Inspection on 28/11/06 for Springfield Nursing & Residential Care Home

This inspection was carried out on 28th November 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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.

Other inspections for this house

Springfield Nursing &... 18/09/08

Springfield Nursing &... 25/09/07

Springfield Nursing &... 12/03/07

Springfield Nursing &... 08/12/05

Springfield Nursing &... 15/08/05

Springfield Nursing &... 23/11/04

Springfield Nursing &... 22/06/04

Springfield Nursing &... 03/06/03

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Springfield Nursing & Residential Care Home 72 and 74 Havant Road Emsworth Hampshire PO10 7LH Lead Inspector Clare Hall Unannounced Inspection 08:30 28 November 2006 th 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 & Residential Care Home DS0000011519.V316828.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Springfield Nursing & Residential Care Home DS0000011519.V316828.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Springfield Nursing & Residential Care Home Address 72 and 74 Havant Road Emsworth Hampshire PO10 7LH 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) (01243) 372445 Springfield Health Services Mrs Deborah Redmond Care Home 61 Category(ies) of Old age, not falling within any other category registration, with number (61), Terminally ill over 65 years of age (61) of places Springfield Nursing & Residential Care Home DS0000011519.V316828.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 13th September 2006 Brief Description of the Service: The home is owned by Springfield Health Services Ltd and is registered to accommodate up to sixty-one residents. The home is located in two houses that are separated by a quiet service road. The home was previously registered as two separate homes; number 72 being a care home providing personal care only and number 74 providing nursing care. Following an agreement by CSCI that one manager could effectively manage both homes, a further decision has been made to register both house 72 and house 74 as one care home. The registered persons have made the decision to continue accommodating up to 25 residents needing nursing care in house 74 and up to 36 residents needing personnel care in house 72. They state that this will be kept under review, with staffing numbers being amended to reflect any changes in the occupancy of the home. House 72 has three floors and house 74 two floors both being accessed by stairs and a passenger lift. Both houses have communal lounges and dining areas on the ground floors for the use of residents that both allow access into well maintained garden areas. The home has sufficient toilets and bathrooms to meet the needs of the residents. The lowest current charges are Nursing £720 and Residential £525. The highest charges are Nursing £760 and Residential £570. Springfield Nursing & Residential Care Home DS0000011519.V316828.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection visit was undertaken over a two-day period. One inspector conducted the first day and two inspectors conducted the second day. During the time spent there the inspectors were given the freedom to access both houses. The manager and staff were helpful throughout and both inspectors gave a detailed feedback at the end of the visit with the registered manager and Director. Opportunity was given for the manager at this time to evidence documents stated as not found. During the inspection visit the inspectors spoke with service users, their relatives and staff across both of the homes. The service provided pre-inspection information as requested by the commission and there was a good response to the distribution of comment cards to staff, relatives and service users. All of these have been used to inform this report. Additional information considered was all the recorded contact with the home, including events, Regulation 37 notifications, Regulation 26 visit summaries and the information contained in the previous reports. Staffs were observed throughout the visit assisting and supporting clients. Case tracking was also undertaken as part of the evidence gathering process. The service had eight requirements raised as a result of the previous inspection. None of these have been met. Continuing concerns were identified relating to the areas raised previously. The commission will consider what action will be taken in respect of this. The inspector has also notified Havant social services regarding the concerns identified for resident’s health and wellbeing in house 74. As results of this visit 31 requirements have been raised, six of which have been raised previously. Although having the same manager the outcomes for residents in number 72 are very good whereas the residents in number 74 receive a poor standard of care. Where the findings of this inspection differ between the two houses it is made clear in the report which house the judgement refers to. Springfield Nursing & Residential Care Home DS0000011519.V316828.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? The manager has implemented new systems and procedures to improve the training of staff. The owners have committed to increasing their training expenditure and this now exceeds the Skills for care recommendation of 3 of total staff wage costs. Springfield Nursing & Residential Care Home DS0000011519.V316828.R01.S.doc Version 5.2 Page 7 70 of care staff employed have achieved a national vocational qualification or equivalent which is commendable. What they could do better: The registered person must ensure that all residents needs have been fully assessed prior to admission. The residents being accommodated must have their identified needs met. The manager needs to ensure she monitors the outcomes of the strategies she is implementing. Medication practices are poor and the manual handling practices of residents is unsafe. Staff must be trained and deemed competent when undertaking care and medications. There appears to be good opportunities for staff training although the learning outcomes need to be measured to identify whether the training is effective. An example would be if the management records indicate staff under go training in manual handling training but the practice outcomes