Care Home: Westgate House

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What the care home does well Prospective service users and their representatives are encouraged to visit the home before making a decision to move in for a trial period. Service users expressed their satisfaction of the accommodation, facilities and garden. The home is run in the best interests of the service users. Service users benefit from a low turnover of staff. Service users are confident that any complaints would be listened to, taken seriously and acted upon. The home is well maintained, clean and free from unpleasant odours. This is a well managed home, run by a qualified and experienced manager. What has improved since the last inspection? The manager Stella McNeil was registered with the commission in 2007. The three good practice recommendations made at the last inspection have been actioned. What the care home could do better: Following the pre- admission assessment, the manager is advised to confirm in writing to the service user that the home is able to meet their assessed needs. Care planning documentation needs to be in sufficient detail regarding lifestyle choices and the preferences of the service user with regard to how care is to be provided and when. Care plans need to be developed further to include how the emotional, social and psychological care needs are identified and met. Following the inspection an action plan was received from the manager detailing how medication procedures are to be more robust to reduce the risk of medication errors being made. The manager is advised to monitor the need for additional night staff to be employed for the residential unit. Key inspection report Care homes for older people Name: Address: Westgate House Millington Road Wallingford Oxon OX10 8FE     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Marie Carvell     Date: 0 4 0 1 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 28 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 28 Information about the care home Name of care home: Address: Westgate House Millington Road Wallingford Oxon OX10 8FE 01491836332 01491827851 manager.westgate@osjctoxon.co.uk www.osjct.co.uk The Orders Of St John Care Trust care home 61 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) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is 61 The registered person may provide the following category of service only: Care home only(PC) To service users of the following gender: Either whose primary care needs on admission to the home are within the following category : Old age, not falling within any other category (OP) Dementia (DE) Date of last inspection Brief description of the care home Westgate House is a care home providing personal care and accommodation for 60 older people. It is able to offer nursing care for up to 21 service users. Westgate House is managed by The Orders of St John Care Trust, which is responsible for 18 other care homes in Oxfordshire. Westgate House has been purpose-built and became operational in June 2003. It is located on a new housing development close to the centre of Wallingford and all the amenities of the town. Each room has been designed with en-suite facilities and the new furnishings and fittings are of a high standard. The Two-storey building is arranged in three wings providing unit living and the communal Care Homes for Older People Page 4 of 28 61 0 Over 65 0 61 Brief description of the care home lounge area creates a central heart of the home. The home has pleasant grounds with seating and a small water feature. The fees range from 675.00 pounds per week to 990.00 pounds per week. Items not covered by the fees include hairdressing, podiatry, newspapers, magazines, toiletries and contributions to some outings and activities. Care Homes for Older People Page 5 of 28 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: three star excellent service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The last key inspection of this service was completed in January 2007. This inspection was an unannounced key inspection. We ( the commission) arrived at the service at 11am and we were in the service until 7pm. It was a thorough look at how well the service is doing. It took into account detailed information provided by the manager, Stella McNeil in November 2009 and any other information that we have received about the service since the last inspection. We looked at how well the service is meeting the standards set by the government and have in this report made judgements about the standards of the service. Time was spent talking to the manager, service users and staff on duty. We looked at communal areas of the home, examined a sample of records required to be kept in the home, including the case tracking of service users records and spent time talking to service users in communal areas of the home and in private, and observed how care was being delivered to service users in two of the units. Care Homes for Older People Page 6 of 28 Care Homes for Older People Page 7 of 28 What the care home does well: What has improved since the last inspection? 