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Inspection on 09/08/05 for Springfield Nursing Home

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

This inspection was carried out on 9th August 2005.

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.

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.

What has improved since the last inspection?

Progress has been made in addressing the one requirement and one recommendation made at the last inspection.

What the care home could do better:

Some of the risk assessments in relation to safe working practices should be reviewed more often so that any changes can be noted and instructions for staff updated. Improvements to the internal and external environment are needed so that residents continue to live in an environment that is safe, well maintained, decorated and furnished to a satisfactory standard. Some of the procedures in relation to the administration of medicines need to be reviewed so that good practice is maintained. The recruitment process needs to be improved so that the home is able to show that any staff they employ are suitable to work with vulnerable adults. The home should continue reviewing and developing the service provided to ensure that current good practice is maintained.

CARE HOMES FOR OLDER PEOPLE SPRINGFIELD NURSING HOME 191 SPENDMORE LANE COPPULL CHORLEY, LANCASHIRE PR7 5BY Lead Inspector ANNE TAYLOR Announced 09 AUGUST 2005 09:30 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 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 F57 F08 S25577 Springfield Nursing Home V233477 090805 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service SPRINGFIELD NURSING HOME Address 191 SPENDMORE LANE COPPULL CHORLEY LANCASHIRE 01257 470140 Telephone number Fax number Email 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 OP (Old Age) - 42 registration, with number PD (Physical Disability) - 6 of places SPRINGFIELD NURSING HOME F57 F08 S25577 Springfield Nursing Home V233477 090805 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1.Up to 42 Service users in the category OP(Old Age, not falling within any other category) who require nursing care 2. Up to 6 service users in the category PD (Physical Disability) who require nursing care. 3. Up to 17 service users in the category OP (Old Age, not falling within any other category) who require personal care only 4. The service should, at all times, employ a suitably qualified and experienced manager who is registered with the NCSC Date of last inspection 29 March 2005 Brief Description of the Service: Springfield is a care home with nursing currently registered to accommodate forty-eight residents, forty-two of whom should be older people and six young physically disabled. At the time of inspection forty residents were living at the home. The younger residents cared for at Springfield had medical needs that outweighed their physical disability and the home manages their specialist needs well. The home is situated on the main road, which passes through the village of Coppull that is 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 F57 F08 S25577 Springfield Nursing Home V233477 090805 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an announced inspection that took place over one full day in August 2005. 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. Comment cards received from residents, relatives and other health care professionals have also been used in the production of this report. 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. All 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. SPRINGFIELD NURSING HOME F57 F08 S25577 Springfield Nursing Home V233477 090805 Stage 4.doc Version 1.30 Page 6 What has improved since the last inspection? 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. SPRINGFIELD NURSING HOME F57 F08 S25577 Springfield Nursing Home V233477 090805 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection SPRINGFIELD NURSING HOME F57 F08 S25577 Springfield Nursing Home V233477 090805 Stage 4.doc Version 1.30 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 standard(s) 3 The pre admission procedure was thorough enough to ensure that the individual wants and needs of prospective residents were assessed. EVIDENCE: Information about the admissions process was in the statement of purpose and service user guide, both of which were available to residents or their relatives. The manager said that she or another experienced nurse usually carried out pre admission assessments for prospective residents. This meant that both the home and any prospective resident could be sure that an appropriately trained person had done the assessments. The assessment forms used by the home were thorough and helped the person assessing to make sure all needs could be fully assessed. The manager said that prospective residents and or their relatives were always involved in the pre admission assessment so that that they would have some idea of what sort of care they should expect to receive when they came to live at the home. When asked