are poor the quality of the training /input needs to be scrutinised. The philosophy of care and staff practice in number 74 must be addressed. Some care staff do not meet the needs of individuals in a safe and respectful manner. These poor care practices and conduct of some staff must be addressed through the homes supervisory and disciplinary procedures. The philosophy of care must also encourage and empower residents in decision making. Residents must be allowed to drive the service provision by actively participating in the decision-making processes regarding care / changes / improvements. Residents who are unable to fill in satisfaction questionnaires must be provided with another means for consultation to safe guard their best interests. Persons with communication difficulties and/or mental health issues must be considered to have the capacity to give consent. They must also be consulted about their care, unless it has been documented other wise Records must be stored appropriately, and care records require regular audit. An audit of the care provided must also be undertaken. The services recruitment practices must also be improved to ensure the protection of vulnerable adults. The dining and lounge facilities in house 74 needs review to ensure people have adequate space. The registered person must address all areas of concern raised at this and the previous inspection report regarding the wedging open of fire doors. This Springfield Nursing & Residential Care Home DS0000011519.V316828.R01.S.doc Version 5.2 Page 8 practice is unsafe putting residents and staff directly at risk, and compromise the inherent fire safety systems within the home. Residents must not share toiletries, and requirement that has been made previously. Substances hazardous to health must be stored safely. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Springfield Nursing & Residential Care Home DS0000011519.V316828.R01.S.doc Version 5.2 Page 9 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 & Residential Care Home DS0000011519.V316828.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is not ensuring that service users with capacity are encouraged to manage their affairs and are involved with the agreements regarding their stay. There is an inconsistent approach to the assessment of any individual who is to be admitted to the home, which would identify their needs. EVIDENCE: A survey undertaken during the visit identified that relatives are involved in signing any contractual agreement between the resident and the home. Residents could not recall having seen or discussed the agreements, but were confident that their representatives/relatives had undertaken this on their behalf. All three residents were described as having full capacity. Springfield Nursing & Residential Care Home DS0000011519.V316828.R01.S.doc Version 5.2 Page 11 Resident’s files held records of clear accounting and invoices. Letters informing of changes in charges were also noted. Two of the three service users asked stated they had not received or read the home’s Statement of Purpose and Service Guide. One lady said she thought she knew where it was should she want to read it. No copies were evident on the files of service users to evidence they had been provided with the necessary information. Copies were available in the main reception area. The pre-inspection visit information indicated there were a number of service users with dementia and four with current mental health needs. One staff member stated the majority of residents in house 74 exhibit signs of having / developing mental frailty. Two of four resident files audited lacked any pre admission information. The manager was given the opportunity to find any relevant pre admission information but was unsuccessful. Springfield Nursing & Residential Care Home DS0000011519.V316828.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. There is a lack of accurate assessment, review and good care practice intervention, which has led to residents sustaining injuries and their health being compromised. There is an absence for the assessment of mental health needs and there is a serious concern for the ongoing poor medication practices. Outcomes for service users in house 74 are poor. In comparison the outcomes for residents requiring a level of personal care only in the residential setting of house 72 is very good. They feel supported, respected, consulted and completely satisfied with the care and support provided. EVIDENCE: Care plans audited were signed thus indicating staff regularly review them. The current needs of service users within care plans and assessments had not Springfield Nursing & Residential Care Home DS0000011519.V316828.R01.S.doc Version 5.2 Page 13 been updated with current issues or adequately reviewed. Due to the poor preadmission assessment the care plan has not been adequately informed. Residents spoken with were not aware of their plans of care and had not been involved in their development. The inspector was concerned at the diversity of the quality of care across the two houses. In the predominantly residential house 72 the quality and care outcomes are very good but for house 74 outcomes were very poor. House 74 Despite the high numbers of service users with mental fragility records lacked any psychological health profile assessment and plan of care so that preventative and restorative care can be provided. Specialist needs in respect of behavioral triggers and or communication needs were clearly lacking. Residents whose risk assessments identified that they required pressurerelieving devices on their chairs were not provided with them. Two residents seen, one of whom had a pressure sore, were not sat on the necessary pressure relieving aids as identified in their risk assessments and plans of care. The pre inspection information provided by the manager indicated the home has two service users with pressure sores. One service users nutritional risk assessment, which stated he was at low risk, was not updated when staff recorded that he had lost 7llb in weight. The action indicator on the tool was not updated or any further actions taken. Another service user had a bed rail risk assessment completed. It identified that it was not safe to use bed rails as he was at