Inspection on 20/03/06 for Astell

This inspection was carried out on 20th March 2006.

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

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

Other inspections for this house

Astell 13/11/06

Astell 31/10/05

Astell 15/03/05

Astell 27/10/04

Astell 09/03/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Astell Overton Park Road Cheltenham Glos GL50 3BT Lead Inspector Mrs Jacqui Burvill Unannounced Inspection 20th March 2006 10:55 X10015.doc Version 1.40 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 Astell DS0000016372.V285674.R01.S.doc Version 5.1 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 Older People. 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. Astell DS0000016372.V285674.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Astell Address Overton Park Road Cheltenham Glos GL50 3BT 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) 01242 529012 01242 584520 Cheltenham Old People`s Housing Society Limited (The Lilian Faithfull Homes) Mrs Rosemary Brooks Care Home 36 Category(ies) of Old age, not falling within any other category registration, with number (36) of places Astell DS0000016372.V285674.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 31st October 2005 Brief Description of the Service: Astell is a large attractive Victorian property, which has been adapted to provide comfortable accommodation for 36 elderly residents who require personal care. The Home is maintained and decorated to a good standard. The Home is owned and managed by a charitable organisation and is one of the Lillian Faithfull Homes. It is situated in a residential area, close to the centre of Cheltenham and to local amenities. Residents are accommodated on three floors of the Home, accessed by a shaft lift. The majority of the bedrooms have en suite facilities. A variety of aids and adaptations have been provided throughout the property to assist the less able residents. Communal areas consist of a large comfortable lounge, which may be divided by screens to provide two separate rooms, when desired. There is also a pleasant dining room and small library, which may be booked for private use. The Home has the benefit of enclosed well-maintained gardens. These are easily accessible and may be enjoyed by the residents in pleasant weather. Astell DS0000016372.V285674.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place between 10.55 and 5.45 pm on 20th March 2006. This inspection looked at key standards not seen at the last inspection and the action taken on the requirements and recommendations made at the last inspection. The manager’s post is vacant at the moment and there are two acting managers who ensure that there is someone senior on duty at all times. The acting managers are supported by other registered managers within Lillian Faithfull Homes. The inspector met with the acting manager and another manager from within Lillian Faithfull Homes. Six service users and four staff were spoken with. The following areas were looked at: There was a partial tour of the premises, medication and medication records, care plans and daily notes, staff recruitment and training records, some policies and procedures and fire safety records. What the service does well: What has improved since the last inspection? Astell DS0000016372.V285674.R01.S.doc Version 5.1 Page 6 There is a separate training and Human Resource department. Staff are devising training programmes and also carry out inductions for new staff and follow this through with frequent visits to the home, ensuring that best practice is developed and maintained. 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. Astell DS0000016372.V285674.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Astell DS0000016372.V285674.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 3 was assessed as met at the last inspection. Standard 6 is not applicable. EVIDENCE: Evidence was looked at with regard to a previous requirement about the Statement of Purpose and Service user Guide. This requirement is now met. These documents are available on the notice board and there is a copy in the staff room. Staff have signed to say they have read and understood the documents. Service users have been given a copy and the inspector spoke to some service users about this. The acting manager stated that they would read it to service users who might be unable to read the print, or that it could be made into a larger print for them on request. Astell DS0000016372.V285674.R01.S.doc Version 5.1 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 9 Standards 7, 8, and 10 were assessed at the last inspection. There was a minor shortfall for Standard 7 and the remaining standards were met. Service users are supported to self medicate where appropriate. Not all of the systems in place ensure they are protected in this. The way in which medication is administered by staff may put service users at risk from not receiving their medication or incorrect entries on the Medication Administration Record sheet. EVIDENCE: The medication trolley was seen and a number of random checks were made on the dosette system in place. The inspector was accompanied by the acting manager, the staff member who usually administers medication and the manager from another Lillian Faithfull home. There were a number of discrepancies. These were; medication left in the pack and signed as given on the MAR sheet, medication left in the pack and no code used to describe why it had not been given, medication not given and the incorrect, or unclear code used, such as ‘O’, where no definition had been given, or used in place of ‘R’ for refused. Although some additional comments Astell DS0000016372.V285674.R01.S.doc Version 5.1 Page 10 had been written on the reverse of the MAR sheet, which is good practice, these did not reflect the reasons why medication had not been given. The medication policy and procedure was looked at to see what information