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Inspection on 30/01/06 for Springfield Nursing Home

Also see our care home review for Springfield Nursing Home for more information

This inspection was carried out on 30th January 2006.

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

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 procedures and management processes in place to assess and address health care needs were well developed and individual needs were met in a supportive and caring environment. The staff team worked well together and showed a good understanding of the needs of the people living at the home. The staff team received appropriate training and guidance that provided them with the knowledge and experience needed to care for this client group. This home put the needs of residents first and made sure they were supported to live an independent lifestyle whenever possible. People living at the home benefited from the happy relaxed atmosphere and good relationships have been established between residents and staff. The home is managed by an experienced person who makes sure that the home is run in the best interests of the residents and is able to meet its stated purpose and aims and objectives.

What has improved since the last inspection?

The local fire authority had reviewed fire safety precautions and the home was able to show that their fire safety measures were satisfactory. A notice board in reception showed residents and visitors which members of staff were on duty that day and on which floor they were working. Visitors particularly liked this, as they knew whom to approach if they needed anything. The range of trips and outings had increased and a large widescreen television and hi-fi system had been bought, all of which improved the activities available to residents. A reduction in the use of agency staff had helped to maintain continuity of care for people living at the home. Repainting of the first floor corridors brightened the area up and made it more pleasant for residents.

What the care home could do better:

More attention is needed to the systems in place for administering medication. The home needs to be able to clearly demonstrate that care staff responsible for administering medication are properly trained and have been assessed as competent. Some improvements to communal areas of the home are needed so that residents continue to live in an environment that is well maintained and furnished to a satisfactory standard. A requirement from the last inspection has been carried forward into this report, as the action taken to clean badly stained carpets was not completely successful. Parts of the recruitment process are not thorough enough and improvements in relation to obtaining full and satisfactory criminal record checks before people start work at the home are needed. A requirement from the last inspection has been carried forward into this report, as documentary evidence to confirm action taken by the home was not in place.

