Inspection on 02/04/08 for Neilston

This inspection was carried out on 2nd April 2008.

CSCI found this care home to be providing an Adequate service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Neilston 30/04/09

Neilston 11/10/07

Neilston 29/06/07

Neilston 20/06/06

Neilston 17/01/06

Neilston 22/09/04

Neilston 05/05/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Neilston 47 Woodway Road Teignmouth Devon TQ14 8QB Lead Inspector Graham Thomas Unannounced Inspection 09:00 2 & 3rd April 2008 nd X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Neilston DS0000003759.V361852.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Neilston DS0000003759.V361852.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Neilston Address 47 Woodway Road Teignmouth Devon TQ14 8QB Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01626 774221 01626 879395 joy@neilston.info Mr John Bryant Wescott Mrs Joy Wescott Mrs Joy Wescott Care Home 22 Category(ies) of Dementia (22), Old age, not falling within any registration, with number other category (22) of places Neilston DS0000003759.V361852.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 11th October 2007 Brief Description of the Service: The quality rating for this service is 1 star . This means the people who use the service experience adequate quality outcomes. Neilston is registered to provide care for a maximum of twenty-two older people who may also have dementia. The proprietors and registered providers are Mrs Joy Wescott and Mr John Wescott who live on the premises. Mrs Wescott manages the home on a day-to-day basis and Mr Westcott takes responsibility for the maintenance of the house and garden. Neilston is situated on a hill in a quiet residential area of Teignmouth, and is approximately one mile from the town centre. It is a detached house with a substantial garden. Car parking is available on the road outside. There are 18 bedrooms single rooms and two double bedrooms. All have en-suite facilities. Accommodation is situated on the ground, lower ground and first floors. There are stair lifts to the first and lower ground floors. Communal space comprises a large lounge and a separate dining room with an adjoining sun lounge, which leads to the rear garden. Written information is provided for people considering going to live at Neilston and those who are resident. A copy of the most recent CSCI inspection report is available. The Registered Provider stated that fees currently range from £288 to £400 per week. Neilston DS0000003759.V361852.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Quality rating for this service is 1 star . This means the people who use the service experience adequate quality outcomes. This inspection comprised of visits to the home over two days. During this time we spoke individually with 3 people living in the home, and 5 visiting relatives. Five staff were interviewed as well as a visiting Community Nurse and a Reviewing Officer from the Local Authority. We also observed staff working with people living in the home. We examined all the rooms in a tour of the home. Various records were examined including a sample of care plans, staff files and maintenance records. Since the last Key inspection, a random inspection was conducted on 16th January 2008. This will be referred to in this report. What the service does well: What has improved since the last inspection? What they could do better: Neilston DS0000003759.V361852.R01.S.doc Version 5.2 Page 6 • Better records must be kept about the medicines people take. • The way medicines are given to people must be made safer • Mrs. Wescott must make sure that staff always wear protective clothing to protect people from infection • Mrs. Wescott must make sure that staff use safe methods for moving and handling people • Hazardous substance must always be stored securely to protect people from harm • Mrs Wescott should improve communication with staff and supervision so that they work in a consistent and safe way • People should be included in their care planning and this should be recorded Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Neilston DS0000003759.V361852.R01.S.doc Version 5.2 Page 7 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 Neilston DS0000003759.V361852.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 3 and 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People considering a move to Neilston can feel confident that their needs will be assessed before they move in so that the home knows it can meet those needs. EVIDENCE: At the last key inspection it was noted that assessments were not sufficiently detailed concerning people’s individual needs, interests and preferences. Substantial improvements were noted at the random inspection in January 2008. On this occasion, we looked at the records for one person who had been recently admitted. This contained an assessment made by Mrs Wescott and a copy of the care plan from the care home at which the person had previously lived. This provided sufficiently detailed information about the person’s needs and preferences. Staff and a visiting relative confirmed that the assessment Neilston DS0000003759.V361852.R01.S.doc Version 5.2 Page 9 had been made before the person moved in. The relative also confirmed that there was an opportunity to visit Neilston before the making a decision and that enough information was provided beforehand. Neilston does not provide intermediate care. Neilston DS0000003759.V361852.