Care Home: Westward

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What the care home does well What the home does wellThe residents have interesting things to do every day.They have meals that they like. Once a week they each make supper, with help from staff.They go on holidays.Residents each have a nice bedroom. There is a big room with a pool table and a table tennis table as well as a dining table. Westward DS0000003857.V359758.R01.S.doc Version 5.2 Page 7They grow fruit andvegetables in the garden, and keep chickens. They live by the sea. What has improved since the last inspection? A new bathroom has been fitted.The residents have been to more courses at the college, anddone more exercise, like swimming and cycling.Staff have done more training, to make sure they keep everybody safe.WestwardDS0000003857.V359758.R01.S.docVersion 5.2Page 9 CARE HOME ADULTS 18-65 Westward 2 Henty Avenue Dawlish Devon EX7 0AW Lead Inspector Stella Lindsay Key Inspection (unannounced) 28th March 2008 10:30 Westward DS0000003857.V359758.R01.S.doc Version 5.2 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 Westward DS0000003857.V359758.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for 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. Westward DS0000003857.V359758.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Westward Address 2 Henty Avenue Dawlish Devon EX7 0AW 01626 864825 01626 864825 westward_care@btinternet.com 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) Mrs Cathy Hillidge Mrs Cathy Hillidge Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Westward DS0000003857.V359758.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 26th October 2006 Brief Description of the Service: Westward is a large, detached house, in the seaside town of Dawlish. The home is in a residential area and has views overlooking the sea. It is close to local amenities, and services are easily accessible either on foot or by local public transport. The home is arranged over two floors and all residents can manage the stairs. A double storey extension has been completed to a high standard. This has provided additional bedrooms with en-suite facilities. There are car parking facilities in Henty Avenue. The home provides accommodation which reflects the assessed needs as well as the choices/personal preferences of each resident whilst maintaining a homely atmosphere. Westward is registered with The Commission for Social Care Inspection to provide care for up to six adults with a learning disability, who may also have challenging behaviour. The Registered Person and staff team aim to provide each resident with 24hour care and support and assistance in developing their self-esteem and independence as far as is practicable. Fees range from £800 to £1,400 depending on the assessed needs of each resident. Westward DS0000003857.V359758.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. This inspection took place on a Friday in March 2008. It involved a tour of the premises, and examination of care records, staff files and the medication system. We met with the home owners, residents, and a staff member on duty. The Registered Manager, Mrs Cathy Hillidge, had supplied useful information to the Commission for Social Care Inspection before the inspection, and five staff and all five residents had returned surveys to us. What the service does well: What the home does well The residents have interesting things to do every day. Westward DS0000003857.V359758.R01.S.doc Version 5.2 Page 6 They have meals that they like. Once a week they each make supper, with help from staff. They go on holidays. Residents each have a nice bedroom. There is a big room with a pool table and a table tennis table as well as a dining table. Westward DS0000003857.V359758.R01.S.doc Version 5.2 Page 7 They grow fruit and vegetables in the garden, and keep chickens. They live by the sea. What has improved since the last inspection? A new bathroom has been fitted. Westward DS0000003857.V359758.R01.S.doc Version 5.2 Page 8 The residents have been to more courses at the college, and done more exercise, like swimming and cycling. Staff have done more training, to make sure they keep everybody safe. Westward DS0000003857.V359758.R01.S.doc Version 5.2 Page 9 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. The summary of this inspection report can be made available in other formats on request. Westward DS0000003857.V359758.R01.S.doc Version 5.2 Page 10 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 Westward DS0000003857.V359758.R01.S.doc Version 5.2 Page 11 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. JUDGEMENT – we looked at outcomes for the following standard(s): 2 and 5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents’ needs had been assessed thoroughly before admission, good clear information is available, and there is opportunity for people to visit and stay for short visits before making the decision to move in. EVIDENCE: The registered provider was very clear about the care the home is able to provide and therefore the nature of the residents for whom they could provide support and this is reflected in the Statement of Purpose and the Service Users Guide. Records showed that staff training is focused on these areas and all staff are expected to complete a course of study regarding challenging behaviour. No residents had been admitted since the last inspection, but records and residents’ statements showed that good practice had been carried out in the past. One resident remembered being collected from hospital by the Manager and a Senior staff member, and though they did not remember being told very much about the home beforehand, they