risk of becoming trapped. Despite this staff still put the bed rails on his bed. Subsequently there were repeated records of injuries sustained by the resident from the bedrails recorded in the residents care notes. Bed rails were still in use. One lady case tracked had an assessment, which stated she was totally immobile. The instructions were for staff to handle in pairs. During the two days spent in the service the hoist was not seen in use at all. Residents were seen being handled in an unsafe manner. One other lady who had it identified she was at risk of malnutrition and dehydration was observed to be too sleepy to eat and missed meals. There were no adequate records to monitor her intake. One service user visited upstairs appeared dehydrated. There was a clear lack of fluids being provided through out the two days. Hot drinks were provided at Springfield Nursing & Residential Care Home DS0000011519.V316828.R01.S.doc Version 5.2 Page 14 trolley times and cold juices at lunch but residents sat without drinks during the other periods and the majority did not have the ability to use the water cooler. One service user spoken with had very poor mouth care and was obviously dry and lacking fluids. There were no drinks within reach. The pre inspection information also identified that the home currently supports 17 service users with impaired hearing and 4 who are visually impaired. Some staff demonstrated a lack of consideration when supporting the elderly frail especially in relation to good communication. Staffs were not giving any explanations prior to interventions or seeking consent, and this caused the residents distress. There was an issue raised at the last visit to whether members of staff who administer medications have completed “accredited” training (i.e. competence based training provided by an “accredited” trainer typically over a 12 week period). Care staff reported in comment cards that they undertake medication administration without training and are often asked by the service user what the medication is for and they don’t know. It was established that the home does not conduct in house competency based training for staff in the safe administration of medicines but relies on the care staff receiving this within their national vocation qualification modules. Poor practices for the safe administration of medicines were observed throughout this two-day inspection. There were controlled drugs discrepancies found on the first day of inspection and still not resolved by the end of the second day despite being relayed to the head of care and manager. Medications were left on tables, un-administered. Staff failed to ensure a good procedure was undertaken for identification of individuals prior to administration. Care staff were given medication to by nursing staff to administer. Staff were observed walking around with pots of pills. Also medication administration records were being signed prior to the administration of prescribed medicine. Medication storage fridges were running over and under the recommended temperatures. Records did not reflect the actual temperature being recorded by the thermometer. The controlled drug cupboard was not securely fixed to the wall and staffs reported they were disposing of Fentanyl patches in communal bins. There were prescription creams left in bathrooms/toilets. Prescription creams of service users who had deceased were still stored in bathrooms. Springfield Nursing & Residential Care Home DS0000011519.V316828.R01.S.doc Version 5.2 Page 15 A senior nurse was observed giving a 09.00 am prescribed dose of morphine solution (analgesic) at 11.15am when it was prescribed for 09.00hrs. The time it was recorded as being administered on the MARS sheet was 09.00hrs. It had been raised at a previous visit that there were toiletries being stored on a shelf in the bathroom. Again on this occasion there were also numerous bars of soap and an assortment of other toiletry items such a razor blade, hairbrush, stored openly on the bathroom shelves. This would indicate there is a policy to share these items. A requirement was raised in respect of this following the previous visit. This practice remains on going. The poor practices observed throughout the two days spent in the home indicated staff lacked experience regarding dealing with people with mental health needs, sensory impairments and physical disabilities. The inspector was concerned at how staff were interacting and supporting residents with these needs. Staff did not appear to be well trained in supporting people with behaviours that may challenge. Care records do not identify mental health needs are assessed or how they are to be managed. House 72 It was clearly apparent that service users in house 72 are far more able to live independent lives, participate in every aspect for daily decision-making and can freely voice any dissatisfaction. One service user met discussed how the service has given him the opportunity to stay side by side with his wife, whilst fulfilling his needs and expectations. He is able to go about the community and undertake his interests with the support of the staff, knowing his wife is comfortable and well looked after. A number of service users in house 72 felt their opinions were respected and choices reflected in their everyday lives. The quality of their daily living was exceptional and the surrounding for which they live in beautiful. They felt the majority of the staff are kind considerate and caring and felt the home was well managed. All service users spoken with felt their needs were met by a caring and attentive group of staff. Some comments received in respect of the service were, • “Generally I think the home is very caring.” Springfield Nursing & Residential Care Home DS0000011519.V316828.R01.S.doc Version 5.2 Page 16 • • • “ The older staff particularly are on the ball, perhaps the younger ones could do with more training, certainly in understanding the ways of older people” “It would be nice if the staff weren’t so hard pressed and had time to chat with the residents”. “Staff are very helpful and friendly” Springfield Nursing & Residential Care Home DS0000011519.V316828.R01.S.doc Version 5.2 Page 17 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. There is a disparity