Inspection on 14/12/07 for Clifton House

This inspection was carried out on 14th December 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Clifton House 19/10/09

Clifton House 05/01/09

Clifton House 08/09/06

Clifton House 01/11/05

Clifton House 05/07/05

Clifton House 15/12/04

Clifton House 01/06/04

Similar services:

Trevaylor Manor

Stallcombe House

Stroud Lodge

The Woodmill

Woodland Vale

Bolealler House

Claremont Nursing Home

Althea Park House

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

CARE HOME ADULTS 18-65 Clifton House 1 Grantley Road Boscombe Bournemouth Dorset BH5 1HW Lead Inspector Trevor Julian Key Unannounced Inspection 14th December 2007 11:00 Clifton House DS0000003930.V356636.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 Clifton House DS0000003930.V356636.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. Clifton House DS0000003930.V356636.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Clifton House Address 1 Grantley Road Boscombe Bournemouth Dorset BH5 1HW 01202 393385 01202 303620 cliftonhouse@together-uk.org www.together-uk.org Together Working for Wellbeing 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) Mr Douglas Low Care Home 23 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (23) of places Clifton House DS0000003930.V356636.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Five named adults (names known to CSCI) over the age of 65 years may be accommodated until such time as their assessed needs cannot be met by the home 8th September 2006 Date of last inspection Brief Description of the Service: Clifton House is situated in a quiet residential area of Boscombe and is close to all local amenities. It is a corner property with a pleasant rear garden and an outside laundry area. It is registered under the category mental disorder (MD excluding learning disability or dementia) for up to 23 male and female service users. The home has 21 single bedrooms, none have en-suite facilities. There are two bed-sits with a shared kitchen and bathroom on the ground floor which, can accommodate two service users assessed as suitable for more independent living. Clifton House is operated by Together an independent organisation that accommodates and supports individuals with enduring mental health problems. Residents receive 24-hour emotional and practical support from a team of experienced residential care workers. The registered manager Mr Low and a very experienced staff team undertake the day-to-day running of the home. In December 2007 the stated weekly charges, were £441. See the following website for further guidance on fees and contracts: http:/www.csci.org.uk/about_csci/press_releases/better_advice_for_people_ choos.aspx Clifton House DS0000003930.V356636.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection took place on the 14th December 2007 between 11:00- 16:30. The purpose of the visit was to monitor the homes performance against key standards. Information was gathered through discussion with the residents, staff and management, a tour of the premises and a review of some care records and procedures. Before the inspection, the manager had completed an Annual Quality Assurance Assessment (AQAA) giving information on the management of the home and basic care needs catered for. Residents and other stakeholders were asked for their views with comment cards. The following cards were returned:Residents 12 Relatives and friends 5 Care Managers 5 Staff 3 Doctors 2 The responses showed very good levels of satisfaction with the service. There had been an adult protection alert received by the Commission just before the inspection which was kept open allowing time for the issues to be addressed. What the service does well: The home’s admission process continued to ensure that people were able to take time before making a decision about the home’s suitability. The process also routinely involved healthcare professionals to ensure a holistic assessment. The care planning process involved the residents and others to ensure that the care provided matched the needs of the individual. Using residents’ meetings and annual reviews the home worked very hard to involve the residents in the running of the home and to seek their views in order to develop the service. People clearly felt comfortable with the staff and several said the staff were kind and approachable. Two people were working in the kitchen after lunch, they said it was part of their weekly task list and both were happy to help. The premises were clean and comfortable. The home felt warm on the day of the inspection although one person did comment that they were cold, they had not expressed any concern to the staff. The senior worker on duty said she would investigate. Clifton House DS0000003930.V356636.R01.S.doc Version 5.2 Page 6 Staff recruitment continued to be thorough to ensure the suitability of applicants. The induction and training programme helps to keep staff up to date with care practice and to provide them with the skills to meet the needs of the residents. The comments received show evidence of high levels of satisfaction with the home:• The staff treat us very well • Thanks to all the staff. We feel the staff cannot do enough for our relative and the rest of the residents • The staff make the home just like home. • The home and staff exceed our expectations by a long way. Impressed by their (staff) humanity, warmth and knowledge. • The home has given my relative respect, help and affection- in short a home which has allowed her to have as fulfilled life as her condition allows. The assessment reviews I have been involved with take place on a regular basis within the required time frame. • The manager and staff appear to provide an encompassing and rounded service taking into consideration a great