Inspection on 26/09/07 for Elmbank Care Home

This inspection was carried out on 26th September 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Elmbank Care Home 06/02/07

Elmbank Care Home 17/11/05

Elmbank Care Home 21/07/05

Elmbank Care Home 08/03/05

Elmbank Care Home 14/06/04

Similar services:

Hillside

Applegarth

122 Scorer Street

Byars Care Home

St Marys Nursing Home

Jubilee Villa Care Home

Bramble Lodge

Parkmanor Residential Home

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

CARE HOMES FOR OLDER PEOPLE Elmbank Care Home 35 Robinson Road Mapperley Nottingham NG3 6BB Lead Inspector Joanna Carrrington Unannounced Inspection 26th September 2007 09:00 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 Elmbank Care Home DS0000026433.V348547.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 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. Elmbank Care Home DS0000026433.V348547.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Elmbank Care Home Address 35 Robinson Road Mapperley Nottingham NG3 6BB 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) 0115 962 1262 0115 952 3726 isabel.mantle@redwoodcare.co.uk Elmbank Nursing Home Limited Mrs Isabel Mantle Care Home 35 Category(ies) of Learning disability (4), Old age, not falling registration, with number within any other category (35), Physical of places disability (2) Elmbank Care Home DS0000026433.V348547.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Elmbank Nursing Home Limited is registered to provide nursing and personal care at Elmbank Care Home for up to 35 persons of both sexes whose primary needs fall within the categories of: Older Persons, not falling into any other category (up to 35 people). Learning disability (up to 4 people). Physical disability (up to 2 people). Those in the category of Learning disability and Physical disability shall normally be over the age of 50 years. One bed may be used in the category LD to accommodate a named person referred to in Variation application dated 23/09/05. This person was aged 47 years on admission. One bed may be used to accommodate the named person named in the variation application dated November 2006. This person was aged 45 years on admission. 6th February 2007 2. 3. 4. Date of last inspection Brief Description of the Service: Elmbank is registered to provide a service for up to thirty-five older people in single and shared rooms, some with en-suite facilities. The premises are an extended residential house in Mapperley, close to a shopping area and four miles from Nottingham city centre. Both nursing and care staff are provided. The home is accessible for wheelchair users and there are accessible gardens to the rear of the property. A lift provides access to the first and second floors. The fees for care and accommodation range from £334 to £500 per week, depending on assessed level of need and whether or not nursing care is required. A copy of the most recent inspection report must be made available to residents and other stakeholders. The Service User Guide must either include a copy or inform the reader how they can get a copy. Elmbank Care Home DS0000026433.V348547.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This site visit, as part of the home’s key inspection took place on 26th September 2007. Inspections focus on outcomes for people that use the service. In order to do this the main method of inspection used at the site visit was ‘case tracking’ which meant three residents were selected and their support was tracked through discussion with them and with staff, checking their care records and observing practice. Altogether four residents, two relatives and three staff members were spoken with. A sample of staff records were also looked at and a tour of the premises also took place in order to check compliance with requirements made at the last key inspection. Information that is collected before the site visit is also used to make judgements. This information could include notifications, information from other professionals and users of the service or their relatives, and also from any surveys that are sent out. Six surveys were returned at the time of writing this report. Services are now required to fill in a document called an AQAA (Annual Quality Assurance Assessment) in which the registered manager identifies from their own quality monitoring what the service does well at and what they need to improve on. The AQAA was returned before the site visit and was used to plan the site visit and also to support judgements made in this report. What the service does well: The service does well at promoting the quality of life of residents and meeting their social and recreational needs. A resident has recently been supported to attend a reunion of her old work colleagues. Residents have opportunities to go on outings and to participate in activities in the home. Residents are supported to make choices and have control of their lives. Residents go to bed and get up when they want to and can spend their time how they want. Families and friends are always welcome to visit. Residents enjoy their meal times and are served a variety of wholesome nutritious meals. Residents’ healthcare needs are managed very well. Healthcare professionals are called on when necessary and relatives are always informed if their relative-in-care is not very well or has had an accident. Residents are assured their needs are met by a competent and effective staff team that are well trained and supported. There is a Service User Guide, which is updated every year that gives people information about the services provided and arrangements for care in the Elmbank Care Home DS0000026433.V348547.R01.S.doc Version 5.2 Page 6 home. Prospective residents needs are assessed in order to make sure the home is suitable. What has