We are the regulator: Our job is to check whether hospitals, care homes and care services are meeting essential standards.

Transcription

1 Inspection Report We are the regulator: Our job is to check whether hospitals, care homes and care services are meeting essential standards. Fir Close 2 Westgate, Louth, LN11 9YH Tel: Date of Inspection: 29 April 2014 Date of Publication: May 2014 We inspected the following standards as part of a routine inspection. This is what we found: Consent to care and treatment Care and welfare of people who use services Safeguarding people who use services from abuse Cleanliness and infection control Assessing and monitoring the quality of service provision Met this standard Met this standard Met this standard Met this standard Met this standard Inspection Report Fir Close May

2 Details about this location Registered Provider Registered Manager Overview of the service Type of service Regulated activity Prime Life Limited Mrs Susan Capes Fir Close is located in the market town of Louth and compromises of two separate buildings. River View provides care for up to 21 older people with age related conditions, including dementia, that prevent them from living independently. Field View provides care for 13 older people, 10 of these beds provide an Intermediate Care Service, in partnership with Lincolnshire NHS. Intermediate care is a short term period of intensive support to help people regain their independence after illness or injury. The home is in a quiet residential area and is close to local amenities and bus routes. Care home service without nursing Accommodation for persons who require nursing or personal care Inspection Report Fir Close May

3 Contents When you read this report, you may find it useful to read the sections towards the back called 'About CQC inspections' and 'How we define our judgements'. Summary of this inspection: Page Why we carried out this inspection 4 How we carried out this inspection 4 What people told us and what we found 4 More information about the provider 6 Our judgements for each standard inspected: Consent to care and treatment 7 Care and welfare of people who use services 9 Safeguarding people who use services from abuse 11 Cleanliness and infection control 13 Assessing and monitoring the quality of service provision 15 About CQC Inspections 17 How we define our judgements 18 Glossary of terms we use in this report 20 Contact us 22 Inspection Report Fir Close May

4 Summary of this inspection Why we carried out this inspection This was a routine inspection to check that essential standards of quality and safety referred to on the front page were being met. We sometimes describe this as a scheduled inspection. This was an unannounced inspection. How we carried out this inspection We looked at the personal care or treatment records of people who use the service, carried out a visit on 29 April 2014, observed how people were being cared for and checked how people were cared for at each stage of their treatment and care. We talked with people who use the service, talked with carers and / or family members and talked with staff. We used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us. What people told us and what we found The home is divided into two houses: Field View and River view. Field View can accommodate up to 13 people, ten of whom are receiving intermediate care. River View can accommodate 21 older people or people living with dementia. Both houses are well provided with lounges, dining rooms, toilets, shower rooms and bathrooms and have access to patios and the garden. At lunchtime we undertook a Short Observational Framework for Inspection (SOFI) in River View. SOFI helps us to understand people's perceptions of the care and treatment they receive when they are unable to tell us themselves. We have used this to find out about the lunchtime experience of people living with dementia. We considered the findings of our inspection to answer questions we always ask: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led? Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with people using the service, their visitors and the staff supporting them. We also looked at three care records. If you wish to see the evidence supporting our summary please read the full report. Is the service safe? The home had policies and procedures in relation to the Mental Capacity Act (2005) MCA and Deprivation of Liberty Safeguards (DoLS). The MCA states that every adult has the right to make their own decisions about their care and treatment and must be assumed to Inspection Report Fir Close May

