Inspection on 16/06/05 for Westmead

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 Adequate. 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Westmead 03/11/09

Westmead 05/06/08

Westmead 07/06/07

Westmead 20/06/06

Westmead 11/11/05

Westmead 03/03/05

Westmead 17/06/04

Similar services:

The Vicarage

7 Hyde Road

5 Seafield Road

Trevaylor Manor

12 Orchard Mews

Stallcombe House

Stepping Stones

Cornerstones

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

CARE HOME ADULTS 18-65 Westmead Leonard Cheshire Saunton Road Braunton EX33 1HD Lead Inspector Dee McEvoy Announced 16 June 2005 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. Westmead D54-D06 S22129 Westmead V224235 160605 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Westmead Address Leonard Cheshire, Saunton Road, Braunton Devon 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) 01271 815915 01271 814501 Leonard Cheshire Mrs Caroline Brennan Care Home 18 Category(ies) of PD Physical Disability (18) registration, with number of places Westmead D54-D06 S22129 Westmead V224235 160605 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 3 March 2005 Brief Description of the Service: Westmead provides accommodation and 24-hour care for eighteen adults with physical and learning disabilities under the ownership of the Leonard Cheshire Foundation. Although their age category ranges from nineteen to sixty-five, the majority of service users are under 40 years. The home is an older property and has been adapted for wheelchair users throughout. All bedrooms are single occupancy and are situated on the ground floor, some with direct outdoor access. Westmead is located in Braunton, a large village offering shops, banks, pubs and other amenities. The home is within easy reach of local beaches. Barnstaple is 5 miles away. The home has specially adapted vehicles available to service users, enabling them to enjoy trips. Overnight accommodation is available for visiting relatives and friends. Westmead D54-D06 S22129 Westmead V224235 160605 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This announced inspection took place over one day. The inspector was accompanied on this occasion by the pharmacist inspector. This inspection focused on a recent complaint received by CSCI; elements of the complaint are referred to in the report. A copy of the complaint can be obtained from the CSCI office on request. During the course of the day the inspector met with the majority of residents and spoke with 5 in some depth, six staff members were interviewed including the manager; four relatives were also spoken with, one following the inspection. One care manager was interviewed by telephone. The Commission received comment cards from 10 residents and 9 relatives following the inspection. The inspector also toured the premises and inspected a number of records including residents’ care plans and associated records and a pre-inspection questionnaire, which was completed by the manager. The majority of residents and relatives were happy with the overall care provided by the home and many had positive suggestions as to how to improve the service. What the service does well: What has improved since the last inspection? Staff recruitment has improved since the last inspection; three new staff have received induction and are working well within the team. Two residents said that the food had improved since the last inspection; with the return of the full time permanent cook, “She spoils us with choice” was the Westmead D54-D06 S22129 Westmead V224235 160605 Stage 4.doc Version 1.30 Page 6 comment from one resident. The kitchen has been completely refurbished since the last inspection and was clean and well organised. Residents have been consulted about the plans to redecorate the home and have chosen all the new colour schemes. Redecoration will improve the standard of accommodation for residents. The home plans to review and refurbishment the bathrooms to ensure that individual needs are met. 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. Westmead D54-D06 S22129 Westmead V224235 160605 Stage 4.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 Westmead D54-D06 S22129 Westmead V224235 160605 Stage 4.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) These standards were not inspected on this occasion. EVIDENCE: Westmead D54-D06 S22129 Westmead V224235 160605 Stage 4.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 & 9 There is a likelihood that staff will not meet changing needs if care plans and risk assessments are not reviewed regularly; staff do not have the information they need to meet social and recreational needs of some residents. Staff provide residents with information, assistance and communication support as needed in order to make decisions about their lives. EVIDENCE: Two residents were case tracked by inspecting care plans and other associated records. The inspector met and spoke with both residents, although one had limited communication and could not easily contribute; one parent, with various concerns, was interviewed on their behalf. The home has developed a good format for care planning, which identifies the areas of support needed but in some instances fails to give clear directions to staff in order to meet these needs (Refer to standards 19 & 20). Personal profiles and personal care information are particularly informative, referring to individual preferences and family history. Care plans and risk assessments require regular review. One manual handling assessment had been reviewed recently but not regularly