Inspection on 16/06/05 for Westend

This inspection was carried out on 16th June 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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

Westend 06/09/07

Westend 20/06/06

Westend 15/01/06

Westend 20/01/05

Westend 10/08/04

Westend 24/03/04

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Trevaylor Manor

Honeybourne House

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

CARE HOME ADULTS 18-65 Westend Pearcroft Road Stonehouse Gloucestershire GL10 2JY Lead Inspector Lynne Bennett Unannounced Thursday 16 June 2005 11:00 th 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 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 Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary 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. Westend D51_D03_S34022_Westend_V228369_160605_Stage4_U.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Westend Address Pearcroft Road Stonehouse Gloucestershire GL10 2JY 01453 758618 01453 758618 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Stroud Care Homes Limited To be appointed Care Home - Personal Care 6 Category(ies) of Learning Disability (6) registration, with number of places Westend D51_D03_S34022_Westend_V228369_160605_Stage4_U.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 20th January 2005 Brief Description of the Service: Westend is a detached family home in the quiet residential area of Stonehouse, close to Stroud. It is one of two homes owned by Stroud Care Homes Limited within the Stroud District that provide accommodation to adults with a learning disability who may present with behaviours which challenge. Each service user has a single room, with en suite facilities, including either a bath or a shower. Service users have been encouraged to decorate their rooms. There is ample communal space, including two large lounges fitted out with good quality fixtures and fittings; one is designated as a quiet room. There is also a domestic size kitchen with an adjoining conservatory for dining. Since the last inspection part of the rear garden has been partitioned off to provide a site for a new residential home. At the time of the inspection service users could not access this site Westend D51_D03_S34022_Westend_V228369_160605_Stage4_U.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over five hours on a day in June 2005. The acting manager and people living at the home showed the inspector around the premises. Time was spent with three people living at the home. The care for two people was looked into. This involved looking at their personal files, care plans, risk assessments, medication records, speaking to one of them and their key workers or other staff. Other records looked at included staff files for new members of staff, minutes of meetings and health and safety records. Three members of staff were spoken to as well as the acting manager. An immediate requirement was issued in relation to the employment of staff without a Povafirst or Criminal Records Bureau check. What the service does well: What has improved since the last inspection? Staff vacancies have been filled providing a stable staff team. An acting manager has worked alongside the group manager to provide consistency and continuity. One of the lounges has a range of sensory equipment and music systems to provide a relaxing environment. Westend D51_D03_S34022_Westend_V228369_160605_Stage4_U.doc Version 1.30 Page 6 What they could do better: 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. Westend D51_D03_S34022_Westend_V228369_160605_Stage4_U.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection Westend D51_D03_S34022_Westend_V228369_160605_Stage4_U.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1 and 5. The Statement of Purpose and Service User Guide give people living at the home and people wishing to live there information about the services provided enabling them to make an informed decision about living at the home. EVIDENCE: The home has a Statement of Purpose and Service User Guide that are available to people living at the home. Each person also has a statement of terms and conditions in place. One person who recently moved into the home from another home in the organisation still has an agreement with the old home. This must be changed to reflect the terms and conditions in place at Westend. The home will shortly have a vacancy. The admissions process for any prospective service users will be examined at the next inspection. Westend D51_D03_S34022_Westend_V228369_160605_Stage4_U.doc Version 1.30 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6,7,8 and 9. There is a clear and consistent care planning system in place providing staff with the information they require to meet the needs of people living at the home. Individual risk assessments encourage and support people living at the home to challenge and deal with problem areas in their lives. People living at the home are supported to make decisions and choices about aspects of daily living and to take responsibility for those decisions. EVIDENCE: Comprehensive plans are in place for people living at the home. These are being regularly reviewed and amended to reflect any changes in the needs of people living at the home. Key workers provide a monthly report summarising people’s needs that are then used to plan for the six monthly PCP (Person centred planning) review. Each file has a summary of reviews and key meetings for the forthcoming year. This can be cross-referenced with updated records and review meetings. This is good practice. People living at the home have access to their records, and where appropriate sign their care plans and risk assessments. They said that they are happy with their key workers and have annual meetings with either their social worker or a personal advisor