CARE HOME ADULTS 18-65
Westmeade 69 Westmeade Close Cheshunt Hertfordshire EN7 6JP Lead Inspector
Tom Cooper Unannounced 29 September 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. Westmeade I52 s19616 Westmeade v248617 290905 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Westmeade Address 69 Westmeade Close, Cheshunt, Herts EN7 6JP 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) 01922 629963 01922 629963 Mrs P Lopez and Dr S Cullen Janet Fishenden CRH Care Home 3 Category(ies) of LD-3 MD-3 registration, with number of places Westmeade I52 s19616 Westmeade v248617 290905 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: The home may accommodate a maximum of three service users with learning disabilities and/or mental disorder between the ages of 18 and 65 years. Date of last inspection 18th January 2005 Brief Description of the Service: Westmeade is an ordinary three bedroom semi detached house located in a quiet close on a modern residential estate in Cheshunt, close to the town centre with its shops, leisure facilities, railway station and other amenities.The home provides accommodation and care for three women with learning disabilities and associated mental health needs. The house is completely domestic in design, style and decor with only a small office on the first floor. There is a pleasnt garden to the rear. The service offered is specialised and individually tailored to meet the complex needs of the individual service users. Staff are on site awake twenty four hours a day. Westmeade I52 s19616 Westmeade v248617 290905 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place on a weekday over the late afternoon and evening. Two service users were at home on the day, with the third away visiting relatives. The two service users present spent the time following their own pursuits, either on their own or with staff support as necessary. Discussions were held with one service user, the manager and the staff on duty. Brief contact was made with the other service user who declined to converse with the inspector. Documentation examined included two service users’ care plans (the third care plan was away from the premises being updated following a recent review), medication, accident, incident and service users’ money records. The inspector also looked around the premises. The inspection indicated that the home was running smoothly, with positive interaction observed between staff and residents and a relaxed and pleasant atmosphere in the house. Some relatively minor record keeping issues were noted. The building was in a good state of repair providing a safe and comfortable environment. What the service does well:
Only one of the two residents present was prepared to discuss her views of the service. She said that she was very happy in the home and considered that staff were friendly and caring. She felt she was able to make decisions for herself and explained how staff were assisting her to develop greater independence in a number of areas such as cooking, shopping, going out into the community and socialising. She liked her bedroom, which she had had decorated and personalised to suit her preferences as had the other two service users. She felt that her lifestyle was enjoyable and was generally most positive about all aspects of the home. The other service user appeared to be content in the home, although she was preoccupied with her afternoon activities and declined to talk to the inspector. The two care plans seen contained a fair overview of individual needs with details of the agreed actions to be taken by staff to meet the care goals set. They contained a range of relevant risk assessments with reasonably clear control measures documented. However the one service user spoken with said she was unaware that there was a care plan for her and there was little evidence of active service user involvement in the care planning process by reference to the documentation seen (see below for further comment). The manager has considerable relevant experience in the care field and has nearly completed her NVQ4 qualification, leading up to the Registered
Westmeade I52 s19616 Westmeade v248617 290905 Stage 4.doc Version 1.40 Page 6 Manager’s Award. She and the two other members of staff observed appeared to have a good rapport with the service users and a good understanding of their individual needs and personalities. Staff said they enjoyed working in the home, felt well supported and had access to relevant training including NVQ qualifications. Good communications and teamwork were maintained by means of handovers between shifts, regular staff meetings and individual supervision. The premises were in good decorative order, and provide a safe, comfortable domestic environment. The fenced rear garden was compact and tidy. What has improved since the last inspection? What they could do better:
Neither of the two service users present made any criticisms of the service provided. Most of the documentation examined was satisfactory, well completed, informative and accurate. However several signature gaps were noted on the medication administration record (MAR) sheets, mainly due to staff failing to use code letters to indicate the service user’s absence from the home when visiting relatives. Any instances of non-compliance with the GP’s prescription must be recorded and explained on the MAR sheets. A requirement has been made that accurate medication records must be kept. The documentation of an incident that had occurred in the home that resulted in staff restraining a service user raised the issue of residents’ rights. Any agreed restrictions on choice and freedom must be explicitly documented in the care plan so that all staff act consistently. This did not appear to be the case in the documentation seen. See requirements.
