the food was excellent, people living at the home said they always enjoyed their food. TNP House DS0000005029.V377843.R01.S.doc Version 5.3 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 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 use the service are able to make complaints and are safeguarded by the homes procedures. EVIDENCE: The AQAA we received prior to the key inspection told us that “the service promote an open policy, people are not be afraid to complain. Service ensures people using the service and their families, friends and staff know who to contact if they have any concerns. Training on Vulnerable adult’s policies and procedures. No complaints received for a very long time”. We saw the home has in place a system for recording complaints; this is to be extended to include comments and compliments. There have been no complaints made to the service or to the commission since the last inspection. No safeguarding referrals have been made. We talked to people using the service who told us that, if they were unhappy about something they would talk to staff. TNP House DS0000005029.V377843.R01.S.doc Version 5.3 Page 17 We saw that peoples rights are protected by systems in place at the home, including their contract, assessments, policies and procedures in place. We saw that people’s finances are managed by themselves and their relatives. We saw staff training records that identified nine staff have now completed safeguarding training; remaining three staff are being booked on the next available course. Ten staff have completed Protection of Vulnerable Adults training remaining two will be booked on the next available course. We saw on staff files that Criminal Records Bureau and Protection of Vulnerable Adults checks are carried out, two written references are taken up prior to employment. TNP House DS0000005029.V377843.R01.S.doc Version 5.3 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 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): 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. The physical environment of the home enables people to live in comfortable and homely surroundings that are well maintained and clean. EVIDENCE: The AQAA we received prior to the key inspection told us that “The staff ensures the home is kept clean and tidy, and safe at all times. The home is homely, welcoming and has an open door policy. Management maintain improvements to decorating and fixtures and fittings. TNP House DS0000005029.V377843.R01.S.doc Version 5.3 Page 19 We saw that the design and layout of the home meets the needs of the people using the service. The communal areas are comfortable and homely; people were relaxed, chatting and moving freely around the home. We saw that the home was clean and well maintained, individual bedrooms were personalised with favourite items of the person occupying the room. We were told by the proprietor that all people using the service are involved in choice of décor, and encouraged to personalise their bedrooms. We saw that the outstanding work to the flooring in a bathroom had been completed. We were told that the provision of two wash basins in a double bedroom has been explored with the plumber, who told the proprietor it is not a viable option. One person continues to use the bathroom the other person uses the wash basin in the bedroom. We saw records that told us Health and Safety checks are carried out, hazardous substances are securely stored. We saw staff training records that identify staff have received infection control training. Policies and procedures are in place for the control of infection. TNP House DS0000005029.V377843.R01.S.doc Version 5.3 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are 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): 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. A well trained and consistent staff team support the people using the service. EVIDENCE: The AQAA we received prior to the key inspection told us that “The home provides a service which has the support of staff who have worked here for many years. Staff training to NVQ level 2 and 3 for most staff. The service do not use agency staff” We saw staff records of the last three people employed by the home. Records told us that staff have received appropriate pre-employment checks; this includes one staff employed since the last inspection. We saw Criminal Records Bureau and Protection of Vulnerable Adults checks for this person. We saw staff training records in staff files, and on staff matrix, that told us one staff has National Vocational Qualification Level 4 and the Registered Managers Award. Five staff have National Vocational Qualification Level 3, two staff have National Vocational Qualification Level 2. TNP House DS0000005029.V377843.R01.S.doc Version 5.3 Page 21 We saw staff rota that told us there are a minimum of two staff on duty at all times including night staff. We talked to staff members who told us that they receive training opportunities, and that mandatory training is carried out. We talked to the cook who told us that provisions are ample and that fresh produce is used. The care manager told us the home is currently recruiting for a new staff member. There is a nucleus of long standing staff at the home, who were able to discuss the needs of people in there care. TNP House DS0000005029.V377843.R01.S.doc Version 5.3 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. 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 and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 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): 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. The people using the service are safeguarded by an experienced manager. EVIDENCE: The AQAA we received prior to the key inspection told us that “The service has qualified and experienced hands on management. Commitment and enthusiasm, and treat people with respect. Welcoming and open management approach, encourage team work”. TNP House DS0000005029.V377843.R01.S.doc Version 5.3 Page 23 We talked to the care manager and records told us that the manager has the Registered Managers Award, and National Vocational Qualification level 4 in Care and Management. The manager has 18 years experience in care of the elderly, twelve years at this service. She takes part in all training with staff, as well as management training to ensure she is up to date with current procedures and guidelines. We saw that people using the service were involved in choices about day to day events around the home during this inspection. We saw that people’s finances are dealt with by families or solicitors; the service is not involved in the management of finances. Each person is invoiced for their expenditure and they then pay their bills. People do however have a lockable facility in their bedrooms where they can keep valuables. We saw health and safety training has now been carried out. The home has a fire risk assessment in place and emergency evacuation plans for each person. This will assist the emergency services in the event of fire. Safety records and maintenance certificates were seen for fire fighting equipment, passenger lift and the lifting equipment in the home. We saw that the manager has a basic Quality Assurance system in place. She works with the staff, residents and relatives to ensure that all are happy with the service, and addresses any concerns they may have. The manager also completed the AQAA and told us some of the information about the home we needed to know. Information was limited in its detail, and would not enable an assessment of outcomes for people using the service to be made, when carrying out the Annual Service Review. This was discussed in detail with the Care Manager at the time of this visit. TNP House DS0000005029.V377843.R01.S.doc Version 5.3 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People 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 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 3 TNP House DS0000005029.V377843.R01.S.doc Version 5.3 Page 25 Are there any outstanding requirements from the last inspection? NO 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 OP33 Refer to Standard Good Practice Recommendations Annual Quality Assurance Assessment needs to contain more detail to enable an assessment of outcomes for people using the service to be made. TNP House DS0000005029.V377843.R01.S.doc Version 5.3 Page 26 Care Quality Commission Care Quality Commission West 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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