between the outcomes regarding social activities and for the provision of adequate nutrition between the two homes. Overall residents who are able to give an opinion are very satisfied but the outcomes for residents who are less able to challenge or be actively involved in how care is delivered receive a poor service. EVIDENCE: The manager has developed a newsletter which keeps the residents informed of all activities on going and day to day event and issues. House 72 Some service users reported they felt a number of the activities were belittling and not what they wanted. Whilst observing the organised activities some residents stated they felt pressured to join in especially when activities are taking place in the main living room. Three service users thought playing skittles and other games childish and patronising. One service user’s relative stated she had “saved her mother from activities by bringing her upstairs”. Springfield Nursing & Residential Care Home DS0000011519.V316828.R01.S.doc Version 5.2 Page 18 Despite this the majority of service users stated they were quite satisfied with the activities provided. House 72 The activities co-ordinator from house 72 stated she didn’t “provide activities over the road.” It was established that residents in house 74 have not been receiving any formalised activities, as there wasn’t an activity co-ordinator. A new member of staff has recently been employed to undertake this. The catering staff explained that they are just updating the dietary preferences sheet, which records dislikes, and the preferences of individuals. There have been a number of negative comments in respect of the food provided. Comment cards reported there was a lot of waiting around for meals. This was also reported directly to the inspector during the inspection. The residents reported that staff invite them into the dining room at 12.30pm but they wait a long time for their lunch. It was observed that the meal was served at one and some residents were still eating at 2.00pm. The servery staff are dependent on the trolley coming over from house 74. It was raised during the December 2005 and March 2006 visit that the delivery of the meals at house 72 poses some problems; meals are prepared in the kitchen in house 74 and transferred across to house 72. This causes some delays in the serving of meals at house 72. The manager stated at this time that in consultation with the residents she would explore methods to address this situation. Residents still report “Often it takes ages to get served”. Comments received in respect of the food from service users was the food is repetitive and unimaginative. One-service user reported that despite their being good choice the food was bland Despite this the ambience of the mealtimes in house 72 is lovely. Staff opened the bar and offered residents an aperitif before their three-course lunch. Residents confirmed they have plenty of choice and all agreed the breakfasts were very good. Service users were very complimentary regarding the dining facilities. They are large, spacious, bright and nicely decorated. Staffs were seen drawing back the curtains to keep the sun from service users eyes. Staff chatted and engaged with residents throughout. The room was filled with pleasant chatter and social activity. House 74 In house 74 residents were seen assisted to their chairs in the dining room at 12.30.The lack of consultation in respect of where they wanted to eat was Springfield Nursing & Residential Care Home DS0000011519.V316828.R01.S.doc Version 5.2 Page 19 noted. The food was not served until 13.05pm and then some residents sat unassisted for long periods. During the meal the residents were not given the necessary aids to promote independent eating. Plate guards and adapted cutlery were left on the top shelf in the kitchen. The space necessary to accommodate the service users in house 74 is more limiting. The dining area is crowded and staff were not seen offering an aperitif as was undertaken in house 72. There was a lack of atmosphere and social interaction. One-service user was sat in her chair facing the window with the sun directly in her eyes. The inspectors closed the curtain so she could see. Staff did not exchange any sort of conversation during this event except when necessary. Food was being provided more as a job or task rather than as an enjoyable social event for residents. One staff member was feeding a service user without giving the necessary attention causing distress. No activities were observed throughout the two days except for the newly appointed activity co-ordinator sitting and chatting with service users in their rooms. Springfield Nursing & Residential Care Home DS0000011519.V316828.R01.S.doc Version 5.2 Page 20 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16,17,18 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. House 74 There is a lack of supervision and experienced staff presence in house 74. Current practice is abusive and detrimental to service users health and well being. Those most vulnerable residents who are unable to make their wishes known are not being supported. House 72 Service users are satisfied that the manager takes all issues they raise seriously and that she addresses their concerns and complaints very quickly. Service users who have the ability to verbalise their needs, expectations desires and satisfaction are protected. EVIDENCE: The processes for monitoring concerns in the home rely quite heavily on people being able to communicate their dissatisfactions. In house 72 residents were very happy. They reported that they just had to mention an issue to the manager and it was dealt with immediately. With the manager being more visible and on site in house 72 any concerns raised by the more able residents are always being addressed. Outcomes for Springfield Nursing & Residential Care Home DS0000011519.V316828.R01.S.doc Version 5.2 Page 21 care and satisfaction are very high. The manager was observed interacting throughout the two day period with the relatives and service users of house 72, dealing with issues, observing the running of the home, engaging in conversations in the lounge and assisting during the meal times. House 72 also had the administrative staff dealing with concerns and