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 Care Homes for Older People Page 8 of 28 order line 0870 240 7535. Care Homes for Older People Page 9 of 28 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 28 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users are provided with sufficient information to make an informed choice about moving into the home for a trial period. All service users are provided with a contract/terms and conditions. Prospective service users are fully assessed by the manager or head of care prior to admission to the home, to ensure that their care needs can be met by the care home. Evidence: All prospective service users are provided with information about the home, including a copy of the last inspection report, the homes brochure and service user guide. Oxfordshire County Council/Primary Care Trust have a block contract with the home for thirty nine of the sixty one beds. Service users confirmed that they had received sufficient information to make an informed choice about moving into the home. Service users said that they were invited to visit the home before moving in for a trial Care Homes for Older People Page 11 of 28 Evidence: period, to look at the facilities and accommodation and to meet other service users and members of staff. A detailed assessment of care need is carried out prior to admission by the manager or head of care, this may include input from healthcare professionals, relatives and advocates as well as the service user. This is well documented in service user files. It is a good practice recommendation that the manager confirms in writing to the service user that having completed the pre- admission assessment, the care home is able to meet the service users care needs to ensure that the individual knows that he/she can expect the home to manage his/her health and welfare needs properly. The manager confirmed that following a four week trial period to establish whether the home can meet the service users care needs, a trial period meeting is held and the outcomes are documented. All service users are provided with a contract/terms and conditions once a decision to stay permanently is made. Care Homes for Older People Page 12 of 28 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans need to be in sufficient detail regarding lifestyle choices and the preferences of the service user with regard to how care is to be provided and when. Care plans need to be further developed to include how the emotional, psychological and social care needs of the individual are identified and met. The healthcare needs of service users are fully met. Medication administration procedures need to be more robust to ensure that service users receive their medication as prescribed by their GP. Evidence: Care plans are drawn up from information recorded on the pre-admission assessment documentation, agreed and signed by the service user/representative as appropriate. The home has been piloting new care planning documentation on behalf of the trust for the last twelve months.The findings have yet to be reviewed. A sample of care plans, risk assessments and daily records were examined with the manager and head of care. Information regarding health and physical care is well documented. However, Care Homes for Older People Page 13 of 28 Evidence: not all care plans evidenced how the emotional, psychological or social care needs of individuals are identified or met. Not all care plans are in sufficient detail regarding lifestyle choices or the preferences of the service user with regard to when care is to be provided or how, this was discussed with the manager and head of care. This is partly due to a delay in providing care planning training to care staff, although nursing and care leaders have received this training. It may reduce further delays if the manager and head of care provide the care planning training in- house. The care planning documentations are time consuming with duplication of forms and information. This was confirmed in discussion with the manager and head of care. Following the inspection we received an action plan from the manager advising us what further action will be taken. The healthcare of service users are met by a local GP practice. The nursing care needs of the service users receiving personal care only are met by the District Nursing team, who visit the home when required. A range of healthcare professionals visit the home as necessary. Following the inspection we received an action plan from the manager advising us that the home is to develop and identify individual guidelines for service users who have behaviours that challenge the service. These are to be included in care planning documents. Nursing and care staff attend challenging behaviour training in house and further liaison and involvement with multidisciplinary teams are to be initiated to further develop strategies in managing behaviours that challenge the service. Service users are encouraged to take responsibility for their own medication following appropriate risk assessments, the majority of service users prefer their medication to be administered by the staff team. Medication is administered by registered nurses on the nursing unit or care staff who have undertaken medication training. At the last inspection a good practice recommendation was made that service user allergies are recorded on the front sheet of the medication records, this has been actioned. One care leader is the homes medication champion, this is a member of staff who has received additional training. Medication training, storage, administration and recording on one unit was discussed with a member of staff and medication administration records were examined. It was not evidenced that PRN ( when required medication) guidelines and care plans were in place, the member of staff was unclear although it was confirmed that they should be. Medication administration records that commenced five days earlier showed that two service users had not received the correct dosage of medication, which should have been administered twice per day, but only given once a day.This error had continued Care Homes for Older People Page 14 of 28 Evidence: unnoticed, although several members of staff have administered the medication. Following this inspection we received an action plan from the manager advising us of action to be put into place, to reduce the risk of medication errors happening in the future, including random drug round checks and ongoing medication training