about how they chose this home one resident said, “My brother chose this home and the matron came to see me whilst I was in SPRINGFIELD NURSING HOME F57 F08 S25577 Springfield Nursing Home V233477 090805 Stage 4.doc Version 1.30 Page 9 hospital, before I came to live here”. SPRINGFIELD NURSING HOME F57 F08 S25577 Springfield Nursing Home V233477 090805 Stage 4.doc Version 1.30 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 standard(s) 7 & 8 The care planning process was thorough enough to ensure the needs of residents were properly identified and managed. The provision of basic nursing care and management of health care needs was of a good standard and made sure the health and welfare of clients was put first. Procedures were in place to facilitate the safe handling of medicines ensuring the safety of residents. EVIDENCE: SPRINGFIELD NURSING HOME F57 F08 S25577 Springfield Nursing Home V233477 090805 Stage 4.doc Version 1.30 Page 11 Care records seen showed that each resident had a plan of care based on the pre admission assessment so that individual needs were identified and instructions for staff as to how those needs would be met were clear. The manager said that residents and their relatives were consulted about the care planning process and some plans had been signed by residents who were able to do so or by their relative. Risk assessments that enabled health care to be provided safely were in place so staff were confident about this part of their job and residents able to feel safe when being assisted with personal care needs or receiving nursing care. Some of the risk assessments seen needed to be reviewed more often so that any changes could be noted and instructions for staff updated. Residents were settled, appropriately dressed and well cared for. Records showed that the home had a positive and proactive approach to the management of health care so the outcomes for individuals were good. Comment cards completed by residents relatives and other health care professionals showed that they were satisfied with the standard of care provided. Residents liked living at the home and felt well cared for. When asked about the care they received residents said, “The home does meet my needs, I’m pleased with all aspects of my care” and “I get help when I need it”. A relative commented, “it is reassuring to have the confidence that the overall needs of all concerned are met”. Staff were able to discuss the individual needs of the people they cared for and how they organised their workload to ensure those needs were met. They made reference to way they used the care plans and attended regular handovers when there was a change of shift, so that they knew about any changes to the care residents needed. Following assessment of medicines three residents were supported to administer some of their medication. Qualified nurses administer all other medication except some external preparations (creams), which were applied by, care staff. It was recommended that evidence of delegation by a registered nurse to competent care staff be recorded. The medication administration records (MAR) were generally up-to-date, but the separate ‘medication profiles’ where not well maintained. It was advised that the use of ‘profiles’ was to be reviewed, and the MAR maintained as lists of current medication. SPRINGFIELD NURSING HOME F57 F08 S25577 Springfield Nursing Home V233477 090805 Stage 4.doc Version 1.30 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 standard(s) 14 & 15 Residents were helped to exercise choice so that they had some control over their lives. The importance of providing a well balanced diet was recognised by the home so that clients were able to eat healthily and given a choice about what they ate. EVIDENCE: During conversations with residents and staff it was evident that residents were able to make choices about the way they lived within the home and in particular within the privacy of their own room. Rooms had been personalised by residents bringing in some of their own possessions so that they had familiar and treasured items around them. A record of all items brought into the home by residents was kept so that staff knew which items belonged to each resident. Residents not able to exercise full control over their financial affairs were mainly helped by a family member. The registered manager knew how and when to access an advocate to act on behalf of a resident without a representative to ensure that any decisions made were in the best interests of that resident. SPRINGFIELD NURSING HOME F57 F08 S25577 Springfield Nursing Home V233477 090805 Stage 4.doc Version 1.30 Page 13 Records were kept of individual likes and dislikes and staff were aware of residents’ dietary needs and personal preferences. This made sure that residents received a nutritional diet in accordance with their needs. The lunchtime meal was relaxed and unhurried with staff available to assist if needed. Some residents had chosen to eat in the dining room, others in their bedroom. One resident said, “I have breakfast and tea in my room and lunch