Inspection on 15/11/05 for Westwood House

This inspection was carried out on 15th November 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. These are things the inspector asked to be changed, but found they had not done. The inspector also made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Westwood House 19/09/07

Westwood House 23/11/06

Westwood House 04/05/05

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

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

CARE HOME ADULTS 18-65 Westwood House Belmont Crescent Swindon Wiltshire Lead Inspector Pauline Lintern Unannounced Inspection 15th November 2005 10:00 Westwood House DS0000061297.V259560.R01.S.doc Version 5.0 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Westwood House DS0000061297.V259560.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Westwood House DS0000061297.V259560.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Westwood House Address Belmont Crescent Swindon Wiltshire Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01793 542069 Milbury Care Services Limited Mr Philip Pederson Care Home 10 Category(ies) of Learning disability (10), Learning disability over registration, with number 65 years of age (1) of places Westwood House DS0000061297.V259560.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Service users accommodated may be aged between 35 years and 64 years. Only the named female service user referred to in the application dated 1 December 2004 may be aged 65 years and over. 4th May 2005 Date of last inspection Brief Description of the Service: Westwood House is one of a number of services owned and managed by Milbury Care Services. Westwood House was opened in December 2004 and provides 24 hour care for a maximum of 10 service users with learning disabilities and associated mental health issues. The aim of the home is to provide a structured environment that enables service users to develop their skills and achieve maximum potential to live as independent a life as possible. The home is staffed by a minimum of four staff on duty on each shift throughout the day. There are two waking night staff and a senior member of staff on call. Westwood House DS0000061297.V259560.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over five hours. On arrival at the home the deputy reported that the manager was on sick leave. The manager did come into the home in the afternoon so the inspector was able to meet with him. One service user had been ill during the night and staff had alerted the local doctor and was waiting for his visit. The inspector had the opportunity to meet with one service user in private. The service user commented that she was happy living at Westwood House and that she had no worries or concerns. She invited the inspector to see her room, which she said she was very pleased with. Although the inspector met other service users she was unable to obtain their views due to communication difficulties. The deputy manager stated that there are six staff on each day shift and two waking night staff. During the inspection records of care plans, risk assessments and health and safety files were sampled. What the service does well: What has improved since the last inspection? Risk assessments for service users are now in place and this is now part of the admissions procedure. Care plans sampled were detailed and reflected how the service users needs are to be met. Some protocols are in place for use of ‘as required’ medication following a requirement from the last inspection. All hand-written additions to medication records are signed, dated and checked by two staff. The complaints procedure is now in a pictorial format for service users. All recruitment records are now available for inspection. Any restrictions on service users choice and freedom are now clearly recorded and are supported by a risk assessment. Westwood House DS0000061297.V259560.R01.S.doc Version 5.0 Page 6 The home now has a copy of the Health Protection Agency infection control guidelines and policies and procedures are now in place for dealing with, and recording, physical aggression towards staff members. 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. Westwood House DS0000061297.V259560.R01.S.doc Version 5.0 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 Outcomes Statutory Requirements Identified During the Inspection Westwood House DS0000061297.V259560.R01.S.doc Version 5.0 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 the following standard(s): EVIDENCE: These standards were not inspected during this inspection. Westwood House DS0000061297.V259560.R01.S.doc Version 5.0 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 the following standard(s): 6, 7, 8, 9 and 10 Service users changing needs are assessed and reflected in their care plan. Evidence shows that service users make decisions about their lives with staff support. Robust risk assessments are now in place to enable service users to have an individual lifestyle, whilst minimising potential risks where possible. Records show that service users confidentiality is respected. Forums, that enable service users to participate in the day to day running of the home need to be developed. EVIDENCE: All personal files indicate to the reader that the file belongs to the service user and that permission must be sought before it is read. Care plans sampled during the inspection showed that service users have been involved in making decisions about their lives and how they wish to live it. One service user requested that staff should knock his door when they need him or when it is time for a meal. Staff report that often service users are reluctant to leave their bedrooms, however, staff do continue to encourage individuals to join their peers if they wish to do so. Care plans show that service users are involved in the general cleaning of the home and in particular their bedrooms. One service user will do his laundry with minimum staff support. Another service user is being Westwood House