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7, 8, 9, 10 and 11 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Improvements in care planning mean that the needs of people living at Neilston are better understood and catered for. Practices concerning the use of medicines are not sufficiently safe. EVIDENCE: At the last key inspection it was found that the individual plans lacked sufficient detail, were not kept up to date and were not understood or followed by staff. Our visit in January showed significant improvements in care planning. During this visit, six individual plans were examined. The plans were more detailed and up to date than those examined at the last key inspection. They were also being followed by staff. For example, two plans showed that the individuals were diabetic. Discussions with the cook confirmed that she was aware of these peoples’ individual dietary requirements. There were records of dietary and weight monitoring in the plans. Recent staff training in nutrition Neilston DS0000003759.V361852.R01.S.doc Version 5.2 Page 11 had resulted in general changes to the menu such as the use of full fat rather than semi-skimmed milk. Another plan showed that the person should be taken for a walk every day. Daily records showed that this was being done. The plans examined showed evidence of regular reviews. Some plans were still awaiting the addition of a photograph of the person. Healthcare needs were identified in the plans as well as records of specialist referrals. A visiting Community Nurse confirmed that there was good communication with the home. She confirmed that standards of hydration were good and that she had no concerns about pressure area care. At the last key inspection an issue arose about arrangements for people who required end of life care. The Community Nurse confirmed that this had now been resolved. All the residents with whom we spoke said that they could see the Doctor when they needed to. Care plans contained details of general and specific health care appointments checks and treatments such as nursing and chiropody. Relatives with whom we spoke said that they were kept informed and consulted about issues concerning their relative in the home. However the involvement of individuals or their relatives was not recorded well in the plans. The home’s system for administering medicines was examined. Medication was held securely in the home’s office. A monitored dosage system was in use. The medication records of three people were inspected. Errors were noted in these records. In one instance, none of the evening doses for one medicine had been signed for. Mrs Wescott stated that the dose had been changed by the GP though was difficult to find any record of this. Some medicines had been signed for although they had not been administered. No homely remedies were in use at the time of this inspection. Additional secure storage was available for controlled drugs though none was in use at the time of our visit. However, there was a separate record of the use of these drugs with two signatures for all the doses administered. It was noted that medicines were being “potted up” in advance for administration later. This practice is potentially dangerous as it poses the risk of medicines being muddled, lost or stolen. During our visit we saw staff talking with people respectfully, knocking on doors before entering and patiently assisting people who were confused. Those people with whom we spoke confirmed that this was always the case. We noted that a toilet and bathroom had frosted glass in the lower half only. This would normally be sufficient as the room is not overlooked. However there was scaffolding and work going on outside the room. This meant that people’s privacy and dignity was potentially compromised. Neilston DS0000003759.V361852.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The warm welcome offered to visitors at Neilston provides good support for people to keep in touch with their relatives and friends. The lifestyle offered by the home offers a satisfactory degree of choice for people who live there. EVIDENCE: Activities recorded in the home’s activities log included Tai Chi, walks, quizzes, sing-along and ball games. During the inspection visit residents enjoyed singing and listening to the organ. Staff were seen playing bingo with residents and accompanying them for walks. Other people were seen reading the paper and watching television. On the second day of our visit an entertainer came to provide the first of a 2 day “taster” workshop for people living in the home. Records showed that some people had been able to attend their local church while others had received communion in the home. This was confirmed in our conversations with people. People living at Neilston said that their visitors were always made welcome and offered refreshments. This was confirmed by visitors with whom we spoke including relatives and professionals. Neilston DS0000003759.V361852.R01.S.doc Version 5.2 Page 13 Residents with whom we spoke praised the quality of the meals. The meals seen during the inspection were of a satisfactory standard. On the first day of the visit, the midday meal comprised roast pork with roast potatoes and vegetables, followed by rhubarb pie and custard. A separate pudding was prepared for people with diabetes. There was no choice of menu offered at lunchtime. However, both the Registered Provider and the cook said that an alternative was always available on request. Although the cook was aware of special dietary requirements, there was no system for communicating individual tastes and preferences and the cook was not aware of these. We observed the lunch time meal during which staff were seen offering discreet help to residents such as cutting up their food. Staff were also seen assisting people to eat in their own rooms. People appeared to enjoy their meal. People’s own routines were respected. For example, during our visit some people chose to spend time in their rooms while others joined fellow residents in the lounge. Neilston DS0000003759.V361852.