were pleased and liked it very much. Another had been able to visit for several short stays over a year before moving in. Westward DS0000003857.V359758.R01.S.doc Version 5.2 Page 12 Following admission of a new person, the care plan had been developed gradually over six months, giving time for residents and staff to get to know each other, and the potential for development within the house and using resources in the neighbourhood. Contracts were with the commissioning body. The terms and conditions, showing what is included in the service, is kept in the policy file and may be shared with residents. Westward DS0000003857.V359758.R01.S.doc Version 5.2 Page 13 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents can be confident that their care plans clearly identify their needs and how they will be met. EVIDENCE: Care plans were clearly written. They were well organised into sections so information could easily be found. The sections included a profile of the resident, assessment, care plan, risk assessments, daily records, medical history, family history and a record of events and incidents. The care plan and risk assessments were regularly reviewed, at different intervals. For instance, worrying behaviours and actions required to minimise or eliminate risk were evaluated monthly, while sleeping patterns and activities were reviewed six-monthly. ‘I have a lot more freedom here, and can do more’, said one resident. This shows that planning and risk assessment are working well, and records also Westward DS0000003857.V359758.R01.S.doc Version 5.2 Page 14 showed that residents are encouraged to make decisions about their lives and the level of support to be given to enable them to do this. Residents are encouraged to manage their own bank and building society books. The Registered Manager is appointee for all residents, in respect of their benefits. We examined the financial sheets which are kept to record personal allowance saved and transactions made. Westward DS0000003857.V359758.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15,16 and 17 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Residents at Westward live full and interesting lives in good company. Exercise and healthy eating are encouraged. EVIDENCE: Residents were encouraged by staff to participate in activities which would assist in developing their social, emotional, communication and independent living skills. Residents were regularly attending courses at colleges in Teignmouth and Dawlish, including cookery, woodwork, art & craft. ‘I constantly get the support I need to do the activities I want’, a resident said. One resident showed us art and craft work they were doing at home. We were also shown the pool table and table tennis table, though no-one played during this inspection. ‘I never, never, ever get bored here’, said another resident. Westward DS0000003857.V359758.R01.S.doc Version 5.2 Page 16 At the start of this inspection, two residents were out swimming with a staff member. The others might have gone too, but had to stay in awaiting someone coming to mend the tumble drier. One resident was able to go out unaccompanied, on foot and on public transport. Bus passes had been obtained for all. One resident had an informal regular job as a dog walker, with support from staff, and this was good for their self-esteem as well as exercise and regular change of scene. One resident showed us round the garden, where fruit and vegetables had been planted out. There were fruit trees, and a place where brambles were allowed to grow for their blackberries. Chickens were kept, for their eggs and the interest of the residents. Three wheeled bicycles had been obtained to help residents to exercise safely. Holidays are planned by consensus – a residents’ meeting had been called, and all residents were asked to say what they wanted from a holiday, for instance, any particular activities. Staff then planned a holiday where all activities would be available, and a venue that would be safe and pleasant for the residents, who were happy to go together. ‘It’s a nice place to live, with lovely staff, friends, and people I live with’, wrote one resident in a survey. The only rules mentioned were for the benefit of others in the house, such as turning off televisions in rooms at 11pm or midnight at weekends, so that others would not be disturbed. A rota had been drawn up showing the residents’ household duties over the week. A resident had produced a chart which was displayed in the kitchen. The residents told us they were happy to join in with these activities. Each resident took a turn each week to produce supper for all. They budget and shop for the ingredients, prepare, cook and serve the meal with assistance according to their ability. The main meal is in the evening. We shared lunch and were pleased to see that the residents waited for all, including staff on duty, to sit before starting to eat. The omelettes were made from eggs collected from the garden. Fresh fruit was given. Meatballs and pasta were planned for the evening meal. The household occasionally eat out, and were pleased to tell us about having lunch at a country pub at Christmas. Westward DS0000003857.V359758.