Key inspection report

DS0000073092.V377338.R01.S.doc

Version 5.2 Page 1

Key inspection report

CARE HOMES FOR OLDER PEOPLE

The Windmill Care Home

Main Road Rollesby Nr Gt Yarmouth Norfolk NR29 5ER

Lead Inspector Geraldine Allen

Key Unannounced Inspection 27th and 28th August 2009 09:00

The Windmill Care Home DS0000073092.V377338.R01.S.doc Version 5.2 Page 2

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.


Reader Information Document Purpose Inspection Report Author Care Quality Commission Audience General Public Further copies from 0870 240 7535 (telephone order line) Copyright 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.

Internet address www.cqc.org.uk


SERVICE INFORMATION

Name of service

The Windmill Care Home

Address

Main Road Rollesby Nr Gt Yarmouth Norfolk NR29 5ER

Telephone number

01493 740301

Fax number

Email address

Provider Web address

Name of registered provider(s)/company (if applicable)

Mr Kiritkumar A Patel Mrs Chetnaben Kiritkumar Patel

Name of registered manager (if applicable)

Mrs Susan Patricia Bensley

Type of registration

Care Home

No. of places registered (if applicable)

29

Category(ies) of registration, with number of places

Dementia (29), Old age, not falling within any other category (29)


SERVICE INFORMATION

Conditions of registration:

1. The registered person may provide the following categories 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: Dementia - Code DE Old age, not falling within any other category - Code OP

2. The maximum number of service users who can be accommodated is 29

Date of last inspection 2nd July 2007

Brief Description of the Service:

The windmill is a care home providing personal care and accommodation for up to older people who may also have dementia. Mr K and Mrs C Patel own a home. The home is located in the coastal village of Rollesby, near to Great Yarmouth, and is close to the local shop, post office and pubs. The home is a two story building with a new ground floor extension. All the bedrooms are single, and nine of the bedrooms have ensuite facilities. There is a shaft lift and level access to all areas on each floor. The home has enclosed gardens with direct access. There is ample off road parking space. The fee rates are variable dependent upon individual need and can be obtained on request from the home. Additional charges are made for items such as hairdressing, private chiropody, newspapers and toiletries. People are told what charges and fee rates will apply at the time of enquiry.


SUMMARY

This is an overview of what the inspector found during the inspection. This inspection was unannounced and took place on the 27th and 28 of August 2009. In total, the inspection lasted six and a half hours. Before the inspection, we looked at information we had received about the service, including details of the last Annual Quality Assurance Assessment (AQAA) and notifications about events that have affected people at the home. On the day of inspection, we gathered information from a variety or sources. These included looking at records and documents, speaking with people living at the home, speaking with visitors, staff and the manager and taking a tour of the building. No requirements had been made at the last inspection and the six good practice recommendations had been met. As a result of this inspection there are no requirements, but six good practice recommendations have been made. This service has been given a 2 star rating and this means it is a good service. What the service does well: People living at the home are cared for by well trained and motivated staff. People told us that staff were kind and helpful and were 'always cheerful regardless of what they have to do'. People said that staff treat them well and respect their privacy and dignity. People told us they appreciated the activities that take place in and outside of the home. They said they could join in if they wished and felt efforts were made so that people were not excluded from outings due to disabilities. The service has a robust recruitment process that helps to protect people from abuse. Staff are trained about safeguarding matters and were knowledgeable about abuse issues. What has improved since the last inspection? There have been improvements to the care plans kept at this service. People living at the home or their representative are more involved in developing their own plan of care and sign to show their involvement and agreement accordingly. Care plans also now contain photographs of the resident as an aid to identification.