in the dining room”. Residents spoken to were generally satisfied with the range and quantity of food available to them. When asked one resident said, “we do get a choice, every day, they come round and ask what you want”. Another resident said, “the food is excellent and if you don’t like it they get you something else”. SPRINGFIELD NURSING HOME F57 F08 S25577 Springfield Nursing Home V233477 090805 Stage 4.doc Version 1.30 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 standard(s) 16 The home had a clear complaints procedure that ensured residents knew how and who to complain to. EVIDENCE: A complaints procedure was in place and residents spoken to know how and who to complain to. One resident said, “I’d go to the matron if I had a complaint, but if anyone complains here, they must be really hard to please.” Comment cards completed by relatives showed that they knew about the home’s complaint procedure but had never had to make a complaint. Resident’s spoken to felt that they were encouraged to raise any concerns they might have about the home, that they would be listened to and action would be taken on any issues raised. Staff were able to discuss how they would respond if a resident complained to them and realised how important it was to make sure residents felt able to raise concerns and be sure they were listened to. SPRINGFIELD NURSING HOME F57 F08 S25577 Springfield Nursing Home V233477 090805 Stage 4.doc Version 1.30 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 standard(s) 19 & 26 The home was clean, comfortable and homely, providing an environment that was suitable for it’s stated purpose and safe for the people living there. Improvements were needed to ensure the continued comfort and safety of residents. EVIDENCE: The home was accessible to all residents. Ramps allowed easy access to the outside. Accommodation was provided on two floors. The upper floor could be reached by a passenger lift so that wheelchair users and the less mobile are able to access both floors. Outside the grounds were tidy and well maintained, providing a pleasant area for residents to enjoy if they wished. An assessment of risk regarding the small outdoor pond should be done to make sure any risk to residents is removed or appropriately managed. Residents spoken to were happy with their private accommodation and most had personalised their rooms so that they felt more at home. One said, “I like SPRINGFIELD NURSING HOME F57 F08 S25577 Springfield Nursing Home V233477 090805 Stage 4.doc Version 1.30 Page 16 my room, I have a lot of my own things. This is the next best thing to being in my own home”. A programme for maintenance and refurbishment was in place so that furnishings, fittings and décor in all parts of the home could be renewed and kept up to date when needed. However, some corridor and bedroom carpets were heavily stained despite recent specialist cleaning. The carpets should be thoroughly cleaned or replaced to make sure residents continue to live in wellmaintained and comfortable surroundings. The home was clean and free from offensive odours. One resident said, “ My room is always clean and tidy”. One visitor said, “ it’s always clean and tidy, it never smells or anything”. Policies and procedures were in place that identified infection control measures in place at the home. Staff were able to discuss infection control procedures and how implementing them correctly helped to minimise the risk of cross infection. The home still needs to make sure that all the facilities and services provided comply with the Water Supply (Water Fittings) Regulations 1999 and that all pipe work in bathrooms and toilets is appropriately covered so that residents continue to live in a safe environment. SPRINGFIELD NURSING HOME F57 F08 S25577 Springfield Nursing Home V233477 090805 Stage 4.doc Version 1.30 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 & 29 The skill mix of and the number of staff on duty was sufficient to ensure the needs of residents were met. The recruitment process was not thorough enough to ensure the continued protection of residents. EVIDENCE: Staff rotas showed the number and skill mix of staff on duty at any time and that enough staff were on duty to ensure the needs of residents could be met. Comment cards completed by relatives also confirmed that there was always sufficient numbers of staff on duty so that residents were looked after and attended to properly. One relative commented, “I cannot praise the staff highly enough, they are to be highly commended”. When asked about staff residents said, “the staff are good, they will do anything for you” and “I think the staff are marvellous, they have to do quite a lot of things for me and nothing is too much trouble”. Staff spoken to felt that there was enough staff on duty so that they were able to provide a good standard of care to residents. A recruitment checklist was in place and staff files were organised both of which helped the recruitment process. In order to protect residents all necessary checks including an up to date Criminal Record check and