from the placing authority. Westend D51_D03_S34022_Westend_V228369_160605_Stage4_U.doc Version 1.30 Page 10 Staff maintain a record of incidents involving people living at the home and the Commission is informed of those incidents which affect the safety or wellbeing of people living at the home. There were however some incidents recorded in daily records for which no incident form was completed – such as an incident in the car and concerns about the relationship between two people living at the home. The Commission would expect to be informed about such events. People living at the home said that they have responsibility for helping with activities of daily living such as cleaning, cooking, washing and shopping. They said that they make decisions about their lifestyle choices and staff provide support where necessary. For instance one person is attending college with staff support and has recently suggested staff wait outside the classroom. Another person wishes to find work at a local cinema complex and staff are supporting them by going to the local job centre. Weekly house meetings continue with lively discussions about the wishes and needs of people living at the home. A comprehensive range of risk assessments are in place minimising hazards to people living at the home. These are being regularly reviewed and are signed by the key worker. It was evident that risk assessments are being put in place to reduce any new hazards that are being identified. Westend D51_D03_S34022_Westend_V228369_160605_Stage4_U.doc Version 1.30 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13,14,15,16 and 17. People living at the home are supported to access a wide range of activities enabling them to live a fully inclusive lifestyle. There are concerns that the provision of transport is not fully meeting the needs of people living at the home putting them at risk of harm. EVIDENCE: People living at the home access a range of local facilities in Stroud as well as visiting Gloucester and Bristol. One person really enjoys the cinema and has seen some recent releases in Gloucester. This person is really looking forward to the opening of a cinema complex in Stroud. Another person went out to a pub for lunch on the day of the inspection and said they really enjoyed this regular treat. Two people attend a day centre five days a week and another person said that they like to accompany them several times a week. One person said they enjoy going to a local college. Staff are looking into courses at the Guildhall in Gloucester for other people living at the home. One person has until recently Westend D51_D03_S34022_Westend_V228369_160605_Stage4_U.doc Version 1.30 Page 12 been involved in work experience and is looking for further opportunities in Stroud. One person chatted about a recent long weekend in London and another person said they plan to go to Newquay for a week. Day trips are planned throughout the year to local places of interest. One person said that they occasionally go to concerts and others said they like to go swimming and walking. The home presently has the use of one car. This was sufficient to meet the needs of people living in the home prior to three people moving in at the end of last year. On days when three people are attending the day centre this is used to transport three residents plus two staff. This does not appear appropriate or safe. Incidents have been recorded when the vehicle is used in this way. The organisation must urgently review the provision of transport for the home People living at the home are supported to develop and maintain relationships, and keep contact with friends and family on a regular basis. The home has a rota outlining people’s responsibilities for household tasks. These are shared between people living at the home. They also choose a meal for one day of the week and can help prepare this. A range of fresh and frozen produce is available. Lunch on the day of the inspection was a choice of Cornish or Cheese Pasty and salad with crusty rolls. One person requested scrambled egg on toast and this was provided. Westend D51_D03_S34022_Westend_V228369_160605_Stage4_U.doc Version 1.30 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18,19 and 20. The staff have a good understanding of the support required by people living at the home and this is evident from the positive relationships, which have been formed with staff. People living at the home have access to healthcare professionals and to a satisfactory medication system, ensuring that their healthcare needs are being met. EVIDENCE: The personal and healthcare needs of people living at the home are clearly recorded in their care plans. Staff explained their role and how they support people living at the home to meet these needs. Interactions with people living at the home were positive and respectful. Clear healthcare records are being maintained. Appointments are noted and outcomes of these appointments recorded in individual notes. People living at the home have access to a full range of healthcare professionals and are supported at outpatient appointments. One person who has limited communication is using speech more often. It was suggested that involvement of a Speech and Language Therapist at this stage might be beneficial. There are also concerns about issues of consent and whether this person is able to give consent. Under the law unless an Westend D51_D03_S34022_Westend_V228369_160605_Stage4_U.doc Version 1.30 Page 14 assessment has been carried out indicating that consent cannot be given, then this person is considered able to give consent. The Community Learning Disabilities Team or Social Worker must undertake an assessment. On occasions one person has bruises or cuts caused by self-harm, staff are advised to keep a record of these on body map charts. The administration