addressing issues at the reception, interacting with service users in the lounge and were even seen to assist in the lounges and dining areas along with the activity staff. There always seemed to be a flurry and presence of senior staff. In house 74, which accommodate service users who are more dependent and have higher needs the outcomes were poor. There appears to be a lack of manager interaction and presence in house 74. The care staff were observed as being the main point of call and the trained nurse on duty was largely unseen downstairs. Care workers had the main presence and were observed undertaking their work in a quiet manner. There was little interaction with service users . A large concern was the lack of information and explanation given to the service users during care intervention, causing service users distress. The whole ambience was different in that there was no social buzz or social interactions going on. One service user was seen sitting in a chair clearly unsuited to her needs. She was slumped forward almost to the floor and staff continued to ignore this and walk past her. The service users lacked fluids and tables to accommodate their drinks and possessions, should they wish to have something near at hand. Staff were observed manual handling service users in a very poor manner causing distress. One lady was lifted out of her chair when still asleep and then speedily walked out of the room without a word from the care worker. Another member of staff was seen swinging one lady into the chair by an under arm lift. All service users had their footplates removed from their wheelchairs and staffs were clearly advocating the use of chair rings and manual handling straps, which is not considered best practice. When asked staff were not familiar with adult protection guidance and stated they had not received training for the prevention of abuse. Abuse leaflets and guidance on staff portfolios had gone unread. It was reported in comment cards and through direct conversation with relatives that there are staff who are short tempered and abrupt. In the homes staff meeting minutes one comment written was “most residents think it is a pleasure to live here. The only let down would be that occasionally certain staff Springfield Nursing & Residential Care Home DS0000011519.V316828.R01.S.doc Version 5.2 Page 22 could be a little short tempered.” Some relatives wished not to name the staff as they felt there may be repercussions. During the mealtimes service users were seen left with plates of food unsupervised and unassisted without the necessary aids to help them feed themselves. One resident who could not eat her lunch was removed from the table and no record was made that she hadn’t eaten. One service user was seen being fed hot soup. As soon as the lady had the soup put in her mouth her non-verbal response was very clear she was in pain. She put her fingers in her mouth but the care worker continued to feed her despite the soup steaming. The inspector intervened, took a sample of the soup and informed the care worker it was hot. A survey was undertaken during the visit to establish whether service users were aware of the complaints processes. Of the three service users asked all stated they had not received a copy of the home complaints procedure. All stated that if they had a complaint they would tell the matron. Springfield Nursing & Residential Care Home DS0000011519.V316828.R01.S.doc Version 5.2 Page 23 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,22,23,26 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The buildings are well maintained and residents are very complimentary regarding their surroundings. A review of the use of space in house 74 needs to be undertaken. The space must be fit for purpose. Despite the general hygiene and cleanliness of the home being good there are improvements necessary for the prevention of infection. EVIDENCE: The home comprises two houses. House 72 has 36 beds and at the present time accommodates predominantly residents needing personal care. House 74 accommodates up to 25 residents requiring nursing care. Springfield Nursing & Residential Care Home DS0000011519.V316828.R01.S.doc Version 5.2 Page 24 A tour of the environment of each building was undertaken, viewing communal areas as well as a sample of bedrooms. The general environment was clean and free from offensive odours. The décor and furnishing of all areas is of a homely nature. Residents and visitors offered positive comments about the décor and furnishings at the home. Bedrooms have door locks and residents are able to lock their doors if they choose. There are issues regarding the service being provided over two properties, which are separated by a private road. The two properties do not share the same postcode but have now been registered as one service. Laundry and kitchen services are shared which means staff are continually crossing over between the homes. The main doors to both homes were open and are not locked during the twoday visit. There was uninterrupted access to both buildings during the two days. The difficulty was that with regular crossing between the houses the visitors log did not reflect who was in what building and it was the same for the whereabouts of staff. The service has two dining room areas, one in each house. House 72 The entrance to house is bright and welcoming with a formal reception area. The manager’s office is located in this building. House 72 has a large airy room which accommodates a lovely conservatory seating area with bar. Residents were seen making full use of the lovely facility. This is also used as the dining area and it has been extended to create a pleasant conservatory area that opens up onto a patio. There is a cold-water dispenser and a fridge containing fortified drinks for the use of the residents is situated in the dining area. An area of the dining /sitting room has been allocated to a nurse station as the residents requested a higher profile of staff. This area was being used to store confidential and personal care records. There were urine samples on top of the nurse’s table and staff were conducting handover in this area. It is was not considered best practice in respect of confidentiality. The manager will need to look at other