5 have capacity to make them unless it is proved otherwise. The Deprivation of Liberty Safeguards are part of the MCA. DoLS supports people in care homes and hospitals to be looked after in a way that does not unlawfully restrict their right to freedom. The home had policies and procedures in relation to safeguarding vulnerable adults and whistle blowing. We spoke with care staff who understood what was meant by abuse and knew how to report their concerns. We saw the home had a programme of regular audit and risk assessments to ensure people were cared for in a safe environment. The service was safe, clean and hygienic. We saw regular checks were made on the cleanliness of the building. Equipment was well maintained and serviced regularly therefore not putting people at unnecessary risk. We observed regular maintenance was carried out, for example on electrical and fire equipment Is the service effective? Our observations found that members of staff knew people's individual health and wellbeing needs. There was a process in place to ensure staff were aware of people's changing needs and what to do if a person became unwell. Staff told us that they shared information at handover between each shift. And updated people's care files four times a day. We found staff attended training courses to meet the individual needs of people with conditions such as diabetes. Is the service caring? We observed staff speak to people in a kind and caring way and give them time to answer questions. We saw no was rushed and staff helped people to do things in their own time. We saw all staff groups, including the kitchen and housekeeping staff had a very good rapport with people and there was a lot of chat and laughter. We observed lunchtime and saw people were treated as individuals and staff promoted and encouraged people to be independent. We saw when staff praised a person for their achievements they treated them as equals. We asked people if they felt well cared for. One person told us, "Sometimes I'm a little spoiled but at 95 I'm entitled to it." Another person told us, "It's like a hotel, even better. Staff are friendly, they look after you." Is the service responsive? We saw care was responsive to people's individual needs. We saw one person liked to have cold drinks and chocolate bars so they had a fridge in their bedroom with a supply of soft drinks and chocolate. Another person had their own bedroom furniture and double bed because this was their personal choice. Staff told us it helped people maintain their individuality. We saw when care workers raised concerns about people's health and social care needs, the provider contacted appropriate health and social care professionals. The individual care files identified this and a record of each referral, professional visit and outcome were recorded. We saw the provider had contingency plans in place in event of an emergency situation. Inspection Report Fir Close May

6 Is the service well led? We saw people were well supported by the staff on duty. There was always at least one senior carer on duty each shift. All the staff we spoke with told us the manager was approachable and supported them with professional and personnel problems. One staff member said, "XX [manager] is honest, she listens to any problems, be they your own, a client or another member of staff." We spoke to people who told us the manager was approachable. One person said, "Her door is always open." Another person said, "We have bus trips, we tell the manager where we want to go and she tells the driver." You can see our judgements on the front page of this report. More information about the provider Please see our website for more information, including our most recent judgements against the essential standards. You can contact us using the telephone number on the back of the report if you have additional questions. There is a glossary at the back of this report which has definitions for words and phrases we use in the report. Inspection Report Fir Close May

7 Our judgements for each standard inspected Consent to care and treatment Met this standard Before people are given any examination, care, treatment or support, they should be asked if they agree to it Our judgement The provider was meeting this standard. Where people did not have the capacity to consent, the provider acted in accordance with legal requirements. Reasons for our judgement When we visited this service on 11 December 2013 we found that the regulation was not being met because the provider did not record when people had consented to their care. We found the provider did not act in accordance with legal requirement of the Mental Capacity Act We found this had a minor impact on people who used the service. For example, we found that staff did not always undertake mental capacity assessments to act in a person's best interest when a person lacked the mental capacity to make decisions about their own care and treatment. On 29 January 2014 we received an action plan from the provider outlining the improvements they would make after our last inspection. During this visit we saw there were robust processes for obtaining consent from people. We looked at care files for three people and saw they contained completed consent forms for specific purposes. These included taking their photograph for identification purposes and their consent to receiving personal care. We saw people had signed their forms and where they were unable to do so a member of their family had signed in their behalf. The home had policies and procedures in relation to the Mental Capacity Act (2005) MCA and Deprivation of Liberty Safeguards (DoLS). The MCA states that every adult has the right to make their own decisions about their care and treatment and must be assumed to have capacity to make them unless it is proved otherwise. The Deprivation of Liberty Safeguards are part of the MCA. DoLS supports people in care homes and hospitals to be looked after in a way that does not unlawfully restrict their right to freedom. We saw where people lacked capacity to make decisions about their care and treatment or where they had fluctuating capacity this was recorded at the front of their care file in the personal details section. Inspection Report Fir Close May

8 We saw one person with fluctuating capacity had been involved with their key worked in writing their care file. We saw they had signed a consent form to share their care plans. This person's consent wishes were recorded as, "Explain in terms I can understand." This meant care staff respected this person's fluctuating ability to understand and retain information. We spoke with three members of staff who told us how they would obtain informed consent and when they would do so. One staff member said, "When someone has communication difficulties there are behaviour indicators to show when they don't want care, like turning away." Another staff member said, "If they have no capacity, decide what is in their best interest, but still explain it to them." We observed staff interact with people at lunchtime. People were given a choice of where to sit and most people sat in friendship groups. We saw one person was unsure of what to have for dessert so a staff member showed them what was available to help them decide. Another person was unsure what they would like to drink with their lunch. A staff member gave them a taste of lemon juice to see if they liked it. People told us staff always asked them for their agreement to give care. One person said, "Staff always ask. Excellent staff." Following our inspection the provider sent us a copy of the consent to treatment and care policy as it was under review on the day of our visit. We saw the policy made reference to the Mental Capacity Act 2005 and guidance for staff to act in person's best interest when the lacked capacity. We saw before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes. Inspection Report Fir Close May