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living at Neilston and their relatives can feel confident that their concerns will be listened to and addressed. There are generally robust systems in place for responding to evidence of abuse. EVIDENCE: People living in the home and the relatives with whom we spoke felt confident that any concerns taken to Mrs Wescott or the staff would be listened to and acted upon. The home’s own complaints log showed no recent complaints. None has been received by the Commission since the last key inspection. All but the most recently recruited staff had received training in the safeguarding vulnerable adults from abuse. Most of those with whom we spoke were able to identify forms of abuse and who to alert if they suspected it was taking place. One member of staff needed to have refresher training in this area. The system of employment checks had improved to better protect people living in the home. Neilston DS0000003759.V361852.R01.S.doc Version 5.2 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Neilston provides well-maintained, clean, pleasant and homely surroundings for people who live there. Insufficient attention is paid to the secure storage of hazardous substances. This could place some people at risk. EVIDENCE: Neilston is situated close to the seaside town of Teignmouth and all its amenities. There is ample free car parking space on the public road outside the premises and some limited parking in the home’s driveway. Internally the home has a complex layout. Individual accommodation is spread over ground and first floors and a lower ground floor. There are mezzanine levels between the floors. In addition there is a basement level which houses the laundry, food store and staff accommodation. During our visit we examined all parts of the home except the staff accommodation. The home is decorated in a homely style and has light and Neilston DS0000003759.V361852.R01.S.doc Version 5.2 Page 16 airy communal areas. These include a lounge, dining room with adjoining sun lounge which leads to the garden. Substantial gardens are situated at the rear of the property. The home was found to be well decorated, clean, comfortable and personalised to accommodate individual taste. People living in the home and visitors commented on the pleasant surroundings and the cleanliness of the accommodation. We noted that all areas were clean and that there was particularly effective control of offensive odours. Our tour confirmed that some rooms had recently been redecorated and fitted with new carpets. Mr Wescott is responsible for the maintenance and decoration of the premises, assisted by a maintenance worker. A generally good standard of maintenance was evident during our tour. There was a record of ongoing maintenance with tasks planned and completed. At the time of our visit, substantial work was going on outside the building to repair a roof. At the last key inspection stair lifts were found not to be working. This had been remedied. One stair lift was not working on this occasion due to a minor fault but this was rectified immediately. At the last key inspection, hazards in the garden have been removed. Most hazardous substances were securely stored. However, some cleaning materials were found unattended in an unlocked room. Neilston DS0000003759.V361852.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27, 28, 29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living at Neilston are supported by a sufficient number of staff who generally receive the training they need. Improvements in recruitment practice mean that people living in the home are safer. EVIDENCE: During our visit we spoke with five staff members individually. Three staff files were examined including the files of those most recently recruited. Staffing rotas were also examined. Neilston is staffed by care staff, 2 part-time cleaners and a cook. Rotas showed that there were routinely four carers on duty in the morning and three in the afternoon and evening. Mrs Wescott also provides some support during these hours. Carers assist with cleaning duties. Overnight one staff member is awake and Mrs Wescott, who lives on the premises, provides additional “sleep-in” cover. Maintenance is carried out and managed by Mr Wescott with the help of an assistant. At the time of our visit, carers spent a substantial part of their duty cleaning. They commented that this diverted them from spending time individually with People living in the home. Neilston DS0000003759.V361852.R01.S.doc Version 5.2 Page 18 Interactions seen between carers and people living in the home were positive and supportive. People who were disorientated were offered gentle guidance and reminders. Staff joined in with people’s spontaneous expressions of pleasure in dancing and singing, which they very obviously enjoyed. A training programme was in place. At the time of our visit, two staff were undertaking a National Vocation Qualification at level 3 and another at level 2. Short courses had also taken place. For example, these included safeguarding vulnerable adults from abuse and malnutrition in older people. The latter of these had resulted in changes of policy in the provision of food in the home. Some necessary training remained outstanding. For example, no cleaning staff had received training in infection control. Recruitment practices had improved since the last