ways to reassure residents of a presence of staff in the communal areas. One couple were visited in their shared room. They reported that their room met all their expectations and they were both very happy. The husband had an Springfield Nursing & Residential Care Home DS0000011519.V316828.R01.S.doc Version 5.2 Page 25 office and work area provided. Both had a small sitting area. The room was spacious, bright, clean and well maintained. It was noted that some of the doors are very heavy for service users to open, especially for those service users who use walking aids. One room lacked a door closure. Numerous fire doors were seen being wedged open. This serious concern has been raised previously. The laundry facility for both the homes is located in house 72. The laundry is small but functional. The flooring and walls have recently been improved and made impermeable. Despite the laundry being small, residents reported that they had no problems with having their laundry returned to them. House 74 The entrance to house 74 has no reception area and visitors can come and go unnoticed. The carpet in this area looks worn. The more dependent residents accommodated in house 74 do not have such a spacious facility. The sitting room was cramped and the position of the armchairs was not conducive for safe manual handling of residents. Relatives complained to the inspector that it was difficult to sit quietly and privately by their relative, as there was no space. The dining facilities were also cramped and staff were observed undertaking poor practices for manual handling. It was noted that one lady who is immobile and hoist dependent was being accommodated in a room where the bed is up against the wall. She reported she found it hard to reach things and it would be so much better if her bed were not against the wall. It was explained that staff move the bed away from the wall so they can try to manual handle her from both sides. The manager does under take regular fabric audits, which identifies the areas needing improvement. The homes main meals are prepared for the nearby residential home and transported across the road by a heated trolley. The home was clean and without odours. There was again a mix of good and poor practices in relation to infection control. The home has a good supply of wall-mounted hand disinfection points but the communal toilets have non-disposable hand towels provided. Springfield Nursing & Residential Care Home DS0000011519.V316828.R01.S.doc Version 5.2 Page 26 The staffs continue to keep prescription and unlabelled creams and toiletries in bathrooms. This was a concern identified at a previous visit. It is not considered good practice for the prevention of infection. Also a number of bars of soap were being stored in the bathrooms and one resident was storing a used urinal on his tabletop. During the two days the staff were observed placing seat cushions on dining table tops and wheelchairs were noted to be dirty. One upstairs bathroom was being used as a storage area for the hoist. Overall the home is nicely decorated and the décor is pleasant and liked by the residents. Residents were complimentary regarding the facilities and the gardens. They spoke highly of the gardener and maintenance personnel. Overall the majority of comments made by residents were that, “Rooms and surroundings are always clean and well looked after” Springfield Nursing & Residential Care Home DS0000011519.V316828.R01.S.doc Version 5.2 Page 27 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The staffing levels have not improved since the last inspection and indications are that home 74 is understaffed. There is a consistency for the provision of training, supervision and induction. There are areas where staff need additional training if they are to understand the needs of residents and practice safely. The recruitment practices are poor and do not safeguard residents. This continuing non-compliance may now lead to further action by the regulator. EVIDENCE: The pre inspection comment card responses indicated that there was a concern regarding the level of staffing in the home. Overall comments received were, • • • • • “Not enough staff on duty.” “Staff are stretched.” “Sometimes reminders have to be given before action is taken to get the medical support needed.” “Generally there is not enough staff.” One comment card was very specific and stated “Not enough staff in 74.” DS0000011519.V316828.R01.S.doc Version 5.2 Page 28 Springfield Nursing & Residential Care Home One concerning comment from a relative was, “Staff can be impatient and abrupt but this could be because they are so stretched”. A further comment received was, “Staff are especially abrupt on night duty”. During the inspection it was reported that staff have been rewarded with cash in hand for struggling through when short staffed. Staff stated that agency staff are not employed and when there is staff sickness or absence, we all just, “ muddle on together.” One comment card reported, “There are never enough staff in the lounge; I think residents have fallen when unsupervised.” Staff further commented, “It’s always the same people going off sick especially at weekends.” “When we are short staffed the staff’s morale is low. Its difficult to do a twelve-hour shift when you are short staffed, especially when it happens regularly.” Further comments were, “Weekend staff do not seem to answer the buzzers as quickly at weekends as the staff do in the week” and “Evening and weekend staff seem to be very slack, there never seems to be anyone around especially at mealtimes”. The duty rota seen had been altered with tippex with changes made. The inspectors did not consider that at all times the home was adequately staffed so as to meet the needs of service users. The duty rota and discussions with staff would indicate that on a weekend recently there were only three staff on duty for twelve hours to look after all residents in house 74 and at night there is just one nurse and one care worker. House 74 There is only one trained nurse on night duty with one care worker at night to support up to 25 service users with nursing and mental health needs. Comments received and the outcomes of this report would indicate that are inadequate staffing levels in this