is available to staff. The policy does not detail the range of codes that can be used or what to do. It does state that staff must sign to say medication has been given. The fact that the record shows staff have signed and the medication is in the dosette box, may lead one to infer that medication is being signed for before it is given. A new medication system is to be introduced and training was due that afternoon, but had to be re- arranged by the provider. A significant number of service users self medicate. The administration sheet does not clearly show how much medication they have been given, and although this is checked periodically, there is no evidence to support this good practice. These aspects were discussed with the managers present. There are forms for service users to complete when they take responsibility for managing their medication. On checking these in the care plans, not all of the details about medication they were taking had been updated. There are secure systems for storing medication and systems in place for storing controlled medication, although these are not in use yet. The acting manager explained that this would be addressed by the new medication system. Handwritten entries on MAR sheets were noted to be completed by a lone member of staff. Two staff should sign this record to ensure that instructions from the GP have been correctly followed. (e.g. change of warfarin) It was noted that the section of the policy entitled ‘Drug Error’ there is a bold heading with the words ‘Self medication procedure’. This is potentially misleading, and was discussed and shown to the manager who agreed it should be removed. Astell DS0000016372.V285674.R01.S.doc Version 5.1 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 14 Standards 12, 13 and 15 were assessed as met at the last inspection. Service users enjoy and benefit from the control and exercise they have over their lives. EVIDENCE: The inspector spoke to service users in their own room and in communal areas. One service user was doing laundry in the resident’s laundry room. The opportunity to do this was appreciated, as she felt able to do as much for herself as she could as ‘it gives me something to do.’ Other service users confirmed this view and felt they were enabled to remain as independent as they could, for as long as possible. Two service users were observed taking part in a small activities session and they confirmed their choice in this activity. Service users liked being able to bring items from their own home into Astell, as it made their room feel more like home. Many of the rooms seen reflected the individual tastes and choices of the service users. One service user commented that it may be helpful to have the next day’s activity displayed on the wipe board, so that service users knew in advance what was due – e.g. Holy Communion. The service user hoped this would make things easier for staff, who she observed having to go round the home to inform service users. Astell DS0000016372.V285674.R01.S.doc Version 5.1 Page 12 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18 Standard 16 was assessed with minor shortfalls at the last inspection. Service users are protected from abuse by systems and training measures in the home. EVIDENCE: The requirements set in respect of Standard 16 were looked at. There was no complaint record in place at the time of the inspection. Various options were discussed that managers could put in place. Service users have an up to date copy of the complaints procedure as part of the service user guide. Service users spoken with confirmed they had a copy of the guide. All staff have received abuse training ‘in house’. This training takes the form of watching a video and completing a question and answer session. Staff are given a copy of the adult protection policy and an ‘untoward incident’ form in their own keeping. Training staff said staff were able to come and discuss any issues or concerns that staff may had. Staff confirmed this in a discussion about adult protection. A member of staff later described a practice she had seen in the home and went to talk to the training staff about this. They were able to confirm that service users may feel safer when being held in a particular way when using a moving and handling technique and that this does not constitute an abusive situation. The organisation’s policy and procedure links in with the Gloucester ‘No Secrets’ procedure. Staff spoken with were aware of the procedure and how to use it, although they all knew to report it to their manager first. Astell DS0000016372.V285674.R01.S.doc Version 5.1 Page 13 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 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 Standard 26 was assessed with a minor shortfall at the last inspection. Service users benefit form a pleasant and safe environment to live in. EVIDENCE: The home is situated a short distance from the centre of Cheltenham. The home was clean and tidy on the day of inspection. There was a partial tour of the home, which took in the communal areas, the bathrooms and toilets and with service users’ permission, some of the bedrooms and sitting rooms. The home appears to be well decorated and maintained to a good standard. The dining room was laid for lunch with linen tablecloths and silk flowers, giving the room a very attractive atmosphere. There is a large through sitting room and a separate small sitting room, which is used as a library. All rooms are well furnished. The requirements made at the last inspection were looked at. The flooring in the laundry area is about to be replaced, as quotes have been obtained. This will be extended into the staff changing area. There are also plans to knock down an interior wall to create a walkway into the linen store. Astell DS0000016372.V285674.R01.S.doc Version 5.1 Page 14 Four service users have the use of a small bedroom and a nearby sitting room for their own use. One service user confirmed