Westmeade I52 s19616 Westmeade v248617 290905 Stage 4.doc Version 1.40 Page 7 The planned training for staff in the protection of vulnerable adults will be valuable. Specific training in dealing with people with autism should also be provided. 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. Westmeade I52 s19616 Westmeade v248617 290905 Stage 4.doc Version 1.40 Page 8 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 Westmeade I52 s19616 Westmeade v248617 290905 Stage 4.doc Version 1.40 Page 9 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) not inspected on this occasion. There had been no new admissions to the home during the past year. Individual statements of occupants’ contractual rights were present in the two service users’ personal files examined. EVIDENCE: Westmeade I52 s19616 Westmeade v248617 290905 Stage 4.doc Version 1.40 Page 10 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, 10 Each service user has an individual care plan, devised by staff, detailing her needs and personal goals and how to work towards achieving them. Work needs to be done to include more fully the service users’ own views regarding their care, especially with regard to behaviour management strategies. Service users are able to make decisions for to themselves in most areas of their lives. However any restrictions on freedom and choice must be documented in their care plans. Service users are involved in the running of the home and their views are consulted and taken into account in the decision making process. Staff encourage and support service users to act independently, including taking reasonable risks. EVIDENCE: Two service users’ plans were examined. The manager said that the third service user’s file was currently out of the home for updating following a very recent review. Both care plan files seen contained good details of individual
Westmeade I52 s19616 Westmeade v248617 290905 Stage 4.doc Version 1.40 Page 11 needs, likes and dislikes, personal aspirations, medication, detailed risk assessments and risk control measures and instructions to staff on how to proceed towards meeting the various goals set. Staff had made detailed daily records of events occurring compiled in objective language and providing a good overview of the individuals’ daily progress. Some discussion took place with the manager over the behaviour management strategy being adopted by staff in respect of one service user presenting occasional challenging behaviour. This did not appear to have been clearly documented in the personal file seen, although information subsequently supplied indicated that the strategy had been devised on a multi-disciplinary basis involving outside health professionals and was considered therapeutically justified. Nevertheless any restrictions on choice and freedom must be clearly documented in the current plan. The personal file documentation would benefit from some reduction in bulk to facilitate access to the crucial information. One service user spoken with said that she was able to make her own decisions and staff were helping her to develop greater independence and confidence both in and outside the home. For example, she was gradually working towards being able to use public transport. The home does not hold regular service users’ meetings although there are frequent informal discussions about the running of the home, that often take place at mealtimes. Additionally, individual discussions take place and these are used to inform the care planning process. Service users’ finances are managed by the staff. Their money is held in three separate folders with all transactions recorded. All the balance records matched the amounts in the folders. All personal information is kept in a locked cupboard. Information is not given to relatives or friends without the service user’s permission and is only given to other professionals on a need to know basis. Westmeade I52 s19616 Westmeade v248617 290905 Stage 4.doc Version 1.40 Page 12 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) 13, 14, 15, 16, 17 Service users have good opportunities for personal development, supported by staff as necessary. Service users are able to take part in various suitable activities. The occasional restrictions on one service user’s activities programme imposed as part of the behaviour management strategy for her should be kept under review. Service users are active in the local community. Service users follow the lifestyles that suit them, including appropriate leisure activities, with staff support as necessary. Service users can maintain personal relationships as they choose. Policies and practices in the home promote and respect service users’ rights and encourage them to take responsibility for housekeeping tasks and social behaviour. Service users are offered a healthy diet and enjoy their meals and mealtimes, supported by staff as necessary.