9 Care and welfare of people who use services Met this standard People should get safe and appropriate care that meets their needs and supports their rights Our judgement The provider was meeting this standard. Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. Reasons for our judgement When we visited this service on 11 December 2013 we found the regulation was not being met because the planning and delivery of care did not ensure the welfare and safety of people who used the service. We found this had a minor impact on people who used the service. For example we found care plans did not describe how staff should respond to people's identified needs and the information was not always accurate or kept up to date. On 29 January 2014 we received an action plan from the provider outlining the improvements they would make after our last inspection. During this visit we found the provider had introduced procedures and processes that ensured care was assessed, planned and delivered in line with individual need. We saw that care files were user friendly and easy to read. We looked at the care files for three people. We saw initial assessments had been undertaken. People's likes and dislikes, drug and food allergies and personal preferences were recorded. Peoples' care was assessed and planned to meet their individual needs which included nutrition, oral health and falls. We saw recorded in one person's care file that they had expressed their preference to shop for toiletries and personal items and had been assessed as vulnerable if they went into town alone. We noted that their care plan recorded that they could go out into the local community to shop with one to one support from a care worker. We saw staff recorded the care people had received. For example, when a person was at risk of malnutrition or dehydration they had a food and fluid intake chart and staff recorded the amount of food or drink the person had taken. We saw one person had a medical condition that required them to eat a special diet. We saw their care plan recorded that staff should order special bread, cakes and biscuits from the person's GP. We spoke with the cook who told us they often made this person cakes Inspection Report Fir Close May

10 with special flour. They told us, "I try to make them something different as prescription cakes and biscuits can get boring." We spoke with three care staff who told about their roles. They explained how they involved people in assessing and planning their care. They also told us about the importance of recording the care given in the daily care records. One member of staff said, "We write care down three times a day after each meal and the night staff also write what they have done." We saw evidence people were involved in making decisions about their care. For example, we heard one staff member ask a person if they had any pain and if they wanted any pain killers. We asked people if they were supported to make decisions about their care. One person told us, "I had a shower this morning. I just ask and they just do it. Staff always ask, excellent staff." We looked at several bedrooms. With the exception of people on short term intermediate care placements, peoples' bedrooms were personalised with photographs, books and ornaments. We saw one person had chosen their own bedroom furniture and had a double bed. We saw another bedroom had been decorated in the person's choice of colour. We saw several people had chosen matching bedding and curtains. We saw people were taking part in meaningful activities, for example we saw one person was knitting a blanket and another person was doing a work search puzzle. We saw people were listening to music, and had musical instruments whilst others were singing along to the music. Later on our inspection we observed a group of women discussing the changes in society since they were young, such as the introduction of the oral contraceptive. We saw recorded in the care files that when a person's condition changed or deteriorated care staff called in the appropriate health professionals such as the person's GP or district nurse. We asked people if they felt well cared for. One person told us, "Sometimes I'm a little spoiled but at 95 I'm entitled to it." Another person told us, "It's like a hotel, even better. Staff are friendly, they look after you." One visitor told us, "Camaraderie is very good XX {friend} loves it here. The care is right for her." Inspection Report Fir Close May