CARE HOMES FOR OLDER PEOPLE Springfield Nursing Home 191 Spendmore Lane Coppull Chorley Lancashire PR7 5BY Lead Inspector Anne Taylor Unannounced Inspection 30th January 2006 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 Springfield Nursing Home DS0000025577.V265207.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. Springfield Nursing Home DS0000025577.V265207.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Springfield Nursing Home Address 191 Spendmore Lane Coppull Chorley Lancashire PR7 5BY 01257 470140 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 Ghulam Qadir Mrs Janet Lawes Care Home 48 Category(ies) of Old age, not falling within any other category registration, with number (42), Physical disability (6) of places Springfield Nursing Home DS0000025577.V265207.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. The service should, at all times, employ a suitably qualified and experience manager who is registered with the NCSC. Up to 42 Service users in the category OP (Old Age, not falling within any other category) who require nursing care. Up to 6 service users in the category PD (Physical Disability) who require nursing care. Up to 17 service users in the category OP (Old Age, not falling within any other category) who require personal care only. Date of last inspection Brief Description of the Service: Springfield is a care home with nursing currently registered to accommodate forty-eight residents. The registration allows the home to accommodate fortytwo older residents of either sex and six young physically disabled people of either sex. At the time of inspection thirty-eight residents were living at the home. The younger residents cared for at Springfield have medical needs that outweighed their physical disability and the home is able to provide for their specialist needs. The home is situated on the main road, which passes through the village of Coppull, two miles from Chorley town centre and Standish. Springfield is a purpose built home offering accommodation over two floors, which can be accessed by the passenger lift. There are single and shared bedrooms, a lounge/dining room and assisted bathing facilities on each floor. The ground floor also houses the administrative offices, reception area, kitchen, laundry, conservatory that is the designated smoking area, a treatment room and staff room. The home has a large garden to the rear and side of the home that has a large patio and water feature fountain and greenhouse. Springfield Nursing Home DS0000025577.V265207.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection that took place over six and a half hours in January 2006. The inspection involved discussion with the people who lived and worked at the home and visitors, examination of records, policies and procedures and a tour of the premises As part of the inspection process the inspector used “case tracking” as a means of assessing some of the National Minimum Standards. This process allows the inspector to focus on a small group of people living at the home. Records relating to these people are inspected along with the rooms they occupy in the home. They are invited to discuss their experience of the home with the inspector, however this is not to the exclusion of other people living at the home. What the service does well: The procedures and management processes in place to assess and address health care needs were well developed and individual needs were met in a supportive and caring environment. The staff team worked well together and showed a good understanding of the needs of the people living at the home. The staff team received appropriate training and guidance that provided them with the knowledge and experience needed to care for this client group. This home put the needs of residents first and made sure they were supported to live an independent lifestyle whenever possible. People living at the home benefited from the happy relaxed atmosphere and good relationships have been established between residents and staff. The home is managed by an experienced person who makes sure that the home is run in the best interests of the residents and is able to meet its stated purpose and aims and objectives. Springfield Nursing Home DS0000025577.V265207.R01.S.doc Version 5.0 Page 6 What has improved since the last inspection? What they could do better: More attention is needed to the systems in place for administering medication. The home needs to be able to clearly demonstrate that care staff responsible for administering medication are properly trained and have been assessed as competent. Some improvements to communal areas of the home are needed so that residents continue to live in an environment that is well maintained and furnished to a satisfactory standard. A requirement from the last inspection has been carried forward into this report, as the action taken to clean badly stained carpets was not completely successful. Parts of the recruitment process are not thorough enough and improvements in relation to obtaining full and satisfactory criminal record checks before people start work at the home are needed. A requirement from the last inspection has been carried forward into this report, as documentary evidence to confirm action taken by the home was not in place. Springfield Nursing Home DS0000025577.V265207.R01.S.doc Version 5.0 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. Springfield Nursing Home DS0000025577.V265207.R01.S.doc Version 5.0 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 Springfield Nursing Home DS0000025577.V265207.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): EVIDENCE: Not assessed at this inspection. Springfield does not provide intermediate care and standard 3 was considered fully met at the last inspection. Springfield Nursing Home DS0000025577.V265207.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, 9, 10 The care planning process was thorough enough to ensure the needs of residents were properly identified and managed. More stringent measures need to be in place regarding the administration of medicines to make sure the process is safe. Staff were sensitive to the needs of residents and made sure that residents’ rights to privacy and dignity were upheld. EVIDENCE: Although standard 7 was not fully assessed at this inspection checks were made to ensure that action had been taken in relation to the recommendation made in the last inspection report about reviewing risk assessments monthly. Records seen showed that this was now being done and the risk assessments were up to date. Standard 9 was partially assessed to monitor progress in meeting recommendations made at the last inspection. Recommendations were made Springfield Nursing Home DS0000025577.V265207.R01.S.doc Version 5.0 Page 11 regarding the use of medication profiles and ensuring that any delegation to care staff for the application