and assessing competency. Time was spent with service users in private and communal areas, in two of the three units. The nursing unit was not visited due to restricted access during an diarrhoea and vomiting outbreak. Service users expressed their satisfaction of living in the home and the care received. Service users said that staff were kind, patient, nothing was too much trouble for the staff team and felt that their care needs were well met. Service users were observed to be well groomed and appropriately dressed, attention is given to encouraging service users to wear suitable footwear, to reduce the risk of falls. Service users said that staff always remembered to assist with hearing aids, dentures and glasses. Staff on duty were observed to interact with service users in a calm, respectful and kind manner. Service users are asked on admission for their preferred terms of address and this is recorded. Maintaining the privacy, dignity and respect of service users is covered in staff induction and regularly in staff meetings. Service users confirmed that staff always treated them with dignity and respect. Care Homes for Older People Page 15 of 28 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users are encouraged to make choices and to remain independent for as long as possible. There is a wide range of activities in place to meet the social needs of the service users. Service users are provided with a varied, nutritious and well balanced diet. Evidence: A weekly activities programme is displayed in the entrance hall and in each unit. Although a varied activities programme is in place, this is not always evidenced from information recorded in service user care plans or daily records. This was discussed with the manager and activities coordinator. The service users benefit from support from a wide circle of volunteers, who run the homes shop, assist with activities, befriend individual service users, provide transport and accompany service users on outings. The home also has an enthusiastic Friends of Westgate group. All volunteers complete a robust recruitment process including police checks. Many of the service users have friends and family who are able to visit on a regular Care Homes for Older People Page 16 of 28 Evidence: basis. Service users are encouraged as far as possible, to maintain contact, with the local community. Religious ministers visit the home on a regular basis and arrangements can be made to provide transport for service users wishing to attend local places of worship. Service user meetings are held every four to six weeks. A box is provided in the entrance, to encourage service users and visitors to make suggestions or ideas for the running of the home. Relative meetings do not take place, but the manager would be happy to arrange these if requested. Service users confirmed that the routines in the home are flexible such as being able to choose how they spend their day, when to go to bed and when to get up in the morning. One service user said that following the festive activities in the home over the Christmas period it was good to have a choice to do as little or as much as she felt like doing. Menus demonstrated that service users are provided with a varied, nutritious and well balanced diet. Service users confirmed that there is always a choice of main meal and that the cook would always prepare something different is requested. At the time of this visit, no service users required special diets. Care Homes for Older People Page 17 of 28 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users are confident that any concerns or complaints will be listened to, taken seriously and acted upon. All staff receive training in protecting vulnerable adults from possible harm. Evidence: The home has a clear, detailed complaints procedure, which is displayed prominently in the home and a copy is given to all service users. In the last twelve months the home has received one written complaint. The recording of the complaint was seen to be clear, detailed and included action taken and outcomes. The manager confirmed that any verbal complaints would be recorded. Service users were clear about the complaints procedure and said that they would speak to the manager or senior member of staff regarding any complaints/concerns. Since the last inspection we have not received any information regarding complaints about this home. All staff receive training in safeguarding vulnerable adults from abuse. This includes introduction of challenging behaviour training, Deprivation of Liberty safeguards training, Mental Capacity Act training and the introduction of a Mental Capacity Assessment and Best Interests checklist. Care Homes for Older People Page 18 of 28 Evidence: No safeguarding adult referrals or safeguarding adult investigations have taken place in the last twelve months. No referrals have been made for inclusion of staff on the protection of vulnerable adults list (POVA). Care Homes for Older People Page 19 of 28 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides safe, well maintained and comfortable accommodation. The location and layout of the building is suitable for its stated purpose. Service users expressed their satisfaction of the accommodation, facilities, garden and access to community resources. The housekeeping staff work hard to ensuring that the home is clean, pleasant and free from unpleasant odours. Evidence: The location and layout of the building is suitable for its stated purpose. Service users expressed their satisfaction of the accommodation, facilities, garden and access to community resources. The home is well maintained and there is an ongoing programme of redecoration and maintenance. At the last inspection two good practice recommendations were made, that bedroom carpets should be replaced if it is