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 and 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff understand the residents’ personal care and health needs well so that they can meet them in a way that promotes their dignity and independence. EVIDENCE: One resident said they were pleased to have their own (en suite) shower so they could get ready by themselves. The registered provider stated that limited assistance with personal care is required by the current residents although prompting is sometimes needed. Residents had been accompanied to health care appointments, as shown by recent records. Clear instructions were seen in residents’ care plans on the actions staff must take in the event of medical emergencies particular to their condition. In the case of some residents it is necessary to postpone informing them of doctors’ appointments until the day, to avoid severe stress. This is clearly specified in their care plan. Westward DS0000003857.V359758.R01.S.doc Version 5.2 Page 18 Staff had noticed when a resident’s mental health was declining, and accessed professional help in time. The Registered Manager and a Senior staff member had attended medication awareness training, and oversee the system. This training was received in 2004 and the staff might benefit from refresher training. All staff were considered by them to be competent to administrate medication. It was seen from records of induction training that administration of medication was covered. The Manager agreed to record this training more fully, to show when the person has been observed to be competent in carrying out this duty, as well as understanding side effects or issues of non-concordance. No residents were assessed as being able to manage their own medication. The Manager provided records to show that residents had consented to take their medication, and the Manager said that there was rarely any problem with concordance, and residents were happy to take their medication. Westward DS0000003857.V359758.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents know how to make a complaint and are confident that they will be listened to. Staff training in the protection of vulnerable adults protects residents from abuse. EVIDENCE: The registered provider stated that no formal complaints had been received in the previous 12 months. Day-to-day problems are sorted out as they arise. The Commission had received no complaints about Westward for Social Care Inspection in the last year. All five residents returned surveys to the Commission for Social Care Inspection, and all said that they know how to make a complaint, and who to speak to if they are unhappy. One said, ‘Information is on the back of my door about making a complaint, which was explained to me when I first moved in,’ and another that they had the complaints procedure in their drawer. None could think of any way in which their life could be improved. The Manager had obtained a new professionally produced policy on dealing with abuse, which was clearly written and reflected current good practice. Staff had watched an awareness raising training video as part of their induction training, and had attended training on the Protection of Vulnerable Adults (POVA) in September 2006. The Manager had received training as a trainer in Westward DS0000003857.V359758.R01.S.doc Version 5.2 Page 20 POVA on 12th and 13th April 2007, so was in a position to update the staff’s training. Training on the Mental Capacity Act 2005 had been booked for 22nd April 2008, as it is likely to have implications for the residents at Westward, and training resources had been provided in the home. Westward DS0000003857.V359758.R01.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Westward provides residents with a homely, comfortable and safe environment in which to live. The rooms are attractive, and there is a choice of places for sociable activities indoors and out. EVIDENCE: The home is decorated and furnished in a homely way. The communal space includes lounge, dining room and games room as well as a large kitchen. The garden had been developed for interest in growing vegetables and herbs, and keeping chickens, as well as outside seating areas. Two residents were pleased to show us their room. ‘I love my room’, said one – ‘ I’m surprised it hadn’t been snapped up by someone else’. They had chosen the curtains and staff had helped put up pictures. Westward DS0000003857.V359758.R01.S.doc Version 5.2 Page 22 Upper windows were restricted to ensure safety. One bedroom had attractive blinds, as the occupant could manage these more easily than curtains. A bathroom had been re-fitted, with tiled walls, attractive lighting and an instant shower. All bedroom doors had suitable locks, and residents could be keyholders if they wished. Some residents propped their door open by day, but safety was maintained by properly functioning fire doors at the end of each corridor. The utility room had a domestic size washing machine and tumble dryer. An attractive hand-basin had been installed, where residents all washed their hands before lunch. Liquid soap had been provided, but paper towels were not available. Infection control policies are in place and records show that staff had received appropriate training. Westward DS0000003857.V359758.R01.S.doc Version 5.2 Page 23 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. JUDGEMENT – we looked at outcomes for the following standard(s): 32,34, 35 and 36 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff have the skills, training and understanding to meet the needs of residents. EVIDENCE: Residents were so confident and happy about their care and their social and creative activities, that it was clear that there are sufficient staff, with good skills and attitudes. All five residents said in surveys returned to the CSCI that staff always treat them well, and that the carers always listen and act on what they say. All staff retuning surveys said there were always enough staff to meet the individual needs of all people living at the home. Staff employed to provide care and support are called ‘Home Supervisors’, which promotes the homely focus of this service. There is a written