improved since the last inspection? What they could do better: To ensure the protection of residents, when a complaint made by a resident is about possible abuse then this must be treated as an allegation and followed up using adult abuse procedures. All staff members must have recruitment checks carried out before they commence employment. This is to protect residents from staff members that maybe unsuitable to work with vulnerable people. All medicines that enter and leave the home must be accounted for so that it can be checked that residents are being given their medicines correctly. Where there are risks to residents identified in care plans then there must also be a risk assessment carried out in order to ensure all the necessary measures are in place for their safety and protection. The most recent inspection report and quality monitoring reports done by the home must be made available to residents and other stakeholders. This is so that residents can make an informed decision about living there and also assures people that it is worth sharing their views about the service if they are listened to and acted on. Care plans could be better by being presented in a format that is accessible to residents and enables them to be more involved in the process. Elmbank Care Home DS0000026433.V348547.R01.S.doc Version 5.2 Page 7 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. Elmbank Care Home DS0000026433.V348547.R01.S.doc Version 5.2 Page 8 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 Elmbank Care Home DS0000026433.V348547.R01.S.doc Version 5.2 Page 9 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 and 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Improvements to admission arrangements now mean residents are assured the service provided will meet their needs and their legal rights are protected. Residents and stakeholders do not have all the current information about the service, in order to make an informed decision about living there. EVIDENCE: All three residents case tracked, including a resident that has been admitted to the home since the last inspection, have on their care file a pre-admission assessment carried out by the manager of the home and a copy of the placing authority’s community care assessment. A resident spoken with remembered someone visiting to ask her questions about her needs and support. Copies of signed terms and conditions with the home were also seen for the three case tracked residents. Elmbank Care Home DS0000026433.V348547.R01.S.doc Version 5.2 Page 10 Both a relative and resident spoken with confirmed that they have been supplied with an up to date Service User Guide, which they have found helpful. The document is contains the CSCI inspection report summary for an inspection in November 2005. The last inspection prior to this one was February 2007. A relative spoken with was unaware of this inspection and was not aware that a copy must be made available to residents and stakeholders of the home. Elmbank Care Home DS0000026433.V348547.R01.S.doc Version 5.2 Page 11 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The healthcare needs of residents are well met but care planning arrangements are not effective enough in ensuring residents safety and in involving residents in the care planning process. The lack of an audit trail means residents are at risk of not getting their medicines as prescribed. EVIDENCE: All residents spoken with agree that the staff team respect their privacy and dignity; staff always knock on their bedroom door before entering and are sensitive to their personal and intimate care needs. One resident did however report that in the morning they had not been given the opportunity to choose what they wanted to wear but were shown an outfit and asked if that was okay. It was suggested to the resident that they make sure their wish to choose their own clothes is stated in their care plan, given how important this is to the resident. This resident, (along with other residents spoken with), was not familiar with her care plans and what they are for. Elmbank Care Home DS0000026433.V348547.R01.S.doc Version 5.2 Page 12 Although this resident has signed to say she has seen them and agrees with them it is understandable why this has not been remembered. The care plans seen do cover all areas of social and health and personal care needs and are evaluated on a monthly basis. But the format used is a tick box approach, with very little space for additional more person-centred information. The care plan for ‘maintaining appearance refers to ‘respecting personal choice’ and states “needs loose, easy to put on / off clothes’ but there is no mention of the resident’s individual preferences. Copies of accident records are held on the file of a resident that has had serious falls and the care plan for ‘personal safety’ shows that in response to falls further entries, which are dated, have been added to this care plan, for example the latest entry states “observe closely when wondering.” There is no accompanying falls risk assessment with this care plan, which would clearly identify the necessary measures to make sure the resident is safe. Care plans and daily records indicate that residents have regular health care checks and specialist healthcare professionals such as dietician, psychiatrist and occupational therapists are called on when necessary. Relatives spoken with confirmed they are always kept informed if their relative-in-care is unwell or has had an accident. A relative described the staff team as “using their initiative” and being quick thinking when her relative-in-care is displaying signs of ill health. A nurse was observed administering medication correctly in line with pharmaceutical guidance and in a way that maintained the dignity of residents. Three medicines were audited. The quantities