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Inspection on 05/01/06 for St Michaels Nursing Home

Also see our care home review for St Michaels Nursing Home for more information

This inspection was carried out on 5th January 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The home provides a comfortable and homely environment where care and support is delivered by a committed staff team.

What has improved since the last inspection?

An acting manager has now been recruited to post. She is currently undertaking the fit person process for Registered Manager with the Commission. Following the departure of the previous and long established registered manager, together with the deputy manager. There had been a period of instability, which had affected staff morale. This was felt by staff to have improved following the recruitment of the new manager. The mechanical sluicing disinfector was operational (having been out of action for a considerable time).

What the care home could do better:

The registered persons must ensure that requirements are achieved within given timescales in accordance with that detailed in the homes inspection reports. This includes the necessary maintenance and upgrading of the fabric of the home. The responsible individual for the Company must ensure that their responsibilities under the Care Standards Act are complied with, including that relating to the required monitoring of the standards of care and services provided in home. A thorough review of the home`s statement of purpose and service user guide and its policies and procedures is required. Mechanisms for actively informing, consulting and involving service users should be developed in order to empower those who are able, to make decisions about their care and daily lives, including their longer term goals. The development of care systems to facilitate a cultural shift from task orientated care delivery to a person centred approach to care would benefit. A review of the format and recording of service users care records was proposed by the acting manager, with a view to improving their consistency and accessibility, which the Inspector is wholly supportive of.