The records kept in respect of medicine administration have improved. Staff are now using the correct codes so that there is a much more robust audit trail. Improvements have been made to the way some items, such as razor blades and sterilising solutions are stored. These are now kept out of the way, reducing risk of accidents. What they could do better: The preadmission assessment of needs should be filled in using greater detail. This will provide a much better understanding of the person's needs and how they should be met. It will also mean that people are confident the home will be able to meet their needs in an appropriate way. Care plan and daily record files need to be organised in a better way than at present so that information about each person is more easily found. Goal setting for each care plan should also be in place so that people can agree what it is they are trying to achieve. For the most part the environment is well maintained but there is scope for improvement within the area known as Millstone. In particular, the enclosed garden needs more sensory features so that it provides stimulation and interest for people with dementia. Also, decoration and furnishing in Millstone needs to be updated so that the area has a less institutionalised feel. Practices regarding the personal allowances looked after by the home are for the most part good. However, current practice for paying the chiropodist needs to be reviewed as it increases the risk of errors occurring. 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 [email protected] or by telephoning our order line – 0870 240 7535.


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


Choice of Home

The intended outcomes for Standards 1 – 6 are:

1. Prospective service users have the information they need to make an informed choice about where to live.

2. Each service user has a written contract/ statement of terms and conditions with the home.

3. No service user moves into the home without having had his/her needs assessed and been assured that these will be met.

4. Service users and their representatives know that the home they enter will meet their needs.

5. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home.

6. 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. No admissions to the home are made until a full needs assessment has been completed. The assessment is comprehensive in its range and needs to be completed in detail in all cases in order that the service can be clear it is able to meet the person's needs. EVIDENCE: All people have a needs assessment completed before they move into the home. Three pre-admission assessments were looked at and they had varying amounts of detail recorded. For example, one assessment showed that the person needed help with personal care but did not say what help was needed and when. However, the assessments do look at all aspects of health, personal and social care and if completed in more detail in all cases, will


provide very good information to ensure the service can judge if they can meet the person's needs. The pre-admission assessments also need to be signed and dated at the time of completion to show who undertook the assessment and when. Some files also contained social services assessment forms and care plan review forms, providing additional information about the person. This service does not provide intermediate care.


Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. The service user’s health, personal and social care needs are set out in

an individual plan of care. 8. Service users’ health care needs are fully met. 9. Service users, where appropriate, are responsible for their own

medication, and are protected by the home’s policies and procedures for dealing with medicines.

10. Service users feel they are treated with respect and their right to privacy is upheld.

11. 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.

People receive appropriate personal and healthcare support and this is recorded in their care plan. The service has safe procedures and practice with regard to the control and administration of medicines. Staff treat people with respect and in a dignified way. EVIDENCE: The case records for three residents were looked at in detail. These were stored in two separate folders; the first folder contained the person's history and the second the plan of care. The histories gave a good pen picture of the person's life throughout their various ages and included details about people who are important to them, their likes and dislikes, hobbies etc.


The care plan is developed following a preadmission assessment of needs. The care plans were completed in full and the instructions and interventions were completed in good detail. The care plans would benefit from having the desired outcomes section completed so that people knew what they were trying to achieve. There were elements of good practice, for example the plan of care agreement was signed by the resident and or their representative as well as the manager. This shows that people have been involved in developing their care plan and agree with its contents. There was also evidence that care plans were being reviewed on a monthly basis, or more frequently if necessary. Various risk assessments were completed and in the care plan files. These included safe handling, fire evacuation, hot water use, pressure areas and nutrition. Records of healthcare interventions were seen within the daily records file. These were well recorded and provided chronological information of all healthcare visits. The daily records gave good information about how the person spent their day and also dietary information. However, the way the folder was laid out made it difficult to retrieve information. The folder would benefit from tabs or some other form of dividers. The arrangements for the storage, administration and recording of medicines was looked at and discussed with the senior carer on duty. The service uses a monitored dosage system, provided by the local pharmacy and the member of staff said this was working well. She said that no residents were self-medicating at the time of inspection. The medication trolleys were both locked when not in use and were tidy and well organised. The medication administration records were up-to-date up and legible. The member of staff confirmed that no controlled drugs were being used at the time of inspection but the arrangements were discussed and looked at. The service has a controlled drugs cabinet, which conforms to legislation, located in a locked cupboard on the first floor. The member of staff confirmed that she has received medication training and her competence is assessed by the manager on a regular basis. People told us that staff were always available and answered call bells quickly although they accepted that there were occasions when staff were very busy and they had to wait a short while. None of the residents spoken with felt this was a problem as they did not need to wait for very long. People said staff were very kind and helpful and one person mentioned that staff were always cheerful regardless of what they had to do. All residents spoken with said staff treated them very well and they said they always received personal care in the privacy of their own rooms or the bathroom. Practice was observed and it was seen that staff spoke respectfully to people and treated them in a dignified way. Personal care was always provided behind closed doors.



Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 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.

13. Service users maintain contact with family/ friends/ representatives and the local community as they wish.

14. Service users are helped to exercise choice and control over their lives. 15. 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 are supported to maintain personal and family relationships. People are able to take part in activities as they wish and in accordance with their personal choices and preferences. People receive a diet that is well balanced and nutritious. EVIDENCE: People told us that they were able to have visitors whenever they wished and visitors were welcome at any time. People spoke about the regular activities taking place in the home which include bingo, quizzes and musical entertainments. They also spoke about the larger events that have taken place including a barbecue shortly before the inspection and a fete due to take place the day following inspection. People also spoke about outings arranged and the special adapted transport provided so that everyone was able to go. All people spoken with felt there was plenty going on within the home and there were also plenty of opportunities to go out when they wished.


People spoke about the many choices they were able to make around their daily living and confirmed that staff, wherever possible, respected their choices. People said they could spend the day where they chose and doing as they wished. People said they could take part in activities or not as they preferred. Discrete observation was undertaken at lunchtime. Staff were available to provide assistance where needed and there was plenty of talk and laughter during the meal. Residents spoken to confirmed they were given a good range of choices for each meal time and also said that if there was nothing they fancied on the menu, the cook would always do them something else. People told us the food was good and varied. The cook confirmed special diets were provided as needed.


Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. Service users and their relatives and friends are confident that their

complaints will be listened to, taken seriously and acted upon. 17. Service users’ legal rights are protected. 18. 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.

The service has a complaints procedure that is clearly written and easy to understand. The complaints procedure is displayed in the home and all residents and their next of kin are provided with a copy. People are protected by staff who are trained about safeguarding matters and also by good recruitment procedures. EVIDENCE: A copy of the complaints procedure was displayed by the front door in the main entrance hall. All residents were provided with a copy of the complaints procedure when they were admitted to the home and a copy was also given to relatives at that time. People told us that they knew what to do if they had concerns or complaints, although all those spoken with said they were very happy at the home. The complaints book records were seen. These showed that a total of seven complaints or concerns had been received since 1st November 2008 to the date of inspection and the manager confirmed that all expressions of concern were treated as a complaint and investigated. Good practice was seen.


Staff receive training about safeguarding vulnerable adults. There were also appropriate policies and procedures in place about this. Staff were knowledgeable about safeguarding issues and what to do if they had concerns. Practice was observed throughout this inspection and was appropriate. The home's recruitment processes include Criminal Records Bureau checks being obtained before the new member of staff starts work. In addition, a minimum of two written references are also obtained.


Environment The intended outcomes for Standards 19 – 26 are: 19. Service users live in a safe, well-maintained environment. 20. Service users have access to safe and comfortable indoor and outdoor

communal facilities. 21. Service users have sufficient and suitable lavatories and washing

facilities. 22. Service users have the specialist equipment they require to maximise

their independence. 23. Service users’ own rooms suit their needs. 24. Service users live in safe, comfortable bedrooms with their own

possessions around them. 25. Service users live in safe, comfortable surroundings. 26. 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.