key inspection. A recently recruited staff member had commenced duty before a Criminal Records check had been obtained. This person confirmed that she was not allowed unsupervised access to people until this check had been completed. Her file revealed that other checks had been undertaken such as a “POVA First” check. Neilston DS0000003759.V361852.R01.S.doc Version 5.2 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31, 33, 35, 36, and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People living at Neilston have benefited from the better management of issues identified at the last key inspection. However supervision and communication between staff and management is not sufficient to ensure that good, safe practice is consistently applied. EVIDENCE: Mr and Mrs Wescott have owned and managed the home for 18 years. Mrs Wescott is a nurse who was trained and qualified in the Philippines and she takes responsibility for the day-to-day running of the home. She holds the Registered Managers Award and is a qualified National Vocational Qualification training assessor. Neilston DS0000003759.V361852.R01.S.doc Version 5.2 Page 20 Systems to audit the quality of the service provided have been introduced. This includes surveys of people living at the home, relatives and others. There is minimal involvement with people’s finances. These are managed either by the person’s relative or a representative. Where the proprietor makes payments to or on behalf of people, records and receipts were available for payments made. Interviews with staff revealed that there was some confusion amongst the staff group around the roles and responsibilities of “senior carers”. Staff also felt that communication between management and staff could be improved. This was confirmed in records which showed that individual supervision was irregular and non-existent for some staff. Staff meetings were also irregular. Some felt that they were not always fully briefed on individual needs before caring for new residents. Records of handover meetings were not well recorded. Health and safety issues were examined. Since the last key inspection, the safety of the garden area had improved by the removal of hazardous substances, locking sheds and the containment of the proprietors’ dogs. Routine maintenance was recorded and invoices were seen concerning regular servicing of, for example, the stair lifts. Staff had received training in health and safety topics such as moving and handling and food hygiene. Infection control policies were in place. Antibacterial gel was available for staff use. The provision of liquid soap and paper towels for carers in individual rooms would improve these measures. Individual staff practice concerning infection control was inconsistent. One staff member was very well versed in this subject and was scrupulous in her practice. However other staff were seen carrying laundry and carrying out cleaning tasks without wearing appropriate protective clothing such as aprons and gloves. These staff were later seen assisting people to eat. This places people at risk of cross infection. The care plan of one person confirmed that the person was entirely dependent on staff for moving and transfers. Examination of moving and handling assessments and discussion with the Community Nurse confirmed that the use of a hoist for this person was required. A hoist was available but this was not being used by staff and was stored on the floor below. The hoist was moved upstairs during the inspection visit. Neilston DS0000003759.V361852.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 2 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 1 X 2 Neilston DS0000003759.V361852.R01.S.doc Version 5.2 Page 22 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. 1. Standard OP9 Regulation 13(2) Requirement Accurate records must be maintained of all medicines administered in the home. The practice of “potting up” medicines for subsequent administration must cease Timescale for action 30/04/08 2. OP9 13(2) 30/04/08 3. OP38 13(3) 4. OP38 13(5) 5. OP38 13(4)(a) The registered person must 30/04/08 ensure that measures to prevent infection, toxic conditions and the spread of infections are applied in the home. This refers in particular to the use of protective aprons and gloves during laundry, cleaning and personal care tasks. The registered person must 30/04/08 ensure that safe methods of moving and handling are used in the home. The registered person must 30/04/08 ensure that hazardous substances used within the home must be securely stored when not in use. Neilston DS0000003759.V361852.R01.S.doc Version 5.2 Page 23 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP7 Good Practice Recommendations The registered person should ensure that people or their representatives are involved in planning the care of people and that this involvement is clearly recorded. The upper part of the bathroom / toilet window described in this report should be obscure to protect the privacy and dignity of those using the room. The registered person should ensure that a choice of menu is available at all times and that the cook is fully informed about individual tastes and preferences. The registered person should ensure that experienced staff have refresher training in safeguarding vulnerable people from abuse. Arrangements for managing and supervising staff should be reviewed and improved to ensure consistent practice in areas of health and safety. 2 OP10 3 OP15 4 OP18 5 OP36 Neilston DS0000003759.V361852.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Neilston DS0000003759.V361852.R01.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!