CARE HOMES FOR OLDER PEOPLE St Michaels Nursing Home 9 Chesterfield Road Brimington Chesterfield Derbyshire S43 1AB Lead Inspector Sue Richards Unannounced Inspection 5th January 2006 10:00 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 St Michaels Nursing Home DS0000059738.V271906.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for 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. St Michaels Nursing Home DS0000059738.V271906.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service St Michaels Nursing Home Address 9 Chesterfield Road Brimington Chesterfield Derbyshire S43 1AB 01246 558828 01246 233768 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) Sun Care Homes Ltd Mrs Janet Dickinson Care Home 39 Category(ies) of Old age, not falling within any other category registration, with number (39) of places St Michaels Nursing Home DS0000059738.V271906.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. No more than 39 service users to be accommodated, which includes x 3 service users aged under 65 years, category PD as named in the notice of proposal letter. 8th September 2005 Date of last inspection Brief Description of the Service: St Michaels Care Home provides accommodation, nursing and personal care and support for up to 39 older persons and three physically disabled service users aged under 65 years. It is located approximately 2.5 miles north east of Chesterfield town centre on a direct bus route and within a residential area. The home provides a choice of lounge/dining space and individual accommodation comprises of 29 single bedrooms and 10 shared (two of which are currently used for single occupancy). Fifteen of the single bedrooms have an en suite. There is a pleasant enclosed rear patio and well-kept garden area providing a choice of seating, which is accessed via a conservatory. There is a choice of bathroom and toilet facilities to each floor. A passenger lift is provided and there is an emergency call system throughout the home. A variety of disability equipment is provided, both environmental and individual equipment. Care is assessed, planned and reviewed by Registered Nurses employed in the home, who are supported by a team of care and hotel services staff. St Michaels Nursing Home DS0000059738.V271906.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The focus of this inspection was on the arrangements for the admission of service users, and also delivery of their care and support, including the arrangements for activities and that relating to the making of complaints and adult protection. Case tracking was undertaken for a sample of service users accommodated in the home. This involved discussions and observations about their care and support with the acting manager, nursing and care staff and service users. Records were also examined in relation to the above, together with selected policies and procedures operated by the home, its statement of purpose and service user guide and staffing rotas. Progress with the achievement of requirements made at the previous inspection for this service (September 2005) was also assessed during this inspection. What the service does well: What has improved since the last inspection? An acting manager has now been recruited to post. She is currently undertaking the fit person process for Registered Manager with the Commission. Following the departure of the previous and long established registered manager, together with the deputy manager. There had been a period of instability, which had affected staff morale. This was felt by staff to have improved following the recruitment of the new manager. The mechanical sluicing disinfector was operational (having been out of action for a considerable time). St Michaels Nursing Home DS0000059738.V271906.R01.S.doc Version 5.0 Page 6 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. St Michaels Nursing Home DS0000059738.V271906.R01.S.doc Version 5.0 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 St Michaels Nursing Home DS0000059738.V271906.R01.S.doc Version 5.0 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): 1, 2, 3, 4, 5 & 6 Information for service users about the home was not up to date or accurate in its content and the service user guide was not actively promoted for service users. The individual needs of service users are determined and recorded by nursing staff and in accordance with a recognised nursing assessment model, based on the activities of daily living, which are care planned as part of the nursing process in response to problems identified. However, the lack of individual daily living plans for service users and attention to some aspects of individual’s care needs indicated that there was a task orientated approach to care rather than a person centred approach. EVIDENCE: The statement of purpose and service user guide was examined, together with the admissions policy for the home and the arrangements for admission discussed with the manager and individual service users. The statement of purpose had not been reviewed for some time and provided inaccurate information, including that relating to the details of the registered provider and St Michaels Nursing Home DS0000059738.V271906.R01.S.doc Version 5.0 Page 9 staff employed and also to the range of needs, which the home provides for. Service users were not aware of the existence of these documents for their access and information. Individual written terms and conditions were provided for service users case tracked. The care records of service users case tracked were examined. This included their documented individual needs assessment and care planning information. Individual daily living plans were not detailed in accordance with service users individual lifestyle preferences. One service user case tracked had his faith and close links with the local church as established prior to their admission recorded in their pre-admission details. However, there was no lifestyle care plan in place, which reflected those needs, how they were to be met or changes to those needs. Comprehensive policy guidance was provided for staff in the event of the admission of the specialist needs of any service users with different faiths and/or cultural backgrounds. A training matrix has been formulated by the newly appointed acting manager in response to issues arising from recent care reviews and following which it was established that there were a number of more recent staff starters, who had not received training in a number of key areas. This had been provided to the Commission during December, together with an action plan for training to be undertaken during January and February 2006. Progress with this will be monitored at the next inspection for this service. One of the service users case tracked had sensory impairment needs identified in their care records, together with specified oral care needs. Their care plans detailed staffs responsibility to ensure that they were able to access and wear specific aids during the day in order to promote their independence and abilities. The service user, who was eating lunch, did not have any of those aids provided. St Michaels Nursing Home DS0000059738.V271906.R01.S.doc Version 5.0 Page 10 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): 7, 8, 9, 10 & 11 Service users health care needs were reasonably well accounted for, although some inconsistencies in records and record keeping and in approaches to