11 Safeguarding people who use services from abuse Met this standard People should be protected from abuse and staff should respect their human rights Our judgement The provider was meeting this standard. People who use the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. Reasons for our judgement The home had policies and procedures in relation to the Mental Capacity Act (2005) MCA and Deprivation of Liberty Safeguards (DoLS). The MCA states that every adult has the right to make their own decisions about their care and treatment and must be assumed to have capacity to make them unless it is proved otherwise. The Deprivation of Liberty Safeguards are part of the MCA. DoLS supports people in care homes and hospitals to be looked after in a way that does not unlawfully restrict their right to freedom. At the time of our inspection there was no one being cared for under a DoLS authorisation. We spoke with care, kitchen and housekeeping staff who told us they received training in MCA and DoLS. They said they were currently undertaking an e-learning programme on MCA and DoLS. An e-learning programme is a computer based programme of study. Staff told us they had practical experience of MCA and were familiar with the MCA assessments and best interest decision making. We looked at three care files and saw where people lacked capacity to make decisions about their care and treatment or where they had fluctuating capacity this was recorded at the front of their care file in the personal details section. Capacity assessments had been undertaken for specific decisions such as taking prescribed medication. The home had policies and procedures in relation to safeguarding vulnerable adults and whistle blowing. We spoke with care staff who understood what was meant by abuse and knew how to recognise signs of abuse. One staff member said, "Any acts of abuse or concerns about abuse you report." Another staff member told us, "Training taught me about the different kinds, what to look for, what channels to take to escalate to seniors and management and to whistle blow." We saw some staff had achieved or were working towards a nationally recognised diploma in adult health and social care. Staff told us MCA, DoLS and safeguarding vulnerable adults were include in this study programme. Inspection Report Fir Close May

12 We saw staff had access to information on MCA, DoLS and safeguarding in the manager's office. We saw information on MCA was on display on the notice board in the staff room. We saw the manager had undertook a safeguarding audit. There had been no reported safeguarding concerns in We spoke with people and a visitor about safety. People told us they felt safe living in the home. One person said, "I'm very content here." We saw people were free to wander about the home and could access the grounds with a member of care staff. Staff told us they thought people were safe. One staff member said, "We've had dementia training, it has helped me to understand them. " Another staff member said, "They are as safe as we can make them." Inspection Report Fir Close May

13 Cleanliness and infection control Met this standard People should be cared for in a clean environment and protected from the risk of infection Our judgement The provider was meeting this standard. People were cared for in a clean, hygienic environment. Reasons for our judgement We saw all areas of the home were clean and furniture and equipment were in good condition. We saw a notice guiding people and staff on the correct way to wash their hands on display in several areas of the home. We saw there was a hand cleansing gel dispenser at the entrance to both buildings and in several other areas of the home. We saw that staff washed their hands before and after giving care to people. We saw staff wore protective clothing such as plastic aprons and gloves when giving personal care. We noted there were supplies of protective equipment such as gloves and aprons in all communal toilets, bathrooms and shower rooms. We saw supplies of cleansing wipes in every toilet. Staff told us they wiped the toilet with these each time a person used it. We saw staff had access to hand washing facilities in people's bedrooms. Staff told us people were offered to wash their hands after visiting the toilet. We saw people were given hand cleansing wipes to clean their hands before lunch. We saw two commode bowls in peoples' bedrooms had residual fluid in them. We brought this to the manager's attention and this was actioned. We also saw two wash bowls for individual use had not been cleaned and dried after use. We brought this to the manager's attention and this was actioned. We saw there was a daily and nightly cleaning schedule for areas such as bedrooms, toilets and bathrooms. The housekeeper talked us through their daily jobs and special jobs. We observed them deep clean a bedroom that had recently been vacated. We saw staff completed a twice daily cleaning checklist in every toilet, shower room and bathroom. We spoke with the recently appointed infection control lead. They told us they had been invited to attend quarterly link practitioner meetings organised by the local NHS infection Inspection Report Fir Close May

14 control team. They told us about their role and how they acted as a resource to other staff. We looked at the minutes from the last team meetings. We saw infection control had been included on the agendas at the day staff and night staff team meetings. We saw the safe disposal of clinical waste and the safe handling of soiled linen had been discussed. We asked staff if they attended infection control training. One member of staff told us, "Since XX [manager] came we have had lots of training." Another staff member told us, "We had hand hygiene and infection control training this week." We saw that training records confirmed this. We looked at the grounds which were well maintained. However, we did see that the clinical waste bins were not locked and there were two linen crates of soiled bedding and towels waiting to be collected by a contract laundry provider. We brought this to manager's attention. Since our visit the manager has informed us that they have arranged a meeting with the clinical waste bin provider. The manager also informed us that the laundry contactor has supplied special bags for the storage of the soiled laundry. We asked people if the home was clean. People told us the home was always clean. One person said, "They clean in here [lounge] every day." Inspection Report Fir Close May