that this arrangement suited her very well, as she liked to spend time in her sitting room. There is a level, attractive garden, with a summerhouse and paths leading to small seating areas, which the acting manager stated was enjoyed and well used by service users in the warmer weather. There is a rolling maintenance programme and a team of staff employed for this purpose. There is a board on which staff can record any areas of the home that need to be looked at. On the day of inspection, one of the team was in the home addressing items that staff had reported. Astell DS0000016372.V285674.R01.S.doc Version 5.1 Page 15 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 Standard 30 was assessed with a minor shortfall at the last inspection. There are sufficient staff on duty to meet the needs of the service users. Service users would benefit from more staff who have NVQ training. One element of recruitment practice may put service users at risk. EVIDENCE: There were five staff on duty at the time of the inspection as well as the acting manager. One of the five staff was the activities coordinator, who works from 10 – 5pm four days a week. Three staff and an acting manager were on duty on the late shift. There are two night staff on duty each night. It was evident from the rota that staff cover additional shifts as and when required. The inspector was informed that night staff levels would be rising from two staff to three. The acting manager provided the inspector with a copy of the rota which also details the number of staff who have an NVQ. At this time, there are 22 day and night staff, of which two seniors have NVQ level 3 and one level 2; and one other staff with NVQ level 2. Three staff are enrolled on an NVQ. The training manager stated that the aim is to get 50 of staff trained within the next seven months. Three staff are enrolled onto the A1 assessors course. The training department looking to develop a support network for care staff, by asking staff who have NVQs to act as mentors. Astell DS0000016372.V285674.R01.S.doc Version 5.1 Page 16 The recruitment records are held in one of the nearby homes. These records were viewed on those premises. The recruitment records for four newly employed staff were seen. Application forms and two references were in place. All four staff had been employed prior to a Criminal Records Bureau check. This was completed on the first day of employment, as staff are asked to bring relevant documents with them to the first training day. Staff are expected to complete a three week induction programme, during which time, they are supernumerary to the rota. POVA First checks are also completed on the first day of employment. It was seen that these checks took between one and three days to return. Staff would only be allowed to work with service users if both checks were clear. The inspector asked what would happen if a CRB check came back with a criminal conviction that either had or had not been disclosed. The human resource manager informed the inspector that the employment of this person would be at the discretion of the Chief Executive of the organisation. In such cases, a risk assessment should be made regarding the decision to employ. CRB and POVA First checks are expected to be completed prior to employment as part of the recruitment check process. The human resource manager stated that CRB checks are being kept for the life of the employee. Part of this reason given was that it was difficult to tell which element of the time line had come first – six months after employment, or when the inspector had seen the actual check. Guidance on these matters can be obtained from the CRB website and by contacting the inspector for the home. Induction records are kept and the induction includes health and safety training, action on elder abuse, infection control, fire training, moving and handling, basic food hygiene and dementia awareness. The training department discussed the methods of training used and how they are able to support and develop good practice by ‘walking the floor’. They can then address any issues that arise or reflect positive practice. There are some very interesting and innovative developments in training staff in food presentation, which were shown to the inspector. The training department is a fairly recent development, having been in operation for about 6 months. Since that time, the human resource manager reported that staff turnover appears to be low, perhaps as a result of the training input and support available to the staff team. Astell DS0000016372.V285674.R01.S.doc Version 5.1 Page 17 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. 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 and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33 and 35 Standard 38 was assessed with minor shortfalls at the last inspection. Standard 31 could not be assessed as the manager post is vacant. There are good systems in place to assess the quality of the service, and a concluding report would enhance this. Service users’ finances are not safeguarded by a clear procedure and documentation. EVIDENCE: The manager’s post is vacant at this time. The home is being run by two acting managers, both of whom are senior staff with NVQ level 3. There are being supported in this by the registered managers of two other Lillian Faithfull Homes. Currently, there is no identifiable policy and procedure that supports the quality assurance systems used in the home. There are variety of these, including ISN 9001 and Investors in People, which was awarded last year. Astell DS0000016372.V285674.R01.S.doc Version 5.1 Page 18 Managers within the organisation meet monthly and there are also Regulation 26 visits. There is a ‘residents’ committee’, where service users are nominated to represent the views of a small number of service users. They then act on behalf of those service users in the meeting and feedback to them afterwards. The service users are visited approximately