Westmeade I52 s19616 Westmeade v248617 290905 Stage 4.doc Version 1.40 Page 13 EVIDENCE: All the service users are encouraged to maintain existing skills and develop new ones to increase their independence. Staff keep the communal areas clean and assist the service users to clean their bedrooms and to do their laundry and ironing. One service user was quite proud of her housekeeping abilities. She has gradually learned to use nearby shops independently. The service users also help with shopping and cooking to varying degrees according to their individual abilities. Two service users attend local colleges for daytime activities and the other has her own daytime programme devised with staff involving walking, artwork, jigsaws and using community leisure facilities. Local facilities used include the gym and swimming pool and there are frequent trips out to places of interest and occasional holidays away from the home. The daily records provided evidence of regular use of community facilities. Staff encourage service users to maintain and where possible expand their individual leisure pursuits, interests and hobbies. Their bedrooms reflect their different personalities, with personal effects such as CDs and pictures and ornaments much in evidence. All the service users follow regular patterns of visiting or staying with their families (one was away on such a visit during the inspection). The service users have access to all areas of the home and garden. Apart from the restrictions referred to earlier in respect of the behaviour management strategy for one service user, routines in the house are minimal. The service users all like to spend time alone in their rooms as well as the living room and this was observed during the inspection. All the service users plan their own menus. One service user was on an additive-free diet. The service user spoken with said that staff advised her over healthy eating and she felt that her diet was good. Records of the daily meals taken are kept in a diary and these showed that all the residents had an adequate diet. Service users can help themselves to drinks and snacks. Westmeade I52 s19616 Westmeade v248617 290905 Stage 4.doc Version 1.40 Page 14 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) 19, 20 Staff monitor individual service users’ condition and progress to ensure that their physical and emotional needs are met. The medication management system is well organised and safely operated. However care must be taken always to sign MAR sheets using the relevant code letters to explain any non-compliance with the GP’s prescription. EVIDENCE: Service user’s files contained details of medical and emotional needs. One service user expressed confidence in the staff and the staff on duty had a good understanding of individual requirements. Outside health professionals such as GPs and consultant psychiatrists are involved as necessary and included in the ongoing review processes. Medication is stored securely in a locked cabinet in the office. A weekly dosette container system is used. Dates of opening were recorded on bottles and packs of medication. No old stock was held in the cabinet. The system was well organised however several signature gaps were found on the medication administration record (MAR) sheets examined, mainly due to staff failing to use the relevant code letter on occasions when service users had been away from the home. A requirement has been made that medication records must be
Westmeade I52 s19616 Westmeade v248617 290905 Stage 4.doc Version 1.40 Page 15 accurate. Only trained staff may administer medication. No service users were self-managing medication at the time of the inspection. Westmeade I52 s19616 Westmeade v248617 290905 Stage 4.doc Version 1.40 Page 16 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 Service users feel that staff take their views seriously and would act on any complaint. Staff continuously monitor service users’ state of mind and condition. Staff are aware of the home’s whistle blowing policy. However the company should provide training in the protection of vulnerable adults. EVIDENCE: The service user spoken with was only vaguely aware of the complaints procedure but when questioned said that she would approach her keyworker or the manager if she wanted to complain. She agreed that that any complaint made would be taken seriously and acted on. No formal complaints had been received. The home’s procedure commits the organisation to a response within seven days. Commendably, the procedure is available in a service user-friendly format using ‘Widget’ symbols. A copy of the Hertfordshire Inter Agency Adult Protection Procedure was in the office and the manager was familiar with the current procedure for responding to allegations of abuse against vulnerable adults. She was confident that staff would know what to do in her absence. She said she had arranged for staff training on this subject. This is particularly important in view of the fact that staff have occasionally had to restrain physically one of the service users and need to appreciate the issues around service users’ rights in a situation where there is an imbalance of power between staff and residents. See recommendations. Westmeade I52 s19616 Westmeade v248617 290905 Stage 4.doc Version 1.40 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, 26, 27, 28, 29, 30 The premises offer a suitable environment that is safe, comfortable, well maintained and homely. Service users’ bedrooms are spacious, well appointed and personalised. Sufficient bathrooms and toilets are provided. Adequate communal space is provided, including a private enclosed garden. No aids or adaptations are currently required in the home. The home is clean, tidy and hygienic throughout. EVIDENCE: The building is suitable for fulfilling the home’s statement of purpose and provides a comfortable, safe environment. All the relevant space standards are met. There is a hard-wired fire alarm system and central heating. All areas inspected were well decorated and furnished in domestic styles, creating a homely environment in which service users appeared relaxed and at home.
Westmeade I52 s19616 Westmeade v248617 290905 Stage 4.doc Version 1.40 Page 18 The three single bedrooms have been decorated in colour schemes chosen by the service users and are personalised to suit their particular interests and preferences, with pictures and CDs and so on. Both service users asked said they liked their rooms. The living room is comfortable and nicely furnished. The domestic style kitchen is in good order, clean and well equipped. Adequate bathing facilities are provided. The garden is enclosed, with a patio and lawn, providing a pleasant and safe outdoor space. All areas inspected were clean, tidy and free from unpleasant smells. Westmeade I52 s19616 Westmeade v248617 290905 Stage 4.doc Version 1.40 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) 32, 33, 34, 36 Many of the staff have completed NVQ qualifications and therefore have a good grounding in modern care practice. Adequate numbers of competent staff are provided at all times. The home has appropriate recruitment, induction and ongoing training policies and practices. Staff receive regular group and individual supervision that results in effective communications and teamwork and makes staff feel supported. EVIDENCE: The manager stated that six members of staff had achieved NVQ level 2,with a new recruit due to start the course soon. The manager was confident that staff had received specialist training in dealing with people with autistic spectrum disorder, however no evidence to verify this was available. Many of the team have worked in the home for several years therefore they know the service users and their differing needs very well. Normally there are two staff on duty during the day shifts to care for the three residents. Night cover is by one person awake. These levels are considered adequate to meet the needs of the current residents.