and the monitoring Westmead D54-D06 S22129 Westmead V224235 160605 Stage 4.doc Version 1.30 Page 10 record for one residents’ condition had not been reviewed since 2003, although daily records did contain some relevant information. Environmental and situational risk assessments were available but the action needed to reduce some risk was not always clear, for example when dealing with swallowing difficulties. A risk assessment had not been completed for the use of bedrails and no consent had been obtained in one case. The interests and aspirations of residents’ had not been completed for the two files inspected, this may limit residents’ potential and personal goals. Care plans inspected had not been signed and one parent was unaware of the contents of the care plan and wondered how the home had gathered the information. Staff, including one agency member, showed a clear understanding of residents’ needs and their methods of communication. On a number of occasions during the day staff were observed to consult with residents and offer choice, for example how and where they spent their day. During the inspection residents were engaged in a variety of individual and group activities, some had gone out for the day, others were preparing lunch, working in the computer room and seeing family and friends. The Leonard Cheshire Foundation has established various ways of ensuring that residents participate in various aspects of life in the home, as well as the wider organisation. Regular residents’ meetings are held where residents are encouraged to set agendas and raise issues and a Disabled People’s Forum and residents’ representative ensure that residents have ‘their say’. Westmead D54-D06 S22129 Westmead V224235 160605 Stage 4.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) 11, 12, 14, 15 & 17 Activities are generally well organised and provide stimulation, variety and interest for the majority of residents during the day but residents would benefit further if there were more things to do in the evenings and at weekends. Residents’ quality of life is enriched by good links with families and friends. Meals are usually nutritious and balanced and offer a healthy and varied diet for residents, however residents do not benefit from individual attention at mealtimes EVIDENCE: Westmead D54-D06 S22129 Westmead V224235 160605 Stage 4.doc Version 1.30 Page 12 Many residents said they enjoyed the activities arranged within the home, but they felt that opportunities were limited in the evening and at weekends. Two parents and three staff agreed and said that this was mainly due to staffing levels (Refer to standard 33). During the inspection three residents were taken carriage riding and others were engaged in various activities within the home. An independent living support worker is employed for 20-hours a week; her aim is to enable residents to develop their independent living skills through activities such as planning and preparing meals. Three residents prepared and enjoyed a meal during the inspection. Some residents are supported to attend college; one resident described the new friendships made at college. Residents are encouraged to maintain contact with family and friends and there were lists within care plans of important dates for residents to send cards on, such as birthdays. Relatives were seen to come and go freely during the inspection and those responding with comment cards were all felt welcome at the home. Two parents raised concerns about the quality and quantity of food available on two occasions; this had been due to an oversight with the ordering. The complaint was upheld in this instance. The majority of residents were generally positive about the food; one said, “Our cook is great, she always gives us a good choice” another said, “No worries about the food, there is always plenty to eat”. The cook is well aware of individual likes and dislikes. On the day of the inspection the kitchen was well stocked with fresh meats, cheeses, fruits and vegetables. Homemade cakes were also available. The kitchen had been refurbished since the last inspection; it was clean and well organised and good records were kept of the cleaning schedule and fridge temperatures. Mealtimes continue to present a challenge for staff, with the majority of residents requiring full assistance. One care manager suggested that one improvement would be to review mealtimes to support individual needs and enable a less stressful mealtimes. The manager continues to explore ways of ensuring that enough staff are on duty to assist residents at mealtimes, including recruiting NVQ students from the local college. Westmead D54-D06 S22129 Westmead V224235 160605 Stage 4.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 & 20 Staff have a good understanding of the residents’ personal support needs but require clear guidelines to ensure that all residents’ health needs are met. Some of the systems in relation to the handling of medicines have the potential to place service users at risk. EVIDENCE: Staff spoken with demonstrated a clear understanding of residents’ personal and emotional care needs and this was evident from the positive relationships, which have developed between them. Two residents said that staff assisted them appropriately, one said, “I get all the help I need.” One resident with complex needs felt less confident being cared for by agency staff and preferred to be cared for by staff well known to them. Concerns were raised by residents at the previous inspection about the number of baths they received. Residents said that