15 Assessing and monitoring the quality of service provision Met this standard The service should have quality checking systems to manage risks and assure the health, welfare and safety of people who receive care Our judgement The provider was meeting this standard. The provider had an effective system in place to identify, assess and manage risks to the health, safety and welfare of people who use the service and others. Reasons for our judgement We saw people had a personal fire evacuation plan at the front of their care files. This plan identified people's need and the actions staff would take in the event of an emergency situation. We saw the fire board, firefighting equipment and actions for visitors to take were on display at the entrance to both buildings. We saw cleaning cupboards were locked and Control of Substances Hazardous to Health (COSHH) products were stored securely. We saw there were up to date risk assessments and guidance sheets for all COSHH products. We saw there were processes in place for staff to report broken or damaged equipment and furniture. The housekeeper told us, "I report any faults in the maintenance book." There were processes in place for the management of complaints and information was provided to people and relatives informing them how to complain. We saw the clinical room was kept securely locked when not in use. We saw staff recorded the fridge and room temperature twice a day. Staff told us what action they would take if the temperatures were out of normal range. We saw the results of a quality audit were on display for people and their relatives to read. We saw staff were provided with mandatory training to keep people safe such as moving and handling, fire safety and dementia care. We saw there were procedures in place for the recording and auditing of accidents and incidents for example falls. We saw a copy business continuity plan for major incident's such as fire, flood or power Inspection Report Fir Close May

16 failure. We saw all potential incidents were risk assessed and there were contact details for managers and other senior personnel. We saw regular safety checks were carried out for key areas such as firefighting equipment, hoists, emergency lighting and water temperatures. On the day of our visit the lifts and bath hoists were safety checked. We spoke to the contractor who was doing this and were told it was a statutory requirement that the lifts and bath hoists were maintained every six months. We saw there was an audit programme that included medication, infection control, complaints and notifications to the Care Quality Commission. The manager told us any weaknesses were identified and actions were taken for improvement. We saw individual risks assessments were undertaken to keep people safe. These included the risk of scalds from hot water and the risk of financial abuse. The manager told us they held informal resident and relatives meeting to gain their feedback on the care in the home. They told us they would introduce more formal meetings and keep a record of what had been discussed. The people we spoke with told us they sometimes attended meetings. All the people we spoke with told us they were happy with their care and treatment and felt safe and secure living in the home. Inspection Report Fir Close May

17 About CQC inspections We are the regulator of health and social care in England. All providers of regulated health and social care services have a legal responsibility to make sure they are meeting essential standards of quality and safety. These are the standards everyone should be able to expect when they receive care. The essential standards are described in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 and the Care Quality Commission (Registration) Regulations We regulate against these standards, which we sometimes describe as "government standards". We carry out unannounced inspections of all care homes, acute hospitals and domiciliary care services in England at least once a year to judge whether or not the essential standards are being met. We carry out inspections of other services less often. All of our inspections are unannounced unless there is a good reason to let the provider know we are coming. There are 16 essential standards that relate most directly to the quality and safety of care and these are grouped into five key areas. When we inspect we could check all or part of any of the 16 standards at any time depending on the individual circumstances of the service. Because of this we often check different standards at different times. When we inspect, we always visit and we do things like observe how people are cared for, and we talk to people who use the service, to their carers and to staff. We also review information we have gathered about the provider, check the service's records and check whether the right systems and processes are in place. We focus on whether or not the provider is meeting the standards and we are guided by whether people are experiencing the outcomes they should be able to expect when the standards are being met. By outcomes we mean the impact care has on the health, safety and welfare of people who use the service, and the experience they have whilst receiving it. Our inspectors judge if any action is required by the provider of the service to improve the standard of care being provided. Where providers are non-compliant with the regulations, we take enforcement action against them. If we require a service to take action, or if we take enforcement action, we re-inspect it before its next routine inspection was due. This could mean we re-inspect a service several times in one year. We also might decide to reinspect a service if new concerns emerge about it before the next routine inspection. In between inspections we continually monitor information we have about providers. The information comes from the public, the provider, other organisations, and from care workers. You can tell us about your experience of this provider on our website. Inspection Report Fir Close May