People live in a safe and well maintained home. For the most part, communal areas are comfortable and in good decorative order. People are able to personalise their own rooms as they wish. Appropriate aids and adaptations are fitted in bathrooms and toilets. The home is clean, tidy, well lit and there were no unpleasant odours. EVIDENCE: A tour of the premises was undertaken with the manager and all areas of the home were seen.


When not in use at mealtimes, the dining room was very attractively laid with damask cloths, overlaid with embroidered cloths and finished off with small column candles. This made the room very appealing. Both lounges in the main part of the home were in good decorative order. An air conditioning unit had been purchased to help with the high temperatures in this area when the sun was out. Communal bathrooms and toilets were clean, in good decorative order and free of clutter for the most part. Equipment such as bath chair hoists were checked and were serviced regularly. The shaft lift had a smooth operation and the manager said some residents were able to use the lift unaided. Service records were looked at and it was seen that the lift is regularly serviced. The carpet in room 14 in the area known as Millstone was stained and rucked up by the bed and needed to be replaced. Other areas within Millstone were not in such good decorative state as the rest of the building. For example, the corridor appeared institutionalised as the pictures had been taken down and not replaced. The use of more appropriate colour schemes, especially in the corridor, also needs to be considered. We were told that the redecoration of the corridor in Millstone was to take place as a priority using more appropriate colours. After this has been completed, the pictures will be replaced on the walls. The enclosed garden accessed via Millstone was much improved since the last inspection. There was level access all the way around and seating in various parts. However, there was scope to do more to increase the sensory aspects of the area. The laundry contained equipment of industrial size, with the washer having sluicing and disinfection programmes. All laundry was done on site, although a laundry person is not employed and this task is carried out by care staff. Laundered items were well organised, with each resident having their own laundry basket containing clean items waiting to be returned to them. The arrangements for the Control Of Substances Hazardous to Health (COSHH) were looked at. A cupboard containing chemicals was located in the ante room to the kitchen. The cupboard was locked and the manager confirmed the COSHH data sheets were kept up to date and available to staff. All areas of the home were clean and all emergency escape routes and fire exits were clear of any clutter.


Staffing The intended outcomes for Standards 27 – 30 are: 27. Service users’ needs are met by the numbers and skill mix of staff. 28. Service users are in safe hands at all times. 29. Service users are supported and protected by the home’s recruitment

policy and practices. 30. 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.

Sufficient staff are on duty to meet the needs of people living at the home. Staff receive training that is appropriate to their role and they are able to access qualifications outside of the home. People living at the home are protected by good recruitment practices. EVIDENCE: A copy of the staff rota for the week of inspection was provided. This showed us that sufficient staff are employed to meet the needs of the people living at the home. Staff confirmed that there were normally enough staff, although unexpected absences such as sickness sometimes meant there was less time. We looked at three recently recruited staff files in detail. This showed us that good recruitment practices were followed. All applicants were required to complete an application form and to make declarations regarding their health and any criminal convictions. All staff had a Criminal Records Bureau check completed, together with a minimum of two written references, before they started work. The interview process also reflected the service's equal opportunities policy. All staff files were kept in good order, with information easy to find.


A copy of the staff training matrix was provided. This showed recent training events and the dates when refresher training was due. Staff complete fully recorded induction training that is compliant with Skills for Care requirements. Staff said they had plenty of training with regular updates as needed. They appreciated the training that was made available and felt it was relevant to help them undertake their role Records showed that three care staff had achieved NVQ at level 2 and five staff had achieved NVQ at level 3. A further member of staff was studying NVQ at level 4. In addition, five staff had qualified as moving and handling instructors. Three of the ancillary staff had completed NVQ in housekeeping with a further one member of staff currently undertaking a qualification.


Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 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.

