Inspection Report

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

Bigwig House
Rhubarb Hill, Holywell Bay, Newquay, TR8 5PT Date of Inspection: 28 October 2012 Date of Publication: November 2012

We inspected the following standards as part of a routine inspection. This is what we found: Respecting and involving people who use services Care and welfare of people who use services Safeguarding people who use services from abuse Management of medicines Staffing Assessing and monitoring the quality of service provision Met this standard

Met this standard Met this standard

Met this standard Met this standard Met this standard

| Inspection Report | Bigwig House | November 2012

www.cqc.org.uk

Details about this location

Registered Provider Registered Manager Overview of the service

Green Light PBS Limited Ms. Debbie Smith Bigwig is a residential care home. It is owned and operated by Green Light PBS Ltd. The service predominately cares for people who have autism and or/aspergers syndrome. The home can accommodate up to a maximum of three people.

Type of service Regulated activity

Care home service without nursing Accommodation for persons who require nursing or personal care

| Inspection Report | Bigwig House | November 2012

www.cqc.org.uk

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'. Page Summary of this inspection: Why we carried out this inspection How we carried out this inspection What people told us and what we found More information about the provider Our judgements for each standard inspected: Respecting and involving people who use services Care and welfare of people who use services Safeguarding people who use services from abuse Management of medicines Staffing Assessing and monitoring the quality of service provision About CQC Inspections How we define our judgements Glossary of terms we use in this report Contact us 6 8 10 12 14 15 17 18 20 22 4 4 4 4

| Inspection Report | Bigwig House | November 2012

www.cqc.org.uk

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 28 October 2012, observed how people were being cared for and talked with people who use the service. We talked with carers and / or family members, talked with staff and talked with stakeholders. What people told us and what we found We saw staff were respectful, friendly and supportive to the people who lived at Bigwig. The atmosphere in the home was warm, welcoming and there was a sense of fun. It was evident, from our observations, that staff and people who lived at Bigwig had a comfortable and respectful relationship with each other. Staff interactions with people, and people's behaviour showed they felt safe living at Bigwig. From our inspection we found that people's views and experiences were taken into account in the way the service was provided and delivered in relation to their care and peoples needs was assessed and care and treatment was planned and delivered in line with their individual care plan. 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 and people were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines. There were enough qualified, skilled and experienced staff to meet people's needs and the provider had an effective system to regularly assess and monitor the quality of service that people receive. You can see our judgements on the front page of this report.

More information about the provider Please see our website www.cqc.org.uk for more information, including our most recent
| Inspection Report | Bigwig House | November 2012
www.cqc.org.uk

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 | Bigwig House | November 2012

www.cqc.org.uk

Our judgements for each standard inspected

Respecting and involving people who use services

Met this standard

People should be treated with respect, involved in discussions about their care and treatment and able to influence how the service is run

Our judgement The provider was meeting this standard. People's views and experiences were taken into account in the way the service was provided and delivered in relation to their care. Reasons for our judgement When we arrived to carry out our inspection, the front door of Bigwig was answered by a person who lived there. This indicated this person felt 'comfortable' and that it was "their home". We saw staff talking with people who lived at Bigwig and saw they were respectful, friendly and supportive of them. The atmosphere in the home was warm, welcoming and there was a sense of fun. Observation of people's interactions with staff told us they felt involved and safe. We spoke to one relative who told us they felt the staff were "very approachable". They told us "we can always go round when we like, it's exactly what we had hoped for". We observed people chose how they spent their day and what they wanted to eat. During our inspection we heard one person ask "can we go to the pub in X?" later this person left Bigwig to enjoy their lunch with a member of staff at the local pub. The ability for people to express their own choices was observed, confirmed through conversations with the registered manager and by viewing care documentation. The service had pictorial cards and had individualised pictures so people could understand what was being asked of them and enabled them to make clear, informed choices. During our inspection we observed good interactions between staff and people who lived at Bigwig. The interaction was inclusive and supported independence. One example of this, was a when a person was putting on their jacket. Rather than the staff member doing the persons jacket zip up, they empowered the person to be independent and facilitated and encouraged the person to zip their own jacket up. Another example of inclusive support was a person who had a packet of crisps on their plate with their sandwich for lunch; the staff member recognised the crisps had not been opened. Rather than opening and "doing for the person", they assisted the person to open
| Inspection Report | Bigwig House | November 2012
www.cqc.org.uk