rota, which shows that there are two staff on duty every day until 10pm, when, as long as all is well, one will leave the other to stay on sleeping-in duty. The home owners may be additional to this, and are on call at all times and live close by. Staff who have sole responsibility by night are trained and judged by Westward DS0000003857.V359758.R01.S.doc Version 5.2 Page 24 the Manager to be competent for this responsibility. Staff arrive at 8.50am to take a handover from their colleague going off duty. The files of two fairly recently appointed staff were examined. The checks that are required to assure residents’ safety had been done and all required documents were present. The Manager said that candidates meet residents informally before their interview, and records had been kept of questions asked on behalf of residents. Training records were seen, showing that effort has continued towards achieving a qualified workforce. Three of the six staff had achieved at least NVQ2 in care, and other training has included First Aid, Health and safety in the workplace, Food safety and catering and Moving and handling. During the previous year staff had attended courses in Mental health and learning disability, Understanding challenging needs, Conflict resolution, and Nonabusive psychological and physical intervention. Staff said they were well supported. Communication between staff and the manager is very good, though informal. The Manager had obtained a professional system for supervision and appraisal, and is preparing a format for recording 1;1 sessions, in order to keep a record of feed back, achievements, training needs and any issues. She had been promoting the confidence of workers who were not familiar with local health services, and had recorded discussions with a younger worker who was responding well to their responsibility. Westward DS0000003857.V359758.R01.S.doc Version 5.2 Page 25 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. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39 and 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well run in the best interests of the residents, and staff are trained in safe working practices. EVIDENCE: Westward is a small family-run home. The registered provider, Mrs Cathy Hillidge, is also registered as the Manager with the Commission for Social Care Inspection. She is an experienced registered nurse and has many years experience of running care homes. Throughout the inspection she demonstrated an in depth knowledge of the requirements for running a care home and clearly knew the residents very well. In surveys returned to the CSCI, staff said they had the support they needed to meet the different needs of their clients, and they found the service to be Westward DS0000003857.V359758.R01.S.doc Version 5.2 Page 26 well organised and a friendly place to work. One said they were ‘happy and proud’ to be part of Westward’s staff. Staff meetings are held regularly, with records kept. The last one had included discussion of the sharing of delegated management duties. One Home Supervisor was taking over responsibility for checking the First Aid box and keeping records, another was taking on responsibility for checking the fire precaution system and leading drills. Staff meetings follow on after Residents’ Meetings, so that their ideas about activities and any other issues raised may be considered. The registered provider is a member of ARC – the Association for Real Change – which supports local providers of services for people with learning disabilities, and attends meetings to keep up to date with current issues. The Manager had procedures for regular checks of care records, health and safety records and medication sheets, in order to maintain good standards and safe working practices. She was developing computerised records, for easier up-dating and communication. The Manager had gathered feedback from residents and their relatives so they can be sure they are a responsive service. She has written a summary to show the results of their feed-back, and any plans for the future that could be shared with the people who live in the home, their friends and relatives and the Commission for Social Care Inspection. Equipment in the home had been serviced and checked for safety, including the fire precaution service and electrical circuit (certificates seen); also the heating system and gas appliances and portable electric appliances. Staff had received training in fire safety on 17/04/07 and this was booked again for 16/06/08. Residents had joined in monthly drills, with records kept including evacuation times. One staff member was trained as a trainer for Level2 Health and Safety in the workplace. Four staff up-dated their First Aid Appointed Person training on 19/02/08. Westward DS0000003857.V359758.R01.S.doc Version 5.2 Page 27 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 Standard No Score 1 X 2 3 3 X 4 X 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 3 26 3 27 X 28 3 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 4 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 3 x Westward DS0000003857.V359758.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action 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 YA20 YA30 Good Practice Recommendations It would be good practice to up-date staff training in medication. Paper towels should be provided by communal handbasins, to prevent any possibility of cross infection. Westward DS0000003857.V359758.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Westward DS0000003857.V359758.R01.S.doc Version 5.2 Page 30 - 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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