Westmeade I52 s19616 Westmeade v248617 290905 Stage 4.doc Version 1.40 Page 20 The personnel file of one member was examined and found to contain a completed application form and two positive references but no Criminal Records Bureau enhanced disclosure. The manager said that CRB disclosures were not held on site. Therefore, although a criminal background declaration had been made on the application form it was impossible to verify that the CRB disclosure had been taken up. The manager was informed that evidence that CRB disclosures have been obtained must be held in the home available for inspection. The member of staff on duty said that communications and teamwork in the home were good. As well as handovers between shifts at which all developments are discussed, monthly staff meetings are held, with minutes taken. Each member of staff has ongoing informal supervision, although formal supervision had been somewhat irregular in recent months. In such a small home where staff work closely together formal supervision may not be so important as in larger establishments. Records were available for inspection. Topics covered include work practice matters, professional development and personal support. The member of staff on duty said that she felt well supported. Procedures are in place for staff to follow when dealing with physical aggression and other difficult behaviour from service users. Westmeade I52 s19616 Westmeade v248617 290905 Stage 4.doc Version 1.40 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, 38, 41 The manager is experienced and is working towards achieving NVQ4 and the Registered Manager’s Award. The manager is caring, friendly and approachable and sets a very positive tone for the home. However she needs to be more proactive in communicating a clear sense of direction and leadership. The home has generally good record keeping systems but medication recording must be improved. EVIDENCE: The manager, in post since January 2005, has considerable relevant experience and is a qualified NVQ assessor. She has nearly completed NVQ level 4 and is working towards the Registered Manager’s Award. She clearly has a good understanding of the service users’ individual needs and a good rapport with them and staff. However, she did not seem very familiar with the layout of the rather bulky service users’ files, which made explaining the care plans difficult. She also needs to be more proactive as a leader, particularly
Westmeade I52 s19616 Westmeade v248617 290905 Stage 4.doc Version 1.40 Page 22 with regard to monitoring the medication records and carrying out formal staff supervision. The proprietors should also ensure that as the registered manager she is given the requisite authority to manage and is in possession of all the information and documents necessary at inspection to provide the evidence to meet the standards, such as the evidence of staff CRB disclosures mentioned earlier in this report. Despite the issues noted above, the service users clearly enjoy living in the home and are secure and well cared for. Westmeade I52 s19616 Westmeade v248617 290905 Stage 4.doc Version 1.40 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 x x x x x Standard No 22 23
ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10
LIFESTYLES Score 3 3 3 3 3
Score Standard No 24 25 26 27 28 29 30
STAFFING Score 3 3 3 3 3 N/A 3 Standard No 11 12 13 14 15 16 17 3 3 3 3 3 3 3 Standard No 31 32 33 34 35 36 Score x 3 3 2 x 2 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Westmeade Score x 3 3 x Standard No 37 38 39 40 41 42 43 Score 3 2 x x 2 x x I52 s19616 Westmeade v248617 290905 Stage 4.doc Version 1.40 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 YA 6 & 7 Regulation 12 and 15 Requirement The manager must consult service users over the contents of their care plans and must take into account their wishes and feelings when devising them. Any restrictions on choice and freedom must be justifiable on therapeutic grounds and clearly described in the care plans. Accurate records of the administration to service users must be kept. Any noncompliance with the GPs prescription must be recorded and explained on the MAR sheet. Evidence that enhanced disclosures from the Criminal Records Bureau have been taken up in respect of all staff employed must be kept in the home at all times available for inspection. Timescale for action By 1st November 2005 2. YA 41 YA 17(1)(a) Schedule 3(3)(i) 17(2) Schedule 4(6)(f) From 29th September 2005 & henceforth By 1st November 2005 & henceforth 3. YA 34 & 41 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. Westmeade I52 s19616 Westmeade v248617 290905 Stage 4.doc Version 1.40 Page 25 No. 1. 2. 3. Refer to Standard YA35 YA36 YA38 Good Practice Recommendations All care staff should be trained in the protection of vulnerable adults and associated procedures for handling allegations of abuse. The manager must ensure that all staff receive formal supervision at least six times per year. The manager should be supported by the proprietors to provide stronger leadership to the team. Westmeade I52 s19616 Westmeade v248617 290905 Stage 4.doc Version 1.40 Page 26 Commission for Social Care Inspection Hertfordshire Area Office Mercury House, 1 Broadwater Road Welwyn Garden City, Herts AL7 3BQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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