home. As the houses are across two sites the staff cannot be present in one house and considered to be part of the numbers in the other. The current registration of the home indicates that all twenty-five service users may be OP: “old age, not falling within any other category”. It was very apparent that a high number of service users had mental health needs and the staff had not been trained in this area. This also has a direct impact on the increased needs and dependency of clients and therefore staffing levels. Springfield Nursing & Residential Care Home DS0000011519.V316828.R01.S.doc Version 5.2 Page 29 The home does employ activity co-ordinators which the nursing care side of the service (house 74) has not had previously. The newly appointed member of staff is just establishing herself. The lack of supervision and poor practice outcomes are an indication of poor quality staffing. Staff recruitment files were audited and it was found that staff have continued to be employed without all the necessary checks being undertaken. Staff working had a lack of police checks and /or had portable checks and lacked two references. There were 14 staff employed who are under 16 years of age employed as kitchen assistants. The manager stated she had not undertaken the usual checks for all these staff despite establishing that one of these staff members had a conviction shown up on a random police check. Records did not demonstrate education authority consultation regarding employment of persons in full time education. The manager was reminded at the previous inspection that all staff must have satisfactory CRB and POVA clearances as well as two satisfactory written references before commencing employment. Despite this staff have been employed again without the full and necessary checks. There was quite a diversity of opinion from staff regarding training. Some stated they receive a good level of training and some staff stated they had had not. Practices observed and discussions with staff indicate staffs have not received the necessary training in communication, supporting people with mental health needs, adult protection and training for the prevention of abuse, infection control and medication. The staff were divided in whether they offer good training and outside courses but did feel the home does well to keep up with the times. Staff reported that they felt they treated everybody as individuals and do everything they can for people. They stated they liked to ensure that relatives are made to feel welcome. Staff files regarding training, supervision and induction were inconsistent. In house 72 staff records appear updated regarding inductions and supervisions. In house 74 some supervision records and induction records have not been updated. Comment card feedback from staff stated they weren’t receiving supervision and were giving medication without being trained. They stated they were Springfield Nursing & Residential Care Home DS0000011519.V316828.R01.S.doc Version 5.2 Page 30 undertaking blood sugar monitoring but did not understand the relevance of the result so didn’t feel they should be doing this. Despite this overall the staff felt the home is a very good home and that they felt they are always improving their service. One comment was “It’s a happy home and I am really happy working here”. Further comments were, “The home gives good quality care and is clean and spotless” and “The home provides an outstandingly beautiful environment to live in and makes every effort to maintain dignity and meet needs.” Springfield Nursing & Residential Care Home DS0000011519.V316828.R01.S.doc Version 5.2 Page 31 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,34,35,36,37,38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The methods of monitoring quality of service provision in house 74 needs improving. Whilst the registered manager is undoubtedly experienced and qualified the overall management of the home is poor. The manager has failed to address the concerns raised following the previous inspection. Concerns have been raised again regarding recruitment practices and fire safety. There are concerns in respect of the training of staff and for health and safety. Springfield Nursing & Residential Care Home DS0000011519.V316828.R01.S.doc Version 5.2 Page 32 EVIDENCE: The previous agreement by the commission to accept a single manager for the residential and nursing homes led to the actual operation of both homes as a single home. Since then the commission agreed to register the two services as one despite each one providing a very different philosophy of care. There may be some advantages to this arrangement for the owner but it is very apparent that there continue to be disadvantages for service users. The registered manager has been employed as manager for eleven years. Her qualifications are listed in the statement of purpose and include NVQ level 5 in operational management and MSc in Gerontological practice. Following the registration of both houses as one care home, the management structure for each home has been slightly altered. The manager is responsible for the over all management of the care home. Each house has a separate member of staff who is responsible for the day-to-day running of the house. During this inspection process there have been clear differences between the care service provisions over the two houses. House 74 Considering the dependency of the clients and the need for a high level of nursing care interventions by staff there is a distinct lack of registered nurse supervision of care staff and their practices. Staffs appear dismissive and unsupported. The main presence in the communal areas in house 74 was three care workers mostly. The outcomes would indicate there is a lack of monitoring of care practices and supervision to address poor practice. A shortage of staff is also clearly having an effect to the quality of care especially in house 74. Information provided is not adapted to meet the needs of individuals with sensory impairments or communication difficulties. The high ratio of service users with mental health needs have not been adequately considered in the training of staff and for care practice. The staffing levels are inadequate and the house lacks a good care practice