SPRINGFIELD NURSING HOME F57 F08 S25577 Springfield Nursing Home V233477 090805 Stage 4.doc Version 1.30 Page 18 verification of entry onto the professional register for trained nurses must be obtained prior to the start of employment. Discussion with the manager showed that she was aware of her responsibility to appoint suitable staff that would be able to provide good care and the continuing need to protect people living at the home. SPRINGFIELD NURSING HOME F57 F08 S25577 Springfield Nursing Home V233477 090805 Stage 4.doc Version 1.30 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 35 & 38 The arrangements for handling money on behalf of residents were thorough enough to ensure their financial interests were safeguarded. The systems in place for managing health and safety matters were thorough enough to ensure the continued safety and welfare of people living and working at the home. EVIDENCE: Discussion with the administrator showed that the home handled very few personal allowances for residents. Any money brought in by relatives for residents was stored in the home’s safe. Records were kept of any personal allowances or money handed in for safekeeping. Receipts were kept for any purchases made on behalf of residents. These systems made sure that there was a clear audit trail of any residents’ money handled by the home and that residents could be sure their money was safe. SPRINGFIELD NURSING HOME F57 F08 S25577 Springfield Nursing Home V233477 090805 Stage 4.doc Version 1.30 Page 20 Certificates were inspected which confirmed that regular servicing had taken place in relation to systems and equipment used by the home to make sure they were safe to use. However, there was some confusion about the suitability of the fire risk assessment. The registered manager was contacting the local fire officer who had helped the home to draw up their risk assessment to make sure it met with their approval. Discussion with the manager and staff demonstrated a clear commitment to health and safety issues and a number safe working practices were verified at the time of inspection. Training in relation to health and safety issues had been provided for all staff so that they were able to promote the health, safety and welfare of the people they cared for. Some training was due to be updated but the manager was aware of this and was in the process of arranging annual updates for staff so that they could continue to practice safely. Residents felt safe living at the home one said, “I feel safe and well looked after here”. SPRINGFIELD NURSING HOME F57 F08 S25577 Springfield Nursing Home V233477 090805 Stage 4.doc Version 1.30 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 3 15 3 COMPLAINTS AND PROTECTION 2 x x x x x x 2 STAFFING Standard No Score 27 3 28 x 29 2 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x x x x x x 3 x x 2 SPRINGFIELD NURSING HOME F57 F08 S25577 Springfield Nursing Home V233477 090805 Stage 4.doc Version 1.30 Page 22 NO Are there any outstanding requirements from the last inspection? 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 19 Regulation 23(2)(d) Requirement The carpets identifed at inspection must be thoroughly cleaned and if cleaning is unsuccessful replaced. An assessment of the outside pond must be carried out to identify and remove or manage any risk to residents. A thorough recruitment process must be in place which includes obtaining a criminal record check and verification of trained nurses entry onto the professional register prior to the start of employment. The home must seek advice from the local fire authority about their fire risk assessment. Timescale for action 30th December 2005 30th September 2005 30th September 2005 2. 19 13(4)(a,c) 23(2)(o) 3. 29 19(1) Schedule 2 17(2) Schedule 4 23(4) 4. 5. 6. 38 30th September 2005 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Good Practice Recommendations F57 F08 S25577 Springfield Nursing Home V233477 090805 Stage 4.doc Version 1.30 Page 23 SPRINGFIELD NURSING HOME 1. 2. 3. 4. 5. Standard 3 19 26 38 9 Risk assessments relating to the provision of health care should be reviewed monthly. Pipework in bathrooms and toilets should be appropriately covered. The home should ensure that all facilties and services provided comply with the Water Supply (Water Fittings) Regulations 1999. The registered manager should make sure training for all staff in relation to safe working practice is updated as planned. Evidence of delegation by a registered nurse to competent care staff regarding the application of prescribed creams should be recorded. The use of medication ‘profiles’ should be reviewed, and the MAR maintained as lists of current medication. SPRINGFIELD NURSING HOME F57 F08 S25577 Springfield Nursing Home V233477 090805 Stage 4.doc Version 1.30 Page 24 Commission for Social Care Inspection 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 F57 F08 S25577 Springfield Nursing Home V233477 090805 Stage 4.doc Version 1.30 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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