DS0000061297.V259560.R01.S.doc Version 5.0 Page 10 encouraged to do some vacuuming as agreed in her review report. Care plans provide information on individual likes and dislikes, mobility, personal care requirements, spiritual needs, communication and health care needs. It is recommended that the home organise regular house meetings and encourage service users to participate in these. Staff have started to develop Person Centred Plans for some service users. One service user has asked staff to send Christmas cards on her behalf. Her file includes pictures of her likes and dislikes. There is clear guidance on how this person likes to make choices on what she wears. As this person is visually impaired staff have developed a method of empowering her to choose the cd she wishes to listen to. They have done this by using different tactile textures or buttons on the cd cover. Since the home has opened the service user can now identify eight different cd’s. One service users care plan shows that staff are encouraging him to open the door to visitors and ask for ID. Staff are helping him become aware of any potential risks. This is detailed in the service users care plan and is identified in the review report. All service users have individual risk assessments in their files, those sampled, showed that they are reviewed every three months. Records show details of behavioural guidelines for staff to follow; however there must be evidence of an evaluation of any interventions used within the care plans. There are records of any restrictions on service users choices or freedom. These include why they are in place and are underpinned by a risk assessment and have guidelines for staff to follow. The main gates are sometimes locked to ensure the safety of all service users. The deputy reported that no service user would wish to leave the premises without staff support. Following a recommendation at the last review, the deputy confirmed that they had tried to access advocacy services for people living in the home, however the company they had contacted were no longer trading. They will continue to explore this. It was reported that one service user chooses to stay in his pyjamas all day and he prefers to eat alone in his bedroom. He has a table in his room to eat his meals on. In the evening most service users will sit together in the sitting room. Westwood House DS0000061297.V259560.R01.S.doc Version 5.0 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 the following standard(s): 13, 14, 15 and 16 Service users do access the local community, however some service users are reluctant to venture far. Service users should be encouraged to participate in appropriate leisure activities. Family and friends are welcome at the home. Service users’ rights are respected. EVIDENCE: Staff reported that one service user likes to spend time alone in his bedroom, where he will watch TV, videos and use the Karaoke machine. His care plan shows that he enjoys walking to the local shops to buy a newspaper. On his return he likes staff to sit down and read it with him. He also enjoys going out in the homes car and singing along to the radio. This service user likes to prepare his own meals, as he enjoys cooking. He then joins other residents to eat. The care plan lists TV programmes that he prefers to watch and his choices in music. Staff support him on trips to the pub for lunch and attending music concerts. Families and friends are welcomed to the home and support is provided for parents who need transport to visit service users at the home. One the day of the inspection one service users mother had visited and staff respected their Westwood House DS0000061297.V259560.R01.S.doc Version 5.0 Page 12 privacy by leaving them alone in his bedroom. One service user goes home to visit his brother on a regular basis. Review reports showed that the manager had identified the need to encourage some service users to integrate more socially. There are plans to introduce two service users to a local ‘drop in service’ to widen their social interacting. Although one service user clearly states that he does not wish to attend a daycentre, this may be a positive alternative. Staff reported that one service user enjoys selling items at car boot sales. Files show that day trips have been planned throughout the summer months. The inspector would like to see each service user with an activity plan individual to their needs and choices. The deputy reported that service users need encouragement to try new activities. The inspector discussed the use of communication boards for some service users to enable them to make decisions about their day and the activities they wished to participate in. There is a requirement for the home to explore more leisure activities for service users, provide information and discuss opportunities available to them. The house meeting would be an ideal opportunity to share this information. Files show that service users access public transport with support from a staff member. One service users records show that she enjoys dancing, disco, hydrotherapy and relaxing at home in the bath. Although this person used to enjoy swimming, they are now reluctant to go again. Staff continue to offer the opportunity to reintroduce this activity. One service user that met with the inspector said that she works three days a week in a garden centre, which she enjoys. Staff said that they were going to explore a visit to Tree Tops as they have a farm there and one service user really likes pigs. There is a certificate displayed on one person’s bedroom wall, which shows that they have completed a course in arts, design and literacy. Westwood House DS0000061297.V259560.R01.S.doc Version 5.0 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 the following standard(s): 19 and 20 The homes’ policies and procedures relating to the administration of medication is generally good, however protocols for ‘as required’ medication remains to be addressed. The home has systems in place to enable them