of prescribed creams should be recorded. Discussion with staff and examination of MAR sheets showed that medication profiles were no longer used and the delegated task of applying creams had been recorded. A medicine round was in progress during the inspection and a trained nurse was seen giving medicines to a care assistant so she could administer them to the residents. The nurse could not see that the medicines were being given to the right person and the delegation of this task had not been recorded. It was not possible to determine whether the care assistant had received appropriate training or if a competency assessment had been carried out. Trained nurses are expected to comply with guidance for the safe administration of medicines issued by the Nursing and Midwifery Council so that their practice is carried out as safely as possible. Any care staff administering medication must receive proper training and be assessed for competence so they too are able to practice safely. Records showed that induction training included instruction on privacy dignity and respect so that staff had knowledge and understanding of this before they started to give care to residents. Staff spoken to were able to discuss how they put into place the home’s policies and procedures relating to maintaining the privacy and dignity of the people they cared for. This helped to make sure that residents felt respected. Staff were observed knocking on bedroom doors before entering. They were seen to be providing care in a sensitive and caring manner, which promoted residents’ dignity. People living at the home say staff maintained their dignity and treated them respectfully. They commented, “staff are very respectful” and “I have a lovely room, staff always knock before entering and they keep the bathroom door closed when I am washing or bathing”. Springfield Nursing Home DS0000025577.V265207.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 The daily routines were flexible so that service users were able to exercise choice, have some control over their lifestyle and maintain contact with family and friends. The range of social activities available met the expectation of people living at the home. EVIDENCE: Records and discussion with residents showed that appropriate attention was paid to helping them take part in valued and fulfilling activities that were already established or developed in and outside the home so that the lifestyle experienced by residents met their expectations and preferences as much as possible. Residents had a range of needs and ability; some were able to go out independently, whilst others were reliant on support from staff. Residents spoken to were generally satisfied with the activities available. One said, “There is plenty to do if you want it, I don’t get bored”. At the time of inspection a group of residents were doing armchair exercises with the activities organiser. They were enjoying this activity and spoke positively about the way in which activities were organised for them. Springfield Nursing Home DS0000025577.V265207.R01.S.doc Version 5.0 Page 13 Residents spoken to said that they were able to exercise choice about what time they got up and went to bed and what clothes they wore, giving them some control over their lifestyle. When asked how they helped residents to exercise choice staff said, “We always ask what they want, we ask if they want to get up and what they want to wear, do they want to go to bed things like that, every day”. The statement of purpose outlined the home’s visiting policy and included a statement about residents being able to exercise choice in relation to visitors. This meant that residents and relatives knew what the home’s approach to visiting was and could comply with any policies operated by the home. Residents spoken to confirmed that they were able to see visitors in their own room or in one of the communal areas of the home so the meetings could be private if they wished. Staff discussed ways in which they tried to make visitors welcome. They were able to show that they understood the importance of residents maintaining contact with their family and friends, as they are still an important part of their life. Springfield Nursing Home DS0000025577.V265207.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): 18 Management processes in relation to abuse were thorough enough to make sure people living at the home were protected. EVIDENCE: The home had an adult abuse policy and whistle blowing policy, in addition to a copy of guidance issued by the department of health. Discussion with care staff showed that they were aware of the above documentation and were quite clear about their responsibilities in relation to protecting the people they cared for. There was some confusion about how senior staff would respond to an allegation of abuse if for some reason the manager were not there. However, policies and procedures were in place that outlined the action to be taken and were available as a point of reference for staff. Senior staff were aware of their responsibilities in relation to protecting people living at the home and making sure staff were appropriately trained to recognise and act upon any signs of possible abuse. Induction training records for new staff included information and guidance about abuse so that all new staff were familiar with the subject and how to respond to any allegation or suspicion of abuse. Springfield Nursing Home DS0000025577.V265207.R01.S.doc Version 5.0 Page 15 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, 26 The home was generally clean, comfortable and homely, providing an environment that was suitable for it’s stated purpose and safe for the people living there. Some improvements were needed to ensure that resident continue to live in a well-maintained and pleasant environment. EVIDENCE: Standard 19 was partially assessed following two requirements made at the last inspection. The requirement made at the last inspection to risk assess the outside pond had been done so that the area was safe for residents to enjoy. A tour of the premises was carried out. The home was generally clean, tidy and free from offensive odours. There was a broken bath panel in one of the first floor bathrooms, which needs repairing. A requirement was made in the last inspection report about the stained carpets. Professional cleaning had been carried out but some corridor carpets were still badly stained so the requirement remains outstanding and is included in this report. Springfield Nursing Home DS0000025577.V265207.R01.S.doc Version 5.0 Page 16 Recommendations made at the last inspection about covering pipe work and making sure the facilities and services provided comply with water regulations had been done. Springfield Nursing Home DS0000025577.V265207.R01.S.doc Version 5.0 Page 17 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): 