18 How we define our judgements The following pages show our findings and regulatory judgement for each essential standard or part of the standard that we inspected. Our judgements are based on the ongoing review and analysis of the information gathered by CQC about this provider and the evidence collected during this inspection. We reach one of the following judgements for each essential standard inspected. Met this standard This means that the standard was being met in that the provider was compliant with the regulation. If we find that standards were met, we take no regulatory action but we may make comments that may be useful to the provider and to the public about minor improvements that could be made. Action needed This means that the standard was not being met in that the provider was non-compliant with the regulation. We may have set a compliance action requiring the provider to produce a report setting out how and by when changes will be made to make sure they comply with the standard. We monitor the implementation of action plans in these reports and, if necessary, take further action. We may have identified a breach of a regulation which is more serious, and we will make sure action is taken. We will report on this when it is complete. Enforcement action taken If the breach of the regulation was more serious, or there have been several or continual breaches, we have a range of actions we take using the criminal and/or civil procedures in the Health and Social Care Act 2008 and relevant regulations. These enforcement powers include issuing a warning notice; restricting or suspending the services a provider can offer, or the number of people it can care for; issuing fines and formal cautions; in extreme cases, cancelling a provider or managers registration or prosecuting a manager or provider. These enforcement powers are set out in law and mean that we can take swift, targeted action where services are failing people. Inspection Report Fir Close May

19 How we define our judgements (continued) Where we find non-compliance with a regulation (or part of a regulation), we state which part of the regulation has been breached. Only where there is non compliance with one or more of Regulations 9-24 of the Regulated Activity Regulations, will our report include a judgement about the level of impact on people who use the service (and others, if appropriate to the regulation). This could be a minor, moderate or major impact. Minor impact - people who use the service experienced poor care that had an impact on their health, safety or welfare or there was a risk of this happening. The impact was not significant and the matter could be managed or resolved quickly. Moderate impact - people who use the service experienced poor care that had a significant effect on their health, safety or welfare or there was a risk of this happening. The matter may need to be resolved quickly. Major impact - people who use the service experienced poor care that had a serious current or long term impact on their health, safety and welfare, or there was a risk of this happening. The matter needs to be resolved quickly We decide the most appropriate action to take to ensure that the necessary changes are made. We always follow up to check whether action has been taken to meet the standards. Inspection Report Fir Close May

20 Glossary of terms we use in this report Essential standard The essential standards of quality and safety are described in our Guidance about compliance: Essential standards of quality and safety. They consist of a significant number of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 and the Care Quality Commission (Registration) Regulations These regulations describe the essential standards of quality and safety that people who use health and adult social care services have a right to expect. A full list of the standards can be found within the Guidance about compliance. The 16 essential standards are: Respecting and involving people who use services - Outcome 1 (Regulation 17) Consent to care and treatment - Outcome 2 (Regulation 18) Care and welfare of people who use services - Outcome 4 (Regulation 9) Meeting Nutritional Needs - Outcome 5 (Regulation 14) Cooperating with other providers - Outcome 6 (Regulation 24) Safeguarding people who use services from abuse - Outcome 7 (Regulation 11) Cleanliness and infection control - Outcome 8 (Regulation 12) Management of medicines - Outcome 9 (Regulation 13) Safety and suitability of premises - Outcome 10 (Regulation 15) Safety, availability and suitability of equipment - Outcome 11 (Regulation 16) Requirements relating to workers - Outcome 12 (Regulation 21) Staffing - Outcome 13 (Regulation 22) Supporting Staff - Outcome 14 (Regulation 23) Assessing and monitoring the quality of service provision - Outcome 16 (Regulation 10) Complaints - Outcome 17 (Regulation 19) Records - Outcome 21 (Regulation 20) Regulated activity These are prescribed activities related to care and treatment that require registration with CQC. These are set out in legislation, and reflect the services provided. Inspection Report Fir Close May

21 Glossary of terms we use in this report (continued) (Registered) Provider There are several legal terms relating to the providers of services. These include registered person, service provider and registered manager. The term 'provider' means anyone with a legal responsibility for ensuring that the requirements of the law are carried out. On our website we often refer to providers as a 'service'. Regulations We regulate against the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 and the Care Quality Commission (Registration) Regulations Responsive inspection This is carried out at any time in relation to identified concerns. Routine inspection This is planned and could occur at any time. We sometimes describe this as a scheduled inspection. Themed inspection This is targeted to look at specific standards, sectors or types of care. Inspection Report Fir Close May

22 Contact us Phone: Write to us at: Care Quality Commission Citygate Gallowgate Newcastle upon Tyne NE1 4PA Website: Copyright Copyright (2011) 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. Inspection Report Fir Close May