the packet of crisps together, by holding one side of the packet. These behaviours demonstrated staff promoted independent living and encouraged autonomy. Care plans are essential to plan and review the specific care needs of a person inform and direct staff about a person and their individual care needs. The care plans showed individual preferences and choices, and were also in a suitable format for people to understand. We saw the service enabled and encouraged families and or/representatives to be a part of the care planning process. Pictorial questionnaires were completed on a monthly basis which enabled people to express their views in relation to their care. This enabled people to express their views as to what was important to them in relation to their care. People were also encouraged to express how they felt about the staff and management. We saw that if there were concerns about the person's capacity to make decisions this was then discussed with other relevant agencies. The registered manager described a situation where door alarms and window restrictors had been fitted to ensure a persons safety, all of which had been documented and discussed with other professionals. The provider may like to note, the intercom in the lounge which was in place for a persons safety and welfare could be turned down when other people are spending time in the lounge to protect the person's privacy and dignity.

| Inspection Report | Bigwig House | November 2012

www.cqc.org.uk

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. Peoples needs was assessed and care and treatment was planned and delivered in line with their individual care plan. Reasons for our judgement We saw during our inspection people participated in a variety of activities. Through-out our inspection, one person went to a rugby match and another to the pub for lunch. We saw peoples activities were in a pictorial format and displayed so people were able to see what they had chosen to do on a daily and weekly basis. People who lived at Bigwig were supported to choose their activities with their key workers. A key worker is a member of staff who is chosen to support a person with individual tasks. The registered manager told us, activities previously enjoyed by people prior to moving into Bigwig were encouraged to ensure continuity of care and continued social interests. We saw peoples care records included a section called 'significant historical events'. This section detailed important events which had occurred in people's lives. This information enabled an understanding of a person; it was useful in ascertaining how peoples past can reflect who they are today. This assists with individualising care delivery as well as ensuring care plans are tailored to the 'person'. We saw from records that care needs pre- assessments had taken place prior to the person moving in. Information from the person, their representatives and other social and health care agencies were sought as to what support and care the person needed. This is important so the provider is able to ensure peoples care needs can be met by the service and staff prior to someone moving in. We looked at three care plans and found these were detailed, informative and directed and guided staff of the action they needed to take in order to meet people's assessed care needs. The care plans were personalised with photographs and provided clear information about the person's health and social care needs and abilities. We were shown a copy of a care plan which was in a pictorial format. This enabled the person to be involved and to have a greater understanding of the content of their care plan. We looked at one persons care plan which detailed a person's complex behaviour. The consequence of this person's behaviour could at times result in staff having to intervene in a supported restraint. Documentation was clear and through observation and discussion with the registered manager, it was apparent this intervention was not taken unnecessarily.
| Inspection Report | Bigwig House | November 2012
www.cqc.org.uk

The person's behavioural patterns were being closely monitored and reviewed by the service and external professionals were involved as necessary. Staff received individual training to support this person. We were shown there was a system in place to update and review the care provided to people on a regular basis. This was important to ensure information contained within people's files was relevant and up to date. People who lived at Bigwig were involved in this process and were asked on a monthly basis for their own views. We saw records which demonstrated this. One relative told us "they know X well" and that they are "very happy". External professionals such as epilepsy nurses and leaning disability social workers were invited to care reviews on a six monthly basis or as required. This meant people were involved to ensure consistent care would be provided to the person. Families were also involved in the care planning process. We spoke to two relatives who informed us they had attended monthly reviews. One person explained the review had involved external professionals, the registered manager, the registered provider and the person's key worker. The registered manager informed us that care reviews focused on future goals and aspirations for people and not just on the 'present'. We saw risk assessments were completed for people who used the service. Risk assessments are a tool to identify any hazards and the action staff must take to reduce the risk from the hazard. The risk assessments were included in the care plan so staff knew how to reduce any identified risks while promoting the independence of people who used the service. We spoke to two members of staff who confirmed to understand what peoples care needs were care plans and documentation was read and readily accessible. The registered manager recognised the importance of new staff having protected time to be able to read peoples care plans. So as a result of this, we were told the staff induction was now going to incorporate an extra day for new staff to be able to spend dedicated time in reading peoples care plans. This demonstrated care planning was an important and integral part of the service and peoples care documentation was taken seriously.