not possible to remove stains and that all service users bedrooms have liquid soap and paper towels for use by staff to prevent cross infection. Bedroom carpets have been replaced as necessary and there is a plan to replace additional carpets, which are beginning to show some wear. Bedrooms on two units now have liquid soap and paper towels. However, following a risk assessment, Care Homes for Older People Page 20 of 28 Evidence: the manager decided not to extend this to the dementia care unit. This will be reviewed and implemented if considered necessary. The housekeeping staff work hard to ensuring that the home is clean, pleasant and free from unpleasant odours. All housekeeping and laundry staff have received training in infection control and health and safety. All staff are provided with protective clothing. Care Homes for Older People Page 21 of 28 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staffing levels appear to be adequate to meet the needs of the service users. Recruitment procedures are robust. Staff are well trained and are able to carry out their duties in a professional manner. Evidence: From discussion with the manager and examination of duty rosters, staffing levels appear to be adequate to meet the needs of service users. Service users benefit from a low turnover of staff, during the last twelve months four nursing/care staff have resigned. Two full time and three bank care staff have recently been recruited and are waiting for recruitment checks to be completed before starting work in the home. This allows for a registered nurse (RN) and two care assistants on night duty for the nursing unit, one care assistant on night duty for the residential unit and two care assistants on night duty for the dementia care unit. In discussion with staff on duty, comments were made that at times on night duty, one care assistant from the nursing unit, is required to assist with care on the residential unit. The manager is advised to monitor the situation and to record when this occurs. Members of staff are encouraged to undertake national vocational qualification training Care Homes for Older People Page 22 of 28 Evidence: (NVQ). The Annual Quality Assurance Assessment (AQQA) completed in November 2009 by the manager confirmed that twenty six of the fifty six care staff in post have completed NVQ at levels II or III. All care leaders have completed NVQ level III and the head of care is a RN and has completed the registered managers award. All other care staff are working towards the qualification or have been nominated and are waiting to start the training. The trust is committed to staff development and has its own NVQ centre. From examination of a sample of staff personnel files it was evidenced that the home has robust recruitments procedures in place. Two senior members of staff conduct all interviews and this is recorded. The home has a training and development programme in place. All staff complete mandatory training and undertake specialist training as appropriate. Nursing staff are assisted with their continuous professional development. Staff spoken to said that they enjoyed working in the home, felt valued and well supported. Communication systems in the home are well organised, with staff handovers taking place at the beginning of each shift. Staff meetings take place every three months and minutes of meetings were available for examination. We gained the impression that staff morale was good. Staff were observed to be courteous and professionals when carrying out their duties. Care Homes for Older People Page 23 of 28 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users benefit from a well managed home. Evidence: The manager, Stella McNeil was registered with the commission in 2007. She is an experienced and qualified manager as well as a registered nurse. Supporting the manager is a full time head of care, a team of care leaders and an experienced administrator. Service users and staff on duty all expressed the view that the home is well managed and run in the best interests of service users. Service users and staff expressed their satisfaction of the managers leadership style. Service users said that they could talk to the manager at any time and she always made time to talk to them or their relatives. Policies and procedures are in place and are reviewed and updated as necessary. Staff are kept informed of updated policies and procedures and these are discussed at staff meetings. Care Homes for Older People Page 24 of 28 Evidence: There is an annual development plan for the home currently being developed. Procedures are in place for dealing with service users monies and valuables, these are in line with trust procedures and are audited annually. All nursing and care staff receive formal 1-1 supervision at least six times per year, a sample of records seen were up to date, well maintained and in line with trust procedures. Reports written by a provider representative, following a monthly unannounced visit to the home, were available for examination. Quality Assurance systems are in place as well as monthly and annual internal audits. These are detailed and well documented. Evidence was seen that the views of service users, relatives and stakeholders are obtained to measure the homes success in meeting the aims, objectives and statement of purpose. A sample of records relating to health, safety and welfare were examined and found to be well maintained and up to date. Care Homes for Older People Page 25 of 28 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 26 of 28 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 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 Care Homes for Older People Page 27 of 28 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. 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