variety of needs required by the residents • The home is run extremely well and residents given the opportunity t o undertake rehabilitation. • Key worker is very mindful of confidentiality • Sometimes incidents occur which I should have been informed of sooner. • The home provides a safe, secure and happy environment which supports people as individuals. What has improved since the last inspection? What they could do better: The contract should be updated to include which room is offered. This will ensure that people only move rooms when it suits the individual. There had been improvements in the recording of financial transactions for the residents. However, the home was not retaining receipts for some significant expenditure Clifton House DS0000003930.V356636.R01.S.doc Version 5.2 Page 7 Medication was generally well managed and securely stored. In one case, there was no audit trail for a medication used by the newest resident. There were no checks on handwritten entries in the medication record, this could lead to transcription errors. Recently an allegation of abuse was brought to the attention of the Commission. The organisation had not fully followed “No Secrets” guidance and this could have resulted in evidence being compromised. The case also provided evidence that the service did not always advise the Commission of significant event affecting the people living at the home. This should be completed within 24 hours of the event. 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. Clifton House DS0000003930.V356636.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Clifton House DS0000003930.V356636.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2, 5 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The home continues to ensure that prospective residents are allowed time to consider their options and the suitability of the placement. EVIDENCE: During case tracking, the newest resident was considered. Two staff had visited the resident at her previous address as part of the assessment process. The resident already knew of the services available at Clifton House. As part of the assessment process the resident visited the home on day and overnight visits with support from the Community Mental Health Team. The assessment included contact with specialist and care managers to ensure the staff were able to identify all the needs. There was also a six week review to check on progress and identify any unmet needs. Information was provided to individuals during the assessment process to give them chance to assess the suitability of the home from their perspective. New residents were given a licence agreement forming a contract between the home and each resident. The licence agreements seen did not include the room to be occupied. Clifton House DS0000003930.V356636.R01.S.doc Version 5.2 Page 10 Care managers’ comment cards showed that the home generally communicates well. Relatives also commented that the home had exceeded their initial expectations. The AQAA identified areas where the service identified areas for improvement. This included contact and communication with families and friends through the admission process. It also identified that in the past twelve months the home had introduced new information packs for prospective residents along with an induction pack to help with the initial orientation into the working of Clifton House. Clifton House DS0000003930.V356636.R01.S.doc Version 5.2 Page 11 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, 9. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home offers individuals good levels of choice in their daily lives helping people to feel fulfilled. EVIDENCE: Care planning was developed from the pre-admission assessments and subsequent reviews. The care plans seen were comprehensive and of a good standard. There was evidence that residents had been involved in the care planning process. The care plans seen, included information on spiritual needs, basic nutritional assessments and individual risk assessments. There was also evidence of timely referral to healthcare professionals. This was also evident from the comment cards received. There was a residents’ forum where people were encouraged to give their views on the running of the home. Clifton House DS0000003930.V356636.R01.S.doc Version 5.2 Page 12 Care managers confirmed that the home regularly reviewed the care plans. In the past, the home had arranged advocacy services for a resident. All the responses showed that the residents enjoyed a good degree of freedom and were able to make decisions about their lifestyles, while support and advice was available within the service or through the other agencies the residents’ were accessing. The home looked after personal allowances for most of the residents. A check showed there were records of expenditure and income but there were no receipts for some significant transactions. The balances checked matched the recorded balances. Residents seen were aware that there were care records and that they could see them if they wished. Records were stored securely to respect confidentiality. The AQAA identified that the service was looking to further develop person centred care plans. These will develop the holistic approach to care provision in the home and to promote independence. Clifton House DS0000003930.V356636.R01.S.doc Version 5.2 Page 13 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, 15, 16, 17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home continues to help residents maintain as independent lifestyle as their circumstances allow. The home offers individuals good levels of choice in their daily lives helping people to feel fulfilled. EVIDENCE: Since the last inspection, some residents have been away for weekend breaks and one person has gone to a centre