| Inspection Report | Bigwig House | November 2012

www.cqc.org.uk

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 It was evident, from our observations, that staff and people who lived at Bigwig had a comfortable and respectful relationship with each other. Staff interactions with people, and people's behaviour showed they felt safe living at Bigwig. For example, we saw one member of staff having a joke with a person in a well meant fashion as they had put the staff members coat on and not their own. People were asked on a monthly basis as part of their care review whether they 'felt safe' and were happy living at Bigwig. Bigwig had a safeguarding policy and procedure. The policy made reference to the local social services guidance called the Alerters Guide. This highlighted the policy had been individualised and was specific to the county. We were also informed the induction process for new staff included a discussion about the safeguarding policy. A copy of the Alerters Guide was displayed in the home for staff and visitors to read. We asked two members of staff if they knew what to do should they witness an incident, or suspect, that a person who lived in the home was being mistreated, abused or neglected. All the staff told us that they would speak directly to the registered manager. Both staff members were aware that they could contact social services if they did not receive an appropriate response from the registered manager. We saw the homes training records which detailed all staff who worked at Bigwig had undertaken training in the safeguarding of vulnerable adults within the last two years. The registered manger also informed us all staff would be undertaking a refresher course in the coming months. The registered manager ensured staff had an ongoing understanding of safeguarding by discussing the homes policy during staff supervision. Supervision is a vital tool used between an employer and an employee to capture working practices. It is an opportunity to discuss ongoing training and development. We were told scenarios of abuse were given to staff and the staff were then asked to explain what they would do in response. This showed us the registered manager ensured the policy was reflected into day to day staff practice and enabled the registered manager
| Inspection Report | Bigwig House | November 2012
www.cqc.org.uk

10

to confirm if staff understood the homes policy and their responsibilities. The registered manager told us she had recently undertaken a two day 'managers' safeguarding training course with the local social services department. This showed us the registered manager took responsibility of ensuring her own knowledge was kept up to date as well as the additional responsibilities expected from being a registered manager in response to any safeguarding concern. Bigwig held money for each of the people who lived there. We were shown money was kept securely and records identified the amount of money the home held for each person, together with a record of all transactions when the money was used. This ensured peoples finances were protected. The Mental Capacity Act (MCA) provides a legal framework that protects people who lack the mental ability to make decisions about their life and welfare. We saw from the homes training matrix that all staff had undertaken this training. We saw documentation and were informed if there were concerns about a person's capacity to make decisions or a deprivation of liberty issue that it was discussed with other relevant agencies and peoples relatives and or/representative.

| Inspection Report | Bigwig House | November 2012

www.cqc.org.uk

11

Management of medicines

Met this standard

People should be given the medicines they need when they need them, and in a safe way

Our judgement The provider was meeting this standard. People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines. Reasons for our judgement The service had two lead members of staff who took responsibility for the ordering of medication. This ensured clear accountability and responsibility. We were shown that there was a robust system in place to obtain medicines, from the pharmacy, for people who lived in the home. This meant that people received the correct medication at the correct time. The provider may like to note, it is important that topical medication is dated when opened as it has an expiry date which may affect the usage. We read the homes medication policy. The policy was relevant, robust and could be accessed by staff as necessary. The provider may like to note the policy did not make reference to the Mental Capacity Act 2005 (MCA). It is important medication policies reflect the MCA to ensure consideration is made in relation to people's individual capacity to make decisions. We saw in the medication section of one persons care plan they had been prescribed topical medication for a skin condition. The staff were guided in use within the medication section of the persons care plan. However, the provider may like to note that, the personal care section was vague and did not give specific direction to staff about where to apply the person's cream as part of their daily routine. Medication administration record (MAR) charts were in place and signed when medication was given. These ensured, accurate records were maintained at all times. However, we saw for one person, there had been an error made, and one person's medication had not been given on 27 October 2012. We discussed this with the registered manager who confirmed this and demonstrated the procedures which had since been put into place following the mistake. This demonstrated the registered manager was pro-active in addressing areas of poor practice and finding solutions for improvement. At the time of our inspection there was one controlled drug kept on the premises for one person. This medication related to epilepsy management, and because this medication may be required in an emergency and would need to be administered immediately, the registered manager had introduced a system to maintain the accountability and security of this medication at all times. The medication remained with a member of staff who held it in a bag on their person at all times, this person was the person who was providing one-toone support.
| Inspection Report | Bigwig House | November 2012
www.cqc.org.uk

12

The medication was checked when handed over to the next member of staff and doubled signed to ensure accurate records were maintained. We were unable to check these records as the member of staff was out with the person at the time of our inspection. The registered manager and staff were supported by a nurse specialist and assisted with the protocols relating to this practice. We saw from the homes training records that all staff were trained in the administration of medication. We were told staff undertook general medication training, but due to the complexities of some medication administration, specialist medication training was undertaken in areas relating to people's individual care needs, such as the administration of epilepsy medication. We discussed homely remedies with the registered manager. A homely remedy is medication that can be given to people which is not formally prescribed such as pain killers and cough medicine. We were told the home did not have a supply of homely remedies nor did they provide any homely remedy unless authorised by a GP. The provider may like to note that a homely remedies policy and supply would enable people to have access to homely remedies as required. However, it is essential the homely remedy supply for the home is authorised by a GP as particular homely remedies may have contraindications to prescribed medication.