and control of medication in the home is satisfactory. Personal medication profiles are in place as well as protocols for the use of ‘as required’ medication. It was suggested that the homely remedies list approved by the GP in 2003 is reviewed when medication is next reassessed with the Doctor. Two signatories are signing some of the handwritten entries on the medication administration record. This is good practice. Westend D51_D03_S34022_Westend_V228369_160605_Stage4_U.doc Version 1.30 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22 and 23. An open and positive atmosphere encourages people living at the home to express concerns and complaints in the confidence that they will be dealt with and actioned. There are vulnerable adults procedures in place, although training for staff could be more robust to ensure the protection of people living at the home. EVIDENCE: The home has a complaints policy and procedure that is displayed around the home. People spoken to are aware of this and that they can express concerns or complaints to the Commission for Social Care Inspection. One complaint was recorded from a person living at the home. The outcome of the complaint and action taken was recorded and fed back to the person making the complaint. The home has access to a trainer of Positive Response training accredited with BILD. Regular refresher training is provided for all staff and new staff complete Positive Response training during their induction. The organisation employs a Psychologist providing support to both people living in the home and staff. Any incidences of use of physical intervention are reported to the Commission. Staff spoken to were aware of the home’s confidentiality and whistle blowing procedures and their responsibilities in light of these. Staff said that they are confident that the acting manager would challenge poor practice. Staff have not attended training in the Protection of Vulnerable Adults. They have access to ‘No Secrets’ and Gloucestershire ‘Adults at Risk Procedure’ and Westend D51_D03_S34022_Westend_V228369_160605_Stage4_U.doc Version 1.30 Page 16 the ‘Alerters’ guide. Staff spoken with said they would not tolerate abuse and would report this immediately. There is evidence that there are concerns about a relationship between two people living at the home. This is being referred to the adult protection unit for advice. (See also Staffing). Westend D51_D03_S34022_Westend_V228369_160605_Stage4_U.doc Version 1.30 Page 17 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24,25, 28,29 and 30. The home provides comfortable, homely accommodation that reflects the personalities and lifestyles of people living in the home. EVIDENCE: Opened in 2002 Westend is a detached property in a quiet residential area near to local shops, facilities and transport systems. New double glazed windows have been fitted throughout the house, with safety restrictors. A car park at the back of the house will shortly be available for use; new paths lead from the house to the car park. A new summerhouse is going to be built in the garden. Each person has single accommodation with en suites including a shower or bath. Rooms reflect their personalities and lifestyles. They have access to comfortable and spacious communal spaces including two lounges one with a television and the other with music and sensory equipment. This room will soon have a pool table. Westend D51_D03_S34022_Westend_V228369_160605_Stage4_U.doc Version 1.30 Page 18 The conservatory is being used as a dining area. This room has no blinds or cooling system so that in the summer months it will become very hot. Blinds and/or a fan must be installed to maintain temperatures in this room at appropriate levels. At the last inspection there were concerns about whether the conservatory was appropriate for use as a dining room. Access to this room is through a small kitchen making the thoroughfare hazardous when meals and drinks are being prepared. This will continue to be monitored. The home was clean, tidy and well ventilated. Westend D51_D03_S34022_Westend_V228369_160605_Stage4_U.doc Version 1.30 Page 19 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33,34,35 and 36. The provision of staff support overnight must be appropriate to the needs of people living at the home minimising the risk of harm. Robust training systems provide staff with the opportunity to acquire knowledge and skills relevant to the tasks they perform. The recruitment and vetting procedure of prospective staff is not protecting people living at the home and potentially placing them at risk. EVIDENCE: A core team of experienced, skilled and trained staff support people living at the home. New staff complete induction training and are observed in practice for the first six weeks. Core training is provided for new staff including Positive Response Training, fire, basic food hygiene and first aid. A new member of staff said that this training had been completed before starting a NVQ Award in Care. She had just completed her first unit. There has been a period of change in the home over the last eight months including a turnover of staff and a new manager. Staff feel that the team are working well together and that communication is good. Staff appeared to have a good understanding of the complex needs of people living at the home and Westend D51_D03_S34022_Westend_V228369_160605_Stage4_U.doc Version 1.30 Page 20 how to support them at times when they may feel anxious or angry. They described triggers that may upset people and how they use diversion and distraction to positive effect. Staff said that staffing ratios were appropriate to the needs of people living at the home. However measures being taken by the home overnight to ensure the safety and wellbeing of people living at the home, such as locking bedroom doors, would