in the New Forest for a week. Further weekend breaks were planned for two residents in the new year. However, Mr Low explained that the fee structure did not allow the home to offer as many opportunities as they would like. There was also an impact on staffing as most people would need to be accompanied by a member of staff. People make a monthly contribution of £117 to a social fund to cover costs of social activities. Clifton House DS0000003930.V356636.R01.S.doc Version 5.2 Page 14 The home is located close to the centre of Boscombe allowing some people to visit shops and community centres independently; this was subject to individual risk assessment. Two residents spoke about their daily routines one person had close contact with her family and went home most afternoons. The other had been working during the morning at a local placement. He said he enjoyed good levels of freedom and was being supported to achieve more independent living. Other people said they accessed local day centres. The AQAA stated that people were encouraged to develop hobbies and interests although there was little evidence of activity in this area during the visit. The AQAA also identified that they will develop activities in sport and leisure. They were also working to train staff in relaxation therapies to assist the residents. Responses from care managers identified that people were encouraged to join in activities in the local community. All the responses showed that visitors were made welcome at the home. People living at the home had routine tasks including cleaning and washing up. Most people said that they found the “chores” to be ok. They also had to make their teatime meal with staff supervision; this had encouraged greater choice. All the people seen during the visit said the meals were good and there was always a choice. One person felt the meals were good although she felt the staff should offer seconds. There was a daily shop for perishable goods eg yoghurt, bread, eggs, etc. A wholesaler supplied other items weekly. Records were maintained to show what each person had eaten. The home uses feedback from monthly meetings to assess the standard of food offered. Clifton House DS0000003930.V356636.R01.S.doc Version 5.2 Page 15 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, 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The views of individuals are incorporated into the care plans to ensure that people are supported in an appropriate manner. Healthcare issues are referred to the appropriate authority to ensure people are kept well. Medication systems allow items to be safely stored and administered. EVIDENCE: The care plans were in place and developed with input from the residents, families, key workers, care managers and healthcare professionals. The plans considered individual preferences. The plans consider most aspects of daily life from managing personal care to referral for dental and optical appointments. Where possible, people were encouraged to maintain as much independence as they could. Sometimes people declined healthcare check-ups, and this was monitored and followed up with people encouraged to accept the check-ups. Clifton House DS0000003930.V356636.R01.S.doc Version 5.2 Page 16 In the past year several people had taken over managing their own medication following risk assessment. Medication was generally well managed and safely stored however a brief audit showed that there had been no audit by the supplying chemist, in one case there was no audit trail for a medication used by the newest resident. There were no checks on handwritten entries in the medication record; this could lead to transcription errors. Clifton House DS0000003930.V356636.R01.S.doc Version 5.2 Page 17 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, 23. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The complaints procedure and other methods allow people to raise concerns. The adult protection protocol was not being followed and could result in people being placed in placed at risk of abuse. EVIDENCE: The organisation had procedures for responding to complaints. People were encouraged to raise concerns in a variety of ways including formal complaints, resident meetings and individual review meetings. Most people responding to the comment card said they knew how to raise complaints however a significant percentage were not aware how to complain. Mr Lowe said that the residents were encouraged to speak up with any issues and recognised the need to remind people of the process. The organisation has a policy on managing allegations of abuse, however as stated previously an allegation was brought to the Commission’s attention, which had not been correctly reported by the service. The home had also gone ahead with an “in – house” investigation before the adult protection system had considered the situation. This action could raise questions about the lack of transparency and could place people at risk of abuse. Any allegation should be reported to Social Services who will then be able to advice on the appropriate course of action. The case also demonstrated that the home did not always report significant incidents affecting the wellbeing of residents to the Commission within 24 hours. Clifton House DS0000003930.V356636.R01.S.doc Version 5.2 Page 18 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): 24, 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Despite limitations of the premises the home is comfortable and well maintained and meets the needs of those currently accommodated. EVIDENCE: The premises continued to be appropriately maintained. The building layout means that people with limited mobility would have problems managing any of the upper floors. The matter was considered during the admission process. No issues about the premises