consultation with service users about their care created the potential for omissions in approaches to care. EVIDENCE: The recorded care plans were examined for those service users case tracked. These were formulated in accordance with the nursing process and were signed and dated and evidenced monthly recorded reviews. Comments made under Section 1 of this report (Choice of Home) in relation to the sensory needs for one of the service users case tracked and potential religious needs of another which were not being met apply here also. Care plans were formulated within a framework of risk management, specific to the care of older persons, including that relating to falls prevention. However, risk assessment and care plans recorded was not always consistent with each other in that care plan changes were not always reflected in risk assessments and vice versa, although both had recorded monthly reviews. St Michaels Nursing Home DS0000059738.V271906.R01.S.doc Version 5.0 Page 11 The Manager advised of her proposal to review the format and consistency of care plans and associated care records. One of the service users case tracked aged below 65 years was admitted by way of an agreed variation to registration application to the Commission for a period of respite only. Their care plans were not specific to the overall purpose of their admission and intended outcomes. This was discussed with the manager who advised that full care review was planned. The service user expressed some uncertainty and feelings of conflict in relation to their longerterm placement in the home and was unclear as to their rights and options for future care, including the choices they may have. Advocacy services had not been offered/provided for this service user (see also Section 3 of this report – Social Care and Activities section of this report). This service user had not been involved in the formulation of their care plan and these were not signed and dated by them although they were wholly capable. The Inspector was unable to discuss in depth the care of the other service users case tracked due to their frailty and ill health. However, discussions were held before the inspection with a representative of one of those service users who also provided supporting written information. The general health care needs of service users case tracked were documented and generally well accounted for and access to outside health care professionals were recorded, including that relating to routine health care screening. The arrangements for the management and administration of medicines in the home were examined and were generally satisfactory. However, medicines policy guidance had not been reviewed since 2002 and was not reflective of identified changes or all areas of practise, for example that relating to the arrangements for medicines returns. Discussions with the Registered General Nurse who administered medicines to service users during the inspection indicated that she was fully conversant with the changes in relation to medicines returns and all areas of practise, with the exception of the need to monitor the medicines refrigerator temperatures with a minimum and maximum thermometer. In addition there were no signatures of receipt recorded in the returns book from body collecting those medicines. Staff were observed to be respectful in their approaches to service users during the inspection. However, a recent complaint made, which is currently being investigated under joint agency adult protection procedures includes issues relating to the alleged lack of respect and promotion of dignity of a service user whilst being assisted with bathing. There were no service users accommodated at the time of the inspection, requiring special/active care in relation to death and dying. Comprehensive policy and procedural guidance was in place for staff in relation to this. St Michaels Nursing Home DS0000059738.V271906.R01.S.doc Version 5.0 Page 12 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): 12, 13, 14 & 15 Service users were able to maintain contact with their families and friends and there was some provision for the organisation of activities within the home. However, access to information for individual service users to empower them to make key choices about their lives was not actively promoted. There were suitable arrangements to provide service users with a balanced diet in accordance with their needs. EVIDENCE: The organisation of activities in the home was examined in accordance with the home’s key policy guidance. Discussions were held with some service users and staff. Positive feedback was given regarding the festive arrangements and activities organised over the festive period and periodic entertainment in the home. The activities organiser is employed for two afternoons per week and service users were again were positive about the benefits of this. Activities records were not available and there was no care planning information in respect of occupation and social care within the care records of service users case tracked. St Michaels Nursing Home DS0000059738.V271906.R01.S.doc Version 5.0 Page 13 Visiting to the home is open in accordance with its policy. Information was not actively promoted for service users regarding access to advocacy and access to personal records was not actively promoted - see Section 2 of this report – Health and Personal Care. The bedrooms of those service users case tracked were inspected. These were personalised. Menus were examined and discussions held with service users about the provision of meals in the home. Feedback was generally satisfactory. Lunch was served during the inspection. Tables were attractively set with service users appropriately assisted by staff in accordance with their needs. The process was relaxed and unhurried. Meals served were presented accordance with service users needs. Service users spoken with said that the enjoyed the food provided and were offered a choice of menu and that their likes and dislikes were accounted for. St Michaels Nursing Home DS0000059738.V271906.R01.S.doc Version 5.0 Page 14 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): 16, 17 & 18 Information provided for service users and their representatives as to how to complain is inconsistent in its various formats. There was no formal record kept, which was available for inspection, of complaints made about the home (including action take and outcomes). There was satisfactory policy and procedural information and arrangements for staff training to promote the protection of service users. EVIDENCE: Written information was provided for service users and their representatives as to how to complain. This was displayed and also provided within the home’s statement of purpose and service user guide. However, these did not all provide the same/accurate information. A record of complaints made was not available. The Inspector discussed a recent complaint raised in writing directly with the owner of the home. There was no record of this complaint, the manager was unaware of its existence and was therefore unable to provide information as to its investigation and outcome. The arrangements to enable service users to vote when appropriate were discussed and were satisfactory. Comments have been made under the Healthcare and Activities sections of this report in respect of the lack of information and assistance for service users to access to advocacy