for two of these medicines tallied with what had been signed as given, however there was not a clear enough audit trail for one of these medicines. Some tablets had not been signed out on the medication administration record when they had left the premises with the resident’s family. For the third medication there were two more tablets remaining than there should have been according to the quantity recorded at the start of the cycle and what had been signed as given. Elmbank Care Home DS0000026433.V348547.R01.S.doc Version 5.2 Page 13 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Meeting residents’ recreational needs and maintaining contact with family and friends is managed well in accordance with residents’ wishes. There are good arrangements in place for providing wholesome appealing meals. EVIDENCE: All residents spoken with said that their family and friends are always made to feel welcome and they can have visitors whenever they want. Residents spoken with also confirmed that they still feel in control of their lives and can choose how they wish to spend their time and when they wish to get up, go to bed and what meals they would like. Residents were observed enjoying their mealtime in a relaxed atmosphere and being given two meal choices. A resident spoken with described the meals as “lovely.” The meals served on the day of the inspection were balanced, nutritious and looked appetising. Elmbank Care Home DS0000026433.V348547.R01.S.doc Version 5.2 Page 14 On the morning of the inspection the activities organiser for the home was playing a card game with residents, which everyone was enjoying. Other residents were sitting in another quieter lounge area, which they explained, was their choice because they do not like to participate in the activities but prefer to watch television and relax. There are regular trips out to garden centres and to parks. One resident has been supported by staff to attend a reunion dinner with her ex-work colleagues. The returned surveys and from speaking with residents confirms that residents are satisfied with the level of activity provided in the home. Elmbank Care Home DS0000026433.V348547.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents are assured their concerns and complaints are taken seriously and acted on. But not recognising when complaints are allegations of abuse means the right procedures are not followed, placing residents at potential risk of further abuse. EVIDENCE: The Complaints Procedure is displayed in the home and is also in the Service User Guide. Feedback from residents and relatives, either in the surveys or from those spoken with, confirms that people feel comfortable taking their concerns and complaints to the manager and they feel assured that these issues are effectively dealt with. All staff members spoken with reported that they have had or are due to attend training on adult abuse. All staff members spoken with demonstrated they understand their duty to report all allegations of abuse and to whistleblow. There was has been one safeguarding adults investigation since the last inspection, which concerned an allegation of financial abuse. The outcome of this investigation was inconclusive. The resident was reimbursed the missing money and the registered manager reported lessons were learnt and systems for the holding of residents’ money have been made more robust. Elmbank Care Home DS0000026433.V348547.R01.S.doc Version 5.2 Page 16 One recorded complaint is concerning a resident that reported a staff member ‘roughly handled’ them. The record of action taken indicates this was not considered as an allegation of abuse and not reported to Social Services or followed up in accordance with Safeguarding Adults procedures. Elmbank Care Home DS0000026433.V348547.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 24 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Significant improvements to décor and maintenance of the home now mean residents are afforded a safe, clean and comfortable environment to live in. EVIDENCE: A tour of the premises confirmed that all the issues identified at the last inspection have been addressed. The dining room has been redecorated and residents spoken with said that they helped choose the new carpets and wallpaper. The dining area was fresh and clean and both relatives and residents commented on how nice the new décor is throughout the home. Ceiling tiles have been fixed and the plaster crack in the cellar has now been rectified. There are now window restrictors on the ground floor windows. The first floor hallways have been redecorated and re-carpeted, as have some Elmbank Care Home DS0000026433.V348547.R01.S.doc Version 5.2 Page 18 bedrooms. A resident that is due to have their room decorated was observed excited and is being involved in choosing the colours. The bedrooms seen were personalised with residents’ photos, pictures and ornaments. Residents and relatives spoken with reported that the home is always fresh and clean. Some further guidance and measures have been put in place for the control of infection. There are regular infection control audits. All staff members have had training on infection control and staff members spoken with demonstrated a good understanding of different types of infections, and how the spread of infections can be prevented. Elmbank Care Home DS0000026433.V348547.