| Inspection Report | Bigwig House | November 2012

www.cqc.org.uk

13

Staffing

Met this standard

There should be enough members of staff to keep people safe and meet their health and welfare needs

Our judgement The provider was meeting this standard. There were enough qualified, skilled and experienced staff to meet people's needs. Reasons for our judgement At the time of this inspection there were three people living at Bigwig. Through our observations we saw there was enough staff to provide care for the people who lived at Bigwig. This was demonstrated through the variety of different activities people were participating in and choosing to do, as well as the calm atmosphere within the home. Staff were not seen to be rushing or rushing the people they were supporting. Care was provided on either a one-to-one support or two-to-one support. However, although staffing ratios were high, it was observed staff were respectful of peoples personal space when people wished to spend time alone, we observed one person listen to music in their room. One relative told us the staff were "very helpful", but there "is a little bit more of a staff turnover than we would like". Another relative told us, "they train them well" and "staff are not lazy". The registered manger told us how people had flourished since living at Bigwig and the positive changes she and the staff had seen in people. One example of this was a person who disliked going to the hairdressers was now able to go with their support worker. The training matrix identified staff undertook training in areas specific to the care and support provided to people who lived at Bigwig, such as makaton, autism and positive behaviour support. This is important as training safeguards the health, safety and welfare of people.

| Inspection Report | Bigwig House | November 2012

www.cqc.org.uk

14

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 to regularly assess and monitor the quality of service that people receive. Reasons for our judgement It was clear that the views of people who lived at Bigwig formed an important part of the quality monitoring system, and care and support was delivered, taking into account peoples views and opinions. People were encouraged to participate in the running of "their home" and care documentation was reflective of people's involvement. Monthly questionnaires were completed by people who lived at Bigwig and these had been designed to enable everyone to express their opinion, taking into consideration people's individual cognitive strengths and weaknesses. The registered manager also sent questionnaires to external stakeholders and families, and collated their feedback, to continually improve the running of the service. We saw example of feedback which had been given, feedback read was positive. One relative we spoke to was complementary about the registered manager and registered provider, they told us "I feel like I can approach them at any time" and "we can speak to the registered provider at anytime". The registered manager told us the organisation was "transparent" and "reflection and feedback" was important to Bigwig and to the organisation as a whole, to ensure services were delivered correctly. She told us the registered provider was "excellent", and she was given "complete ownership" of Bigwig which she told us "is better for our development". It was encouraging to hear the registered manager felt in main control of "her" service and was supported by the provider. Auditing systems were in place for medication and financial management. This indicated the registered manager and nominated individual on behalf on the company understood the importance of identifying any problems and acted appropriately where necessary to make improvements. We saw an example of this from the medication error which had been identified, and from the actions which had been put into place, to rectify further mistakes from occurring. The registered manager and provider explained there was a new service audit being introduced to formalise the current management feedback visits. We were shown a copy of the annual quality questionnaire which had been sent out in
| Inspection Report | Bigwig House | November 2012
www.cqc.org.uk

15

May 2012. We were told that, although, no key issues had been raised from the questionnaires, the provider had recognised a system needed to be put into place to formally collate the results so they could be shared.

| Inspection Report | Bigwig House | November 2012

www.cqc.org.uk

16

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 2009. 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 dentists and other services at least once every two years. 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 but we always inspect at least one standard from each of the five key areas every year. We may check fewer key areas in the case of dentists and some other services. 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 | Bigwig House | November 2012

www.cqc.org.uk

17

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. 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.

Met this standard

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 | Bigwig House | November 2012

www.cqc.org.uk

18

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. We make a judgement about the level of impact on people who use the service (and others, if appropriate to the regulation) from the breach. 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 | Bigwig House | November 2012

www.cqc.org.uk

19

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 2009. 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 | Bigwig House | November 2012

www.cqc.org.uk

20

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 2009. 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 | Bigwig House | November 2012

www.cqc.org.uk

21

Contact us

Phone:

03000 616161

Email:

enquiries@cqc.org.uk

Write to us at:

Care Quality Commission Citygate Gallowgate Newcastle upon Tyne NE1 4PA

Website:

www.cqc.org.uk

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 | Bigwig House | November 2012

www.cqc.org.uk

22