improvements had been made since the last inspection with regards to bathing and records confirmed this (Refer to standard 27 regarding facilities). Health needs are generally well met, with evidence of multidisciplinary work. Residents have access to physiotherapy, speech therapy and other health specialists provided by the local health authority. The home is currently working with the local hospital to recruit a physiotherapist to provide remedial physiotherapy for residents up to 20 hours a week. Westmead D54-D06 S22129 Westmead V224235 160605 Stage 4.doc Version 1.30 Page 14 An aromatherapist visits regularly and some residents were enjoying an aromatherapy massage during the inspection. One parent was concerned that a vulnerable resident’s weight was not monitored regularly. Weights should be monitored and recorded regularly. One care manager was happy with the overall care provided at the home. One parent wrote, “My child loves living at Westmead and the staff are excellent with her.” All parents responding with comment cards were satisfied with the overall care provided at the home. Incomplete guidelines were available to staff for the administration of rectal diazepam. This poses a risk to residents. Some medicines were found unsecured around the home and in places accessible to persons other than the person in charge of medicines. Regular review of competence to administer medicines is not documented. Incomplete records of current medication were available in Individual Service Users Plans. Medicines trolley does not have the facility to store medicines securely. Westmead D54-D06 S22129 Westmead V224235 160605 Stage 4.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 & 23 The home has a satisfactory complaints system with some evidence that residents feel their views are listened to and acted upon. Systems for protection of vulnerable adults are in place. EVIDENCE: Residents spoken with knew who to speak with if they had any concerns or complaints; no complaints were received from residents during the inspection. One resident said, “ I would soon let them know”. Two other residents felt confident that their concerned would be listened to and acted upon by the manager. Three of the nine parents responding with comment cards had raised complaints with the home; one was dissatisfied with the outcome and did not feel confident that issues would be addressed. The inspector investigated a compliant received by CSCI during the inspection; the findings can be obtained from CSCI. Robust policies and procedures for responding to suspicion or evidence of abuse or neglect ensure that residents are protected. Staff receive the appropriate training to recognise and challenge poor or abusive practices. The majority of residents said that they felt safe at the home however residents were concerned about the use of agency staff and didn’t feel as confident with them. Westmead D54-D06 S22129 Westmead V224235 160605 Stage 4.doc Version 1.30 Page 16 Concerns were raised by three parents about the arrangements for dealing with residents’ money. The current system was described as “a mystery” by one parent; some records are poor and difficult to follow. The home is still attempting to set up individual banks accounts and is exploring ways of encouraging and supporting service users to manage personal finances. An internal financial review has highlighted recommendations and actions to improve financial information, which include involving parents, where appropriate. Westmead D54-D06 S22129 Westmead V224235 160605 Stage 4.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, 27, & 29 The standard of the décor within the home is satisfactory although some areas are looking worn and tired. Residents’ bedrooms are homely and personalised but do not always promote independence for personal care. The bathrooms do not meet individual residents’ needs. EVIDENCE: Westmead D54-D06 S22129 Westmead V224235 160605 Stage 4.doc Version 1.30 Page 18 The home was generally comfortable and safe; it was clean and free from offensive odours. A number of communal areas are in need of redecoration, as mentioned by some parents. One parent thought that the overall appearance of the home looked “run down”. Since the last inspection a budget has been identified for this work and the residents have been fully consulted on the planned redecoration, including choosing the colour schemes. As previously reported, six of the bedrooms have en-suite facilities however only one of these is usable. As a result, 17 residents use three bathrooms; this is not ideal. The manager said that the home planned to review the bathing facilities to ensure that residents’ needs were met and that facilities offered sufficient personal privacy. The benefit of ensuring that residents’ needs were assessed by a suitably qualified person, prior to alterations, was discussed with the manager. Westmead D54-D06 S22129 Westmead V224235 160605 Stage 4.