32. Service users benefit from the ethos, leadership and management approach of the home.

33. The home is run in the best interests of service users. 34. Service users are safeguarded by the accounting and financial

procedures of the home. 35. Service users’ financial interests are safeguarded. 36. Staff are appropriately supervised. 37. Service users’ rights and best interests are safeguarded by the home’s

record keeping, policies and procedures. 38. 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 manager is experienced and competent to undertake her role. People are consulted and their views obtained about how well the service meets their expectations. There are good procedures in place regarding resident's personal allowances. Staff receive supervision that is recorded. Practices protect the health, safety and welfare of people who live, work at or visit the service. EVIDENCE: Mrs Bensley has been the home's manager for the last 2 years and has been registered for just over 12 months. At the time of inspection, she was


studying for the Registered Managers Award and was due to commence NVQ at level 4. We looked at the arrangements for quality assurance. The most recent questionnaires were sent out to residents and relatives during July and these were beginning to be returned at the time of inspection. The manager said a report and action plan would be written and made available to all residents and relatives once the findings had been collated. Some of the comments seen on the returned questionnaires included: 'the carers are all very helpful', 'my mother is always beautifully clean and well turned out in her own clothes', 'this is like a home from home', 'so friendly', 'I appreciate the fact that staff let me know if there are any health issues', 'we are very happy with the care and attention shown to mother'. The manager said she held resident meetings 5-6 times per year and staff meetings were held on a monthly basis. She uses these meetings to share information and to seek views. The procedures used for resident's personal allowances were looked at and we checked amounts held against records for two residents. One was correct and the other was not. However, the error was easily traced and corrected although it does suggest that practice for paying the chiropodist needs to be reviewed to ensure future errors do not occur. Otherwise, good records were seen based on best practice, with full details of all deposits and withdrawals. Receipts were kept for each transaction. Staff signed in duplicate for all transactions. The manager told us that she had received training regarding staff supervision and staff confirmed they were receiving supervision on a regular basis. Supervision sessions were fully recorded. Renewal and maintenance records were seen and were up to date. These included records for health and safety and fire safety. All staff were up to date with fire training, including night staff. There was a maintenance checklist displayed on the wall in the office. This showed when essential maintenance was last done and the date when the next check was due.


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 (Commendable) 3 Standard Met (No Shortfalls) 2 Standard Almost Met (Minor Shortfalls) 1 Standard Not Met (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 ENVIRONMENT

Standard No Score Standard No Score

1 X 19 3 2 3 20 3 3 3 21 3 4 X 22 X 5 X 23 X 6 N/A 24 3 25 X

HEALTH AND PERSONAL CARE 26 3 Standard No Score

7 3 STAFFING 8 3 Standard No Score 9 3 27 3

10 3 28 3 11 X 29 3

30 3 DAILY LIFE AND SOCIAL

ACTIVITIES

Standard No Score 12 3

MANAGEMENT AND ADMINISTRATION

13 3 Standard No Score 14 3 31 3 15 3 32 X

33 3 COMPLAINTS AND PROTECTION 34 X Standard No Score 35 3

16 3 36 3 17 X 37 X 18 3 38 3


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. Refer to Standard

Good Practice Recommendations

1 OP3 The pre-admission assessment of needs should be completed in full detail so that it is clear what support the person needs and when. The assessment should also be signed and dated on the day it is completed so it is clear what support the person needs at that date and the member of staff who has made that judgement.

2 OP7 Desired outcomes should be recorded in care plans so that residents and staff are aware of what they are trying to achieve.

3 OP7 The files used to store daily records and healthcare visits need to be better organised so that information about the person is more easily accessed.

4 OP20 Consideration needs to be given for further developing the garden located by Millstone so that there are more sensory elements to provide stimulation and interest for people.

5 OP20 Care needs to be taken with the decoration and furnishing in Millstone to ensure the area does not appear


institutionalised. 6 OP35 Thought should be given to how the chiropodist is paid so

that the risk of errors occurring in people's personal allowances is reduced.


Care Quality Commission East Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: [email protected] 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.

Date post:	23-Jan-2022
Category:	Documents
Upload:	others
View:	1 times
Download:	0 times

Key inspection report

Documents