28, 29, 30 Training was provided for new and existing staff that helped make sure they were competent do their jobs and able to practice safely. The recruitment process was not thorough enough to ensure the continued protection of residents. EVIDENCE: Training records showed that new staff received induction and ongoing training that provided them with the basic skills needed to carry out tasks allocated to them. Staff spoken to said that training opportunities were good and that regular training courses were held for fire safety, moving and handling and other health and safety topics so that they were kept up to date about safe working practices. National vocational training (NVQ) was available to care staff and some care staff had already achieved level two or three. The home was aware of the need to ensure that fifty per cent of care staff complete this training before the national minimum standard can be considered fully met. Standard 29 was not fully assessed, however, a requirement was made at the last inspection about making sure criminal record checks were obtained before a member of staff starts work at the home. The files of two staff recently employed at the home were examined. Their records showed that criminal Springfield Nursing Home DS0000025577.V265207.R01.S.doc Version 5.0 Page 18 record checks had been obtained after their start date. The administrator said that checks of the protection of vulnerable adults register had been carried out but there was no documentary evidence to support this or to confirm what arrangements had been put in place to make sure these employees were properly supervised until their full criminal record checks proved satisfactory. The requirement remains outstanding and has therefore been included in this report. Springfield Nursing Home DS0000025577.V265207.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): 31, 33, 38 Residents lived in a home, managed by a responsible person who was able to make sure the home met its stated purpose and was managed and organised in a way that helped make sure the service was run in the best interests of residents. Enough attention was paid to the management of health and safety to make sure the home was safe for people to live and work in. EVIDENCE: Records showed that the registered manager is a first level registered nurse who has completed a relevant management course and kept up to date with clinical areas of practice so that she can meet the professional registration requirements of the Nursing and Midwifery Council. Discussion with staff showed that the manager provided leadership and direction so that every one knew what their role was and what was expected of Springfield Nursing Home DS0000025577.V265207.R01.S.doc Version 5.0 Page 20 them. Visitors spoken to say, “ the manager and staff are very good if you mention anything it is sorted out”. The home was able to meet its stated purpose as demonstrated by comments from residents and visitors. Residents’ comments included, “It’s very good here, we’re all very happy” and “It’s absolutely super here, I’m well looked after, we all are”. Visitors spoken to were positive about the care their relatives received one said, “my father’s needs are met and we are kept informed of any changes and consulted about his care”. A system was in place to monitor the quality of service delivered so that the home could be made aware of its strengths, weaknesses and whether residents were satisfied with the service they received or not. This was achieved by sending out satisfaction questionnaires each year. The feedback obtained was collated and a summary made available to so that residents could be reassured that their views were acknowledged and contributed to the running of the home. Discussion with the administrator showed that feedback from the survey was used as a means of improving and developing the service. An annual development plan was not available so the inspector was not able to confirm that feedback from residents had been included in it. Residents and staff spoken said that they were consulted about the day to day running of the home as much as they could be so that they felt involved. One resident said, “we did fill a form in and we get the chance to say if we are happy with everything, there is a group that meets called the friends of Springfield and we discuss things about the home”. Standard 38 was only partly assessed to see if the recommendation made at the last inspection had been addressed. The home had sought advice from the local fire authority about their fire risk assessment to make sure it was adequate. Springfield Nursing Home DS0000025577.V265207.R01.S.doc Version 5.0 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 X 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 X 28 2 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X X X X 3 Springfield Nursing Home DS0000025577.V265207.R01.S.doc Version 5.0 Page 22 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP9 Regulation 18(1)(c) Requirement Timescale for action 30/04/06 2. OP19 3. 4. OP19 OP29 Persons working at the care home must receive training appropriate to the work they are to perform. Care staff responsible for administering medicines must receive appropriate training and complete a competency assessment. 23(2)(d) The carpets identified at 31/03/06 inspection must be thoroughly cleaned and if cleaning is unsuccessful replaced. The registered provider must produce a programme of refurbishment that shows when this will be achieved. (Timescale of 30/12/05 not met). 23(2)(c) The broken bath panel identified 31/03/06 at inspection must be repaired or replaced. 19(1)Sch A thorough recruitment process 31/03/06 217(2)Sch must be in place, which includes 4 obtaining a criminal record check prior to the start of employment. (Timescale of 30/09/05 not met). Springfield Nursing Home DS0000025577.V265207.R01.S.doc Version 5.0 Page 23 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. Refer to Standard OP9 OP18 OP28 OP33 Good Practice Recommendations Trained nurses should be aware of and adhere to the NMC guidelines for the administration of medicines. The registered manager should make sure that all staff are aware of the home’s polices and procedures in relation to the protection of vulnerable adults. The home should ensure that fifty per cent of care staff is trained to NVQ level 2 or above. A copy of the home’s annual development plan should be submitted to the commission. Springfield Nursing Home DS0000025577.V265207.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Chorley Local Office Levens House Ackhurst Business Park Foxhole Road Chorley PR7 1NW 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 Springfield Nursing Home DS0000025577.V265207.R01.S.doc Version 5.0 Page 25 - 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. 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