services. St Michaels Nursing Home DS0000059738.V271906.R01.S.doc Version 5.0 Page 15 At the previous inspection for this service, carried out in September 2005, recognised procedures and policy guidance was observed to be provided in relation to the protection of vulnerable adults, management of service users monies and dealing with violence and aggression. At that time, staff spoken with was familiar with these and training and updates reported to have been provided for staff in respect of abuse awareness and adult protection. The manager had also organised further training in respect of this for newer staff. The manager had taken the appropriate action to ensure that a recent complaint was reported and investigated via joint agency adult protection procedures, which was in process at the time of the inspection. St Michaels Nursing Home DS0000059738.V271906.R01.S.doc Version 5.0 Page 16 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 The programme of upgrading, repair and renewal of the home is not yet completed. EVIDENCE: A full inspection of the building was not undertaken during this inspection. However, some communal areas and the bedrooms of those service users cased tracked were inspected. A programme of upgrading, repair and renewal for the home has been identified on previous inspection reports for this home and agreed by the registered person for completion by the end of March 2006. There is no (commercial) dishwasher provided in the kitchen. Staff were hand washing all items of cutlery, pots and pans etc. St Michaels Nursing Home DS0000059738.V271906.R01.S.doc Version 5.0 Page 17 St Michaels Nursing Home DS0000059738.V271906.R01.S.doc Version 5.0 Page 18 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 Staffing levels and skill mix were satisfactory. EVIDENCE: Staff rotas were examined and the arrangements for staffing discussed with the manager and some staff on duty in conjunction with the needs and dependencies of service users accommodated. St Michaels Nursing Home DS0000059738.V271906.R01.S.doc Version 5.0 Page 19 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): EVIDENCE: St Michaels Nursing Home DS0000059738.V271906.R01.S.doc Version 5.0 Page 20 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 2 2 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 1 17 2 18 3 2 X X X X X X X STAFFING Standard No Score 27 3 28 X 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X X X X X St Michaels Nursing Home DS0000059738.V271906.R01.S.doc Version 5.0 Page 21 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 OP19 Regulation Requirement Timescale for action 31/03/06 2 OP25 4. OP25 5. OP37 23(2)b)(c) The written programme for the (d(k(n) upgrading, repair and renewal of the building must be fully completed. 13(4(c The status of the maintenance of the hot and cold water systems must be confirmed by suitable certification, including legionellas testing. (NB Inspection report 09/05 by 08/11/05). Serious concern identified in writing during this inspection by way of an immediate requirement. 13(4(c Records of hot water temperatures must clearly indicate baths and showers tested and ensure that hot water emitted from these outlets provides water close to 43 degrees centigrade (between 4143 acceptable). NB – as Point 3 above). 26(2(3(4) On a monthly basis, the &(5 responsible individual must conduct their visits to the home in accordance with the requirements of the said regulation and provide a written report under the requirements of DS0000059738.V271906.R01.S.doc 05/02/06 05/02/06 05/02/06 St Michaels Nursing Home Version 5.0 Page 22 6. OP1 7. OP1 8. OP3 9 OP4 10 OP7 11 OP7 12 OP9 (4)(c to the Commission and the registered manager of the home and any of its directors/partners. (NB from previous inspection 09/05 by 08/11/05). Serious concern identified in writing during this inspection by way of an immediate requirement. 4 The statement of purpose for the home must be reviewed and revised in order to provide accurate and up to date information for service users and their representatives and be available to them. 5 The service user guide must be reviewed and revised to provide accurate and up to date information for service users and be provided to each service user. 14, 15 Daily living plans must be provided for each service user in accordance with their agreed/known lifestyle preferences, wishes, feelings and needs. 12 The registered person must ensure that the care home is conducted with due regard to the religious persuasion or of any disability of service users and that those needs are met. 17Sched 3 Information recorded in service users care plans and risk assessments must be consistent with each other and accurate. 15 Service uses must be consulted about their care plans and wherever possible they must be drawn up with their involvement be accessible to them and be signed and agreed by the service user whenever capable or their representative. 13 The medicines policy must be reviewed and updated to include recognised changes in practise and omissions of information as DS0000059738.V271906.R01.S.doc 31/03/06 31/03/06 05/02/06 05/02/06 05/02/06 05/03/06 28/02/05 St Michaels Nursing Home Version 5.0 Page 23 13. OP9 13 14. OP12 16 15 OP14 12 16. OP16 22 17. OP16 17 18 OP16 22 19 OP19 13, 23 discussed with the manager. The daily temperature of the medicines refrigerator must be monitored using a minimum and maximum thermometer. Records of individual’s access and involvement in activities must be maintained and be kept in the home. The registered persons must as far as is practicable enable service users to make decision with respect to the care they are to receive and their health and welfare – in this instance facilitate the provision of information and access to advocacy services for service users and facilitate access to their personal records in accordance with their needs. Information provided for services users – the complaints procedure – must be accurate and up to date. A record must be kept of all complaints made by service users or their representatives/relatives of service users or by person working at the care home, and include details of the action take by the registered person in respect of any such complaint. A statement containing a summary of the complaints made during the preceding twelve months and the action that was taken in response must be provided to the Commission. The registered person must consult with the Environmental Health Officer regarding the arrangements and equipment required for the washing of utensils, pots and pans in the main kitchen of the home. DS0000059738.V271906.R01.S.doc 28/02/06 28/02/06 28/02/06 28/02/06 31/01/06 28/02/06 31/01/06 St Michaels Nursing Home Version 5.0 Page 24 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 OP33 OP9 Good Practice Recommendations There should be a recorded annual development plan provided for the home. A signature of confirmation for the receipt of medicines returns should be obtained from the representative of the collecting body in the medicines returns record book. St Michaels Nursing Home DS0000059738.V271906.R01.S.doc Version 5.0 Page 25 Commission for Social Care Inspection Derbyshire Area Office Cardinal Square Nottingham Road Derby DE1 3QT 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 St Michaels Nursing Home DS0000059738.V271906.R01.S.doc Version 5.0 Page 26 - 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!