to ensure service users healthcare needs are met where possible. EVIDENCE: Evidence from service users care plans demonstrates that individuals’ personal and healthcare requirements are identified and guidelines are in place for staff to follow. There was evidence to suggest that staff respected service users’ personal preferences regarding their personal care. Following a requirement at the last inspection the deputy reported that they have started to develop protocols for the use of ‘as required’ medication, however this has not yet been completed. Documents show that the home has regular visits from the Consultant Psychiatrist. He reviews service users medication and monitors any changes in behaviours that are displayed. Although the home has good mechanisms in place for recording any behaviours, there needs to be a regular evaluation of what is working and what is not. This will show any patterns that may be taking place and this may in turn help staff to identify triggers to behaviours. There is evidence of management of behaviour guidelines and procedures in place for dealing with physical aggression towards staff. Westwood House DS0000061297.V259560.R01.S.doc Version 5.0 Page 14 Service users files show that they have access to all healthcare professionals such as dentist, optician, chiropody, GP, and Community and Diabetic Nurse. Records show that staff encourage an awareness of personal hygiene for service users and they use gentle prompts. The care plan of one service user says that they prefer to be woken in the morning with a cup of tea and will then take their medication. It states that they need some help with personal care and likes staff to ask them what they would like to wear on that day. Staff report that this service user prefers to use the middle bathroom, as it is less claustrophobic for them. Staff support one service user to shave in the morning and that it states that it should be a male member of staff. All controlled drugs are securely locked away. Medication records were checked at the time of the inspection and met the minimum standards. Medication to be returned was clearly labelled ready for collection. The doctor came to visit one service user during the inspection and it was noted that the staff ensured that the door was closed and the service users privacy was respected throughout the visit. Westwood House DS0000061297.V259560.R01.S.doc Version 5.0 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 the following standard(s): 22 and 23 Service users have a pictorial complaints procedure within their care plans. Where appropriate, service users have the opportunity to attend their review meetings where they can raise any concerns. All staff receive training in abuse awareness training. EVIDENCE: Each service user has a copy of the complaints procedure in a pictorial format. This identifies who the complainant can contact and has addresses and telephone numbers. The deputy confirmed that all of the service users families have a copy of the complaints procedure. Milbury Care homes have their own forms for enabling people to make a complaint. The Commission has received a copy of a compliment from one service user prior to the inspection. One service user who met with the inspector said that she was happy and had no concerns about the home. The staff receive training in abuse awareness and there are certificates to support this. Staff complete a training course on the use of Non Violent Crisis Intervention and at the time of the inspection, only one new staff member had not attended this course. There are yearly refreshers and it is expected that all staff attend. The deputy manager assured the inspector that it was very rare that CPI was used within the house. The Manager confirmed that often talking to service users was enough to calm down a potential situation. There are records, which demonstrate that all incidents of physical and verbal aggression towards staff and other service users is recorded and monitored. Westwood House DS0000061297.V259560.R01.S.doc Version 5.0 Page 16 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 the following standard(s): 24, 25 and 30 The home provides a homely, comfortable environment. The home appeared clean and hygienic at the time of the inspection. Service users’ bedrooms suit their individual needs and lifestyles. EVIDENCE: During the inspection the inspector toured the building, which was found to be clean and tidy. The inspector was invited by one service user to see her room. It was full of personal items and was spacious enough to have ample room for a full sized television, a music centre and a large fish tank. The service user said that they were very happy with the room. Other rooms evidenced that they were individualised to suit the person’s needs and particular interests. Staff reported that one person particularly liked Elvis so he had posters of him on the bedroom wall. One service user is visually impaired and the manager had identified the need for a sensory area. He reported that he hoped to make the garden into a sensory area for her to relax in. The home is in good decorative order and the fittings and furnishings are of a good quality. There is adequate space for people to sit alone if they wish. The kitchen is large with plenty of worktop space and a large cooker. The kitchen was clean and hygienic at the time of the inspection. The manager reported that Milbury now have a maintenance help line, although the home had not had to use it yet. Westwood House DS0000061297.V259560.R01.S.doc Version 5.0 Page 17 Following the last inspection the home now has a copy of the Health Protection Agency infection control guidelines. Staff also receive training in infection control. The home uses red alginate bags to reduce the risks of handling soiled linen. There is an induction file, which includes a section on infection control and the correct way to wash your hands. The home has systems in place for reducing the risk of Legionella. All surfaces and floors in the