indicate that the home need to be employing waking night staff instead of sleeping in staff. Vacancies and sickness in recent months meant that staff were working additional hours but it was hoped that recent advertisements for senior staff would bring the team back to full strength. Regular staff meetings are taking place and there is a handover between shifts each day. Files for new staff indicated that two staff started working without a Povafirst or Criminal Records Bureau check in place. Staff must not commence work without these documents. In exceptional circumstances a member of staff may start work without a Criminal Records Bureau check but only with a Povafirst check and all other documentation in place. In such a circumstance the Commission must be informed and a risk assessment put in place. A named person must supervise staff without a Criminal Records Bureau check until this is obtained. An immediate requirement was issued. All other documentation as required under Schedule 4.6 was in place and at least two references had been obtained prior to employment. A new reference request form is being used which meets with the requirements of Schedule 2.4. Supervision sessions and annual appraisals are being scheduled. The acting manager acknowledges the importance of these meetings and the need for good communication systems within the home. Westend D51_D03_S34022_Westend_V228369_160605_Stage4_U.doc Version 1.30 Page 21 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37, 39 and 42. Quality assurance systems are in place providing a way in which people living at the home can give regular feedback about the service they are receiving. There needs to be a slight improvement in health and safety procedures to ensure that people are living in a safe environment. EVIDENCE: The acting manager has been in post a few months and will be applying to the Commission to become the registered manager for the home. She has started a NVQ in Care at Level 4 to be followed by the Registered Managers Award. The acting manager appeared to have a hands on approach to her work and was open and approachable to both staff and people living at the home. Staff confirmed that they are confident that she would challenge poor practice. They felt that the manager would use constructive criticism to develop staff in a way that would not demean them. Westend D51_D03_S34022_Westend_V228369_160605_Stage4_U.doc Version 1.30 Page 22 A quality assurance system is in place that includes asking people living at the home, visitors and the maintenance department to complete a survey. This is done intermittently throughout the year giving an opportunity for regular feedback. Monthly Regulation 26 visits are taking place and copies being sent to the Commission. Environmental and fire risk assessments are in place and being reviewed. COSHH data sheets are kept for hazardous products that are stored securely. Fridge and freezer temperatures are recorded. Opened food in fridges was labelled with the date of opening. Temperatures of cooked meals are being taken and recorded. Water temperatures are being recorded but these indicate that hot water from all outlets around the house is being supplied at over 43 degrees Centigrade. This must be resolved. Westend D51_D03_S34022_Westend_V228369_160605_Stage4_U.doc Version 1.30 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 x x x 2 Standard No 22 23 ENVIRONMENT Score 3 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 2 3 3 3 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 3 x x 2 3 3 Standard No 11 12 13 14 15 16 17 x 3 2 3 3 3 3 Standard No 31 32 33 34 35 36 Score x x 3 1 3 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Westend Score 2 3 3 x Standard No 37 38 39 40 41 42 43 Score 3 x 3 x x 2 x D51_D03_S34022_Westend_V228369_160605_Stage4_U.doc Version 1.30 Page 24 No Are there any outstanding requirements from the last inspection? 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 5 Regulation 5(1)(b)(c) Requirement The statement of terms and conditions for new service users living at the home must be amended. Incidents detrimental to health or welfare of service users must be recorded and reported to the Commission. Transport must be urgently reviewed to ensure that the home meets the needs of service users. A consent assessment must be carried out for one service user. Blinds and/or fans must be fitted to the conservatory. Appropriate numbers of staff must be working in the home to ensure the safety and wellbeing of service users. Staff must not be appointed without a CRB check in place. Hot water temperatures must be maintained at 43 degrees centigrade. Timescale for action 16 August 2005 16 June 2005 16 July 2005 16 August 2005 16 August 2005 16 June 2005 16 June 2005 16 July 2005 2. 6 3. 13 17(2) Sch. 4.12(b) 37 16(2)(m) (n) 12(2)(3) 12(3) 18(1)(a) 4. 5. 6. 18 28 33 7. 8. 34 42 19(1) Sch 2 13(4)(c) Westend D51_D03_S34022_Westend_V228369_160605_Stage4_U.doc Version 1.30 Page 25 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. 2. 3. Refer to Standard 18 20 23 Good Practice Recommendations A referral should be made for a Speech and Language assessment for a service user. Body maps should be used to record any bruising or injury to the service user. The homely remedies list should be reviewed. Staff should attend training in the Protection of Vulberable Adults. Westend D51_D03_S34022_Westend_V228369_160605_Stage4_U.doc Version 1.30 Page 26 Commission for Social Care Inspection 1210 Lansdowne Court Gloucester Business Park Brockworth Gloucester GL3 4AB National Enquiry Line: 0845 015 0120 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 Westend D51_D03_S34022_Westend_V228369_160605_Stage4_U.doc Version 1.30 Page 27 - 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. 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