every two weeks to see if they have views they want to share. The service users meetings are held three monthly and are documented. It is not clear if there are mechanisms in place to gather the views of relatives, stakeholders and other professionals. Service user questionnaires have not been used as one of the managers from with the organisation explained that service users may be reluctant to fill them in and she did not want staff to influence the process in any way by supporting service users with this. There does not appear to be an overall report covering an analysis of the information gathered by all of the systems in use, so as to plan further developments to the service. The records relating to service users’ money were seen. These include a document about money ‘passing through’, and cashing service users’ cheques. Documentation regarding this service, which is provided by the organisation must be clearer. The manager of one of the other Lillian Faithfull homes described her method of recording this, which sounds appropriate. This will be passed onto the acting manager to follow and use. Records of money spent were not clear, for example, hairdressers receipts were written on small pieces of paper and rarely signed by the hairdresser, nor was there confirmation of payment, nor was there a sheet recording these payments. The policy regarding service users’ money, safeguarding their finances needs to be reviewed. Astell DS0000016372.V285674.R01.S.doc Version 5.1 Page 19 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People 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 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 X 8 X 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 3 3 X X X X X X X STAFFING Standard No Score 27 3 28 2 29 2 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 2 X 2 X X X Astell DS0000016372.V285674.R01.S.doc Version 5.1 Page 20 Are there any outstanding requirements from the last inspection? Yes 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 OP7 Regulation 15(1) Requirement The registered person shall ensure that all care plans set out in detail, the action to be taken by care staff, to meet the identified health, personal and social care needs of residents. (Carried forward from the last inspection) Not all care plans reflected the details of care provided. The registered person shall ensure that residents’ care plans are reviewed and updated to reflect changing needs. (Carried forward from the last inspection) Not all care plans had been regularly reviewed or updated. The registered person must ensure that staff follow the administration of medication policy and procedure correctly. All staff who are responsible for administering medication must receive training in the homes medication administration system and knowledge base in the wider use and understanding of medication. DS0000016372.V285674.R01.S.doc Timescale for action 31/05/06 2. OP7 15(2)(b) 31/05/06 3. OP9 13 (2) 30/04/06 4. OP9 13(2) 18(1)(a) 30/07/06 Astell Version 5.1 Page 21 5. OP9 17 (1) (a) Sch3(i) 13 (4) (b) (c) 17(2) 6. 7. OP9 OP16 Service users’ self medication records must clearly list the medication and the date they were prescribed the medication. There must be a risk assessment in place to support service users who wish to self medicate. The registered person shall keep a record of all complaints made by a resident or representatives or relatives of a resident or by persons working at the home about the operation of the home, and the action taken by the registered person in respect of any such complaint. (Carried forward from the last inspection) No record was in place for complaints to be recorded. There have been no complaints made. Minor complaints are dealt with as they arise. 30/04/06 30/04/06 30/04/06 8. OP26 13 (3) 23 (2)(b) The registered person shall 30/04/06 ensure that the laundry floor covering is replaced to provide a safe impermeable finish and that the wall surfaces in the laundry are readily cleanable. Previous timescale of 30/9/05 not met. (Carried forward from the last inspection) Quotes have been obtained and work is due to take place shortly. The registered person must 30/04/06 ensure that thorough recruitment checks are carried out prior to employment offers being made. The registered person shall make 31/07/06 suitable arrangements for the training of staff in first aid and provide a qualified first aider at all times. (Carried forward from the last inspection) Training sessions have been planned in order that at least DS0000016372.V285674.R01.S.doc Version 5.1 Page 22 9. OP29 17 Sch2&18 (1ab 4bi) 13 (4) c 18 (c) (i) 10. OP30 Astell one person on duty will be a qualified first aider. 11. OP33 24 (2) There must be an annual report of the quality assurance systems in use in the home which is to be sent to the local CSCI office. Records must be in place to record and safeguard service users’ finances. 31/07/06 12. OP35 17 (2) Sch9(a) (b) 30/04/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. Refer to Standard OP9 OP9 OP33 OP35 Good Practice Recommendations The words ‘self medication procedure’ should be removed from the section of the medication policy entitled ‘Drug Error’, as this could be misleading. Two staff should sign the medication administration record when changes to medication have to be handwritten on the MAR sheet. A quality assurance policy and procedure should be devised to detail how the systems are used within the home and how this affects the development of the service. There should be a clear policy and procedure describing how service users’ finances are to be held and recorded. Astell DS0000016372.V285674.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection Gloucester Office Unit 1210 Lansdowne Court Gloucester Business Park Brockworth Gloucester, GL3 4AB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Astell DS0000016372.V285674.R01.S.doc Version 5.1 Page 24 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!