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents are cared for by an effective and competent staff team. Recruitment procedures are not robust enough in protecting residents from staff that may not be suitable to work with vulnerable people. EVIDENCE: There was positive feedback from relatives and residents spoken with about staffing. The staff team were described as “very good”, “very kind” and “more than competent”. All of the returned surveys state that there are always staff available when you need them. Two out of four residents spoken with did report that on occasion they have to wait a long time when they call for assistance. Staff members spoken with talked about the training they have recently been on and reported they are up to date with mandatory health and safety training such as fire safety and moving and handling. A staff member that has recently started working at the home talked about the Skills for Care common induction standards workbook that she is currently working through and spoke highly of the induction process and support she has had since working at the home. Training records also show that staff have or are booked to do training on Elmbank Care Home DS0000026433.V348547.R01.S.doc Version 5.2 Page 20 equality and diversity issues, and on managing behaviours and dementia awareness by the specialist dementia team. There are ‘link carers’ for palliative care, tissue viability and infection control. This means the link carer attends regular training sessions then shares this knowledge with the rest of the team. All three staff files examined contained a photo of the staff member. There was evidence that a criminal record bureau (CRB) check has been obtained for all three staff members but on two of the files the CRB attachment was the wrong section as it does not include evidence of the date of issue and issue number. All three files contained two written references but for the most recently appointed staff member verbal references were received first then written references were obtained after their start date. Elmbank Care Home DS0000026433.V348547.R01.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are good management arrangements at the home, which help ensure the home is run well, in the best interests of residents and protects their health and safety. EVIDENCE: Residents, relatives and staff all made positive comments about the registered manager and described her as approachable and supportive. Staff members acknowledge they are getting more training now and it is apparent from the outcomes of this inspection and from what people said that the manager is proactive and has made positive changes to the running of the home. Elmbank Care Home DS0000026433.V348547.R01.S.doc Version 5.2 Page 22 Residents are happier in their surroundings due to the improvements made to the environment. Residents and relatives spoken with confirmed they have recently filled out feedback questionnaires, and these have also been sent out to GPs and other healthcare professionals for their views on the service. This exercise is undertaken twice a year and a report was seen for the service quality audit for September 06 to March 07. The registered manager explained that outcomes of audits and surveys are fed back to residents at meetings, but not in writing. A quality manager undertakes unannounced visits every month to check records and speak with residents and staff. The records of transactions for money held on two residents’ behalf were examined and all found to be in order. There were receipts for all purchases and signed entries for all money received and outgoings. The AQAA confirms that the electrical and gas systems and other equipment are regularly serviced. The fire log shows that fire alarm testing and drills are undertaken as required and there is an updated fire risk assessment. Fire exits are clear and a risk assessment was seen for the pond in the back garden, to ensure residents that access this space are safe. Elmbank Care Home DS0000026433.V348547.R01.S.doc Version 5.2 Page 23 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 2 3 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 1 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X X X 3 X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X X X 3 X X 3 Elmbank Care Home DS0000026433.V348547.R01.S.doc Version 5.2 Page 24 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 Standard OP1 Regulation 5(1)(d) Requirement The most recent inspection report must be made available to residents and other stakeholders to enable people to make informed decisions. Care plans must contain relevant risk assessments, with particular attention to the prevention of falls. This is to ensure the safety of residents. There must be adequate arrangements in place for the safe administration and safekeeping of all medicines; medicines must be signed out when leaving the premises and all stocks accounted for. Safeguarding adults procedures must be followed in the event of any allegation of abuse. Two written references and criminal record bureau checks must be obtained before a staff member commences employment. Reports on the outcomes of quality assurance and monitoring must be made available to residents and other DS0000026433.V348547.R01.S.doc Timescale for action 01/11/07 2 OP7 13(4) 31/12/07 3 OP9 13(2) 01/11/07 4 5 OP18 OP29 13(6) 19(1) 01/11/07 01/11/07 6 OP33 24(3) 01/02/08 Elmbank Care Home Version 5.2 Page 25 stakeholders. This assures residents that improvements are identified and acted on based on their sought views. 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 OP7 OP9 Good Practice Recommendations The care plan should be recorded in a style, which is accessible to the resident, to ensure that they are meaningfully involved in the process. Remaining quantities of medication from a previous cycle should be carried forward onto the current medication administration record. This is so that there is a clear audit trail. Elmbank Care Home DS0000026433.V348547.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Derbyshire Area Office Cardinal Square Nottingham Road Derby DE1 3QT 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 Elmbank Care Home DS0000026433.V348547.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!