were raised in the comment cards. During a tour of the premises most rooms were warm and the residents said they were comfortable, however one person did say that they felt cold in their room but they had not mentioned it to the staff. The rooms were personalised by the occupant with pictures and other mementoes. Appropriate locks were provided on each bedroom allowing the occupant privacy but giving access in case of Clifton House DS0000003930.V356636.R01.S.doc Version 5.2 Page 19 emergency. One person said that she had moved rooms as a larger one had been available but this had been for her benefit. The home had one assisted bath which was serviced by an approved contractor. A new easy access shower room had been installed in place of a conventional bath and had been a popular improvement, allowing increased choice. The home was clean and odour free. People were responsible for their own space and this led to a comment received stating that their relative should keep their own room tidy. People said they were given support from staff if they needed help keeping tidy. The AQAA states that the housekeeper will be conducting an audit to prioritise redecoration programme for the coming year. They also hoped to increase the residents’ involvement in the daily tasks around the home. Clifton House DS0000003930.V356636.R01.S.doc Version 5.2 Page 20 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. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Recruitment and training programmes help to ensure that the home is suitably staff. EVIDENCE: The organisation offers a comprehensive training programme both “in house” and through the local authority. Access to the training programme was arranged through the supervision process. Three people were completing their NVQ level 3 in care others had NVQ level 2. There was a training programme giving details of training completed and nominations in progress. Staff seen said the training provided was very good. All new staff complete the skills for care induction standards before their trial periods are completed. A small sample of staff files showed that the home followed guidelines on recruitment with the required checks and references in place. Application forms were used and there were no gaps in the employment history section. Clifton House DS0000003930.V356636.R01.S.doc Version 5.2 Page 21 The staff roster did show that on certain shift there were male only staff on duty. One resident said that she sometimes needed help with personal care and that she would prefer a female carer in that situation. Mr Low was aware of the situation and was trying to work with the resident and her family to resolve the issue. The home was staffed with only sleep-in staff overnight. Recent events at the home meant that this was reviewed and a wakeful person employed temporarily. Clifton House DS0000003930.V356636.R01.S.doc Version 5.2 Page 22 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, 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Management systems at Clifton House generally ensure the safety of residents and staff. The systems also ensure that residents and other interested parties are able to give their views on the running of the home. EVIDENCE: The home has a stable and experienced senior team and the organisation encourages staff to maintain their own professional development. Comment cards were full of praise for the way the home was run one care manager stated. “The manager and staff appear to provide an encompassing and rounded service taking into account a great variety of needs required by the residents. Clifton House DS0000003930.V356636.R01.S.doc Version 5.2 Page 23 Another commented, “the home is run extremely well and the residents given the opportunity to undertake rehabilitation.” The home works with the residents to seek their views on the way the service operates. The home holds an annual review seeking comments from all stakeholders. The results of the review were available to residents. Staff receive training in first aid, manual handling, health & safety, food hygiene and infection control. The homes accident reports were analysed locally and by the organisation to monitor for trends or problem areas. Contractors checked specialist and fire safety equipment. Clifton House DS0000003930.V356636.R01.S.doc Version 5.2 Page 24 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 4 3 x 4 x 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 3 25 x 26 x 27 x 28 x 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 2 x 3 3 LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 x 3 x 3 x x 3 x Clifton House DS0000003930.V356636.R01.S.doc Version 5.2 Page 25 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. 1 2 Standard YA23 RQN Regulation 13(6) 37 Requirement The provider must ensure that allegations of abuse are managed appropriately. The registered person must inform the Commission of any significant event affect the wellbeing of residents within 24 hours. Timescale for action 29/02/08 29/02/08 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 YA5 YA7 YA20 YA20 Good Practice Recommendations The licence agreement should specify the room to be offered. Financial records should include receipts for significant expenditure. There should be a clear audit trail for medication entering and leaving the medication system. Handwritten entries in the medication records should be checked by a second person to reduce the risk of transcription errors. Clifton House DS0000003930.V356636.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Poole Office Unit 4 New Fields Business Park Stinsford Road Poole BH17 0NF 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 Clifton House DS0000003930.V356636.R01.S.doc Version 5.2 Page 27 - 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!