kitchen and bathroom areas were clean and there were no unpleasant odours. Westwood House DS0000061297.V259560.R01.S.doc Version 5.0 Page 18 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 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32 and 34 Staff are provided with a good training programme. The homes recruitment policies and procedures protect the service users where possible. EVIDENCE: The inspector sampled two staff files. There was evidence that all necessary documents been received prior to commencing employment. There is evidence of staff having POVA first checks and CRB checks. All other documentation was available for the inspector. Staff records showed that staff are receiving regular training in manual handling, health and safety, abuse awareness, fire, infection control, diabetes, O’Brien, supervision and appraisal, risk assessments, food hygiene, CPI, human resources and medication training. It was reported that the deputy is planning to undertake a four-day first aid course shortly. Three staff have successfully passed their NVQ award level 3 and a night staff member has completed their NVQ2. All staff receive LDAF training in preparation for their NVQ. The deputy reported that she has her NVQ level4 and the Registered Manager’s Award. She is also a qualified NVQ assessor. The deputy said that staff receive supervision monthly. The two latest staff to start work at Westwood House have received a week’s induction. This is due to the fact that they are both very experienced. The induction period would be longer if the staff are inexperienced. The home uses agency staff to support them when necessary. Westwood House DS0000061297.V259560.R01.S.doc Version 5.0 Page 19 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 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 39, 41 and 42 The home needs to develop methods for monitoring Quality Assurance. The home’s health and safety policies and procedures safeguard the service users where possible. Record keeping is generally of a high standard, however a few improvements are required. EVIDENCE: The inspector discussed with the manager and the deputy ways of ensuring that Quality Assurance is being measured. The home needs to ensure that service users, their families and funding authorities have the opportunity to feedback their views on the service being provided. The home has a high standard of record keeping, however it is recommended that there are no gaps left between entries in the daily diaries. It is also recommended that daily entries include a record of items of clothing being worn by service users each day. All health and safety records were inspected. Records showed that the last fire drill took place on 9/11/05. Other completed tests and checks were; fire systems 8/11/05, fire fighting equipment 8/11/05, alarms 9/11/05 and emergency lighting took place on 12/9/05. There is a file recording all COSsH Westwood House DS0000061297.V259560.R01.S.doc Version 5.0 Page 20 data and guidelines. The induction file covers all aspects of health and safety and agency staff are requested to read this prior to starting their shift. Each service user has their own procedure for staff to follow in the event of a fire. There are records of fridge, freezer and water temperatures being checked. There are risk assessments in place, which cover all household items. All radiators are covered and the windows have restrictors on them. Westwood House DS0000061297.V259560.R01.S.doc Version 5.0 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 Score 3 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 2 3 2 3 3 Standard No 24 25 26 27 28 29 30 STAFFING Score 3 3 X X X X 3 LIFESTYLES Standard No Score 11 X 12 X 13 3 14 2 15 3 16 3 17 Standard No 31 32 33 34 35 36 Score X 3 X 3 X X CONDUCT AND MANAGEMENT OF THE HOME X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Westwood House Score X 3 2 x Standard No 37 38 39 40 41 42 43 Score X X 2 X 2 3 X DS0000061297.V259560.R01.S.doc Version 5.0 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 YA6 Regulation 14(2)(a) Requirement Timescale for action 15/12/05 2 YA14 3 YA20 4 YA39 The registered person shall ensure that care plans include an evaluation of interventions and medications being used. 16(2)(m) The registered person should 15/12/05 ensure that service users have the opportunity to choose from a range of activities and have an individual activity plan. 13(2) The registered manager must 01/06/05 ensure clear protocols are available for ‘as required’ medication. This is outstanding from the last inspection with a timescale of 01/06/05 24(1)(a)(b) The registered manager ensures 15/01/06 that mechanisms are in place to measure Quality Assurance. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA7 Good Practice Recommendations It is recommended that the registered person should DS0000061297.V259560.R01.S.doc Version 5.0 Page 23 Westwood House 2 3 YA12 YA14 5 6 YA41 YA41 consider the development of communication boards and passports to provide an effective communication aid for service users. It is recommended that the registered person should record where service users have refused choices offered to them. It is recommended that the registered person should ensure that service users have opportunities to participate in activities, which enable them to influence decisions in the home such as house meetings. It is recommended that the registered person should ensure that a description of clothes being worn by service users is recorded daily. It is recommended that the registered person should ensure that daily notes do not have any gaps between written entries. Westwood House DS0000061297.V259560.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Chippenham Area Office Avonbridge House Bath Road Chippenham SN15 2BB 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 Westwood House DS0000061297.V259560.R01.S.doc Version 5.0 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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