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 The number and skill mix of the staff on duty do not always meet residents’ needs. Staff morale is low resulting in high sickness levels and a moderate staff turnover. This situation may have a detrimental impact on the standard and consistency of care offered within the home. EVIDENCE: Residents were in the main positive about life in the home but concerns were raised about staffing levels, which were felt to impact on a variety of activities and issues, refer to standards 14, 19 and 23. Six of the nine relatives responding with comment cards felt that there were not always sufficient numbers of staff on duty. Three commented on the use of agency staff; one felt that the home relied too heavily on agency staff. The duty rotas confirmed that on occasions, the number of staff on duty fell short of the homes preferred levels. The home is experiencing staffing problems; sickness levels are high and morale is low, in spite of this the majority of residents and relatives were happy with the overall care. Three permanent staff have been recruited since the last inspection. The home continues to actively recruit permanent staff but agency staff are frequently used. Several residents were unhappy with the level of agency staff. Westmead D54-D06 S22129 Westmead V224235 160605 Stage 4.doc Version 1.30 Page 20 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) Standards not inspected on this occasion EVIDENCE: Westmead D54-D06 S22129 Westmead V224235 160605 Stage 4.doc Version 1.30 Page 21 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 x x x x x Standard No 22 23 ENVIRONMENT Score 3 1 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 1 3 3 1 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 2 x 2 x 2 x Standard No 11 12 13 14 15 16 17 3 3 x 2 3 x 2 Standard No 31 32 33 34 35 36 Score x x 1 x x x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Westmead Score 3 2 1 x Standard No 37 38 39 40 41 42 43 Score x x x x x x x D54-D06 S22129 Westmead V224235 160605 Stage 4.doc Version 1.30 Page 22 YES 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 YA 6 Regulation 15 (1) (2) (b) (c) Timescale for action Unless it is impracticable to carry 28/7/05 out such consultation, the registered person shall, after consultation with the service user, or a representative, prepare a written plan (service user’s plan) as to how the service user’s needs in respect of his health and welfare are to be met and keep the plan under review. (Residents interests are recorded) The registered person shall 28/7/05 ensure that unnecessary risks to the health and safety of residents are identified and so far as possible eliminated (Risk assessments must identify behavioural and environmental risks, with clear actions to reduce risks. This includes choking risks and the use of bed rails.) 1) The home must have 1/8/05 guidelines in place for the recognition of type of seizure and the use of rectal diazepam for all service users for whom it is prescribed. Immediate Requirement left, 01/07/2005. 2) All staff administering Version 1.30 Page 23 Requirement 2. YA 9 13 (4)(c) 3. YA 20 13 (2) Westmead D54-D06 S22129 Westmead V224235 160605 Stage 4.doc rectal diazepam must be trained and assessed as competent by the nurse delegating the task. 3)All medicines must be stored securely in the home, this is to include medicines requiring refrigeration, monthly deliveries, medicines at mealtimes and medicines for return. 4. YA 23 20 (1) The registered person shall not 8/9/05 pay money belonging to a service user into a bank account unless: The account is in the name of the service user, to which the money belongs (Previous timescales of 23/6/05 and 12/8/04 not met) . The registered provider shall 30/12/05 ensure that suitable adaptations are made, and such support, equipment and facilities as may be required are provided for residents (This refers to the need to review the bathing facilities to ensure that service users’ assessed needs are met and that facilities offer sufficient personal privacy.) 25/8/05 The registered person shall, having regard to the size of the care home, the statement of purpose and the number and needs of service users, ensure that at all times suitably qualified, competent and experienced persons are working at the care home in such numbers as are appropriate for the health and welfare of service users (Previous timescales of 28/4/05 and 29/7/04 not met.) 5. YA 29 23 (2) (n) 6. YA 33 18 (1) (a) Westmead D54-D06 S22129 Westmead V224235 160605 Stage 4.doc Version 1.30 Page 24 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. Refer to Standard YA 14 YA 17 Good Practice Recommendations You should increase opportunities for residents for leisure activities at weekends and in the evenings. It is recommended that sufficient staff are available at mealtimes to ensure individual needs and preferences are met. Residents weight should be regularly monitored and recorded. Residents with complex needs should have continuity of staff to enusre that individual needs are met. 1)YA 20.6 All medicines requiring refrigeration should be stored in the appropriate temperature range of 2C to 8C and the maximum and minimum temperature be monitored and recorded. 2)YA 20.10 It is recommended that the competence of staff administering medication be reviewed at least twice a year as part of the regular supervision process. 3)YA 20.6 For all dose changes occurring during the period covered by the MAR chart a new entry should be made. En-suite facilities should be reviewed to promote independane and privacy and dignity. It is recommended that the home review the bathing facilities to ensure that service users’ assessed needs are met and that facilities offer sufficient personal privacy. 3. 4. YA 19 YA 20 5. 6. YA 25 YA 27 Westmead D54-D06 S22129 Westmead V224235 160605 Stage 4.doc Version 1.30 Page 25 Commission for Social Care Inspection Suite 1, Renslade House Bonhay Road Exeter EX4 3AY 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 Westmead D54-D06 S22129 Westmead V224235 160605 Stage 4.doc Version 1.30 Page 26 - 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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