philosophy to enhance the quality of resident’s daily lives. The opinions of some service users are not probed and staff do not consider innovative ways to ensure each individual’s needs and expectations are met and the quality of their lives enhanced. Springfield Nursing & Residential Care Home DS0000011519.V316828.R01.S.doc Version 5.2 Page 33 The manager is starting to undertake individual residents’ annual reviews. In these reviews staff, relatives and service users are given the opportunity to express their needs, satisfactions and expectations. The inspector was concerned again that the relatives /representatives were invited to be involved directly and service users may be overlooked. One residents daughter explained she had an appointment with the manager for a review of care but wasn’t sure if her mother (the resident) was also going but was sure she could if she wanted to. The resident was not aware of the meeting. Less able residents do not seem to be at the centre of decision making despite having full capacity. Relatives appear to be driving force behind consultation and decision making in house 74. House 72 The quality processes implemented by the manager are well suited to individuals who can express their satisfaction and verbalise their dissatisfactions. This in turn has led to good quality monitoring and outcomes for service users in house 72. Staffing seems appropriate and the resident’s dependency is lower. During the two days the inspector noticed numerous staff assisting in the dining and living areas. There were servers, the activities co-ordinator, the managers, administrative staff and care staff. There is a buzz of social activity and conversation. Residents are able to converse with the manager and discuss any issues through out the day. They reported that these issues are always addressed promptly. Overall the manager has put in some very good quality monitoring tools, which can measure the quality of care by responses from individuals who have the capacity to verbalise their needs/dissatisfactions. But, there is a lack of monitoring outcomes for people who are unable to communicate their needs. The outcomes for the more dependent and most vulnerable service are not measured/audited. Residents in house 74 do not receive the same quality of care as those in house 72. The manager stated and showed a food audit, which had been conducted in 2004, but this had not been undertaken recently. The manager and catering staff stated this would be undertaken in December 2006. The service has very nicely presented staff portfolio documents for staff to complete during induction and supervision. Induction documents fully meet the Springfield Nursing & Residential Care Home DS0000011519.V316828.R01.S.doc Version 5.2 Page 34 skills for care recommendations. Staff can record any ongoing training and development. Some of these records have not been completed. The records audited would indicate the standard of induction undertaken by care staff varies depending on which house you are allocated to. When walking around the establishment it was noted that a large number of fire doors are being wedged open. One door lacked a closure. One comment received reported that some doors are too heavy to open especially when using walking aids. At the previous inspection visit many fire doors were being wedged open. A requirement was raised to address this. Despite this, the practice continues. Also during the previous visit several storage cupboard doors had signs on stating they were fire doors and should remain locked. It was stated at this time that in practice these doors are being left open, as access is needed by all staff to obtain linen and equipment. Concern was raised that as these doors are being left open, a culture might develop where doors that should be locked are in fact not locked. This was seen to be the case when a door into a boiler room was left unlocked; and it was identified this could pose a risk to residents who might wander into it. Despite a new lock being put on this door during the second day of the March visit, and assurances given by the manager to address this the above concerns were identified again during this inspection. On the first day of the visit it was pointed out to the manager that there were substances hazardous to health left on a counter top in the sluice. The house does have a high ratio of service users who are confused. The cleaning agents remained there throughout the second day also. Springfield Nursing & Residential Care Home DS0000011519.V316828.R01.S.doc Version 5.2 Page 35 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 1 X X HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 1 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 1 18 1 2 2 3 3 2 3 3 2 STAFFING Standard No Score 27 2 28 2 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 2 2 3 X 2 2 1 Springfield Nursing & Residential Care Home DS0000011519.V316828.R01.S.doc Version 5.2 Page 36 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 OP3 Regulation 14 Requirement The registered person must not provide accommodation to a service user unless the needs of the service user have been assessed. The registered persons must ensure that a plan of care is drawn addressing the needs of residents. This has been raised previously and the timescale of 31/03/06 has not been met. 3 OP7 13 The registered person must ensure the care practice and assessments meet relevant clinical guidelines and assessed needs in respect of moving and handling. The registered person must ensure care records are reflective of the current needs, are reviewed appropriately and drawn up with the involvement of the service user. The registered person must ensure care staff maintain the DS0000011519.V316828.R01.S.doc Timescale for action 01/01/07 2 OP7 15 01/01/07 01/01/07 4 OP7 15 01/01/07 5 OP8 12 01/01/07 Springfield Nursing & Residential Care Home Version 5.2 Page 37 6 OP8 17,15,16 7 OP8 14 8 OP10 12(4) 9 OP12 12(4) 10 OP14 12(2) 11 OP15 16,14,15 oral hygiene of each service user. The registered person must ensure that the risks identified in relation to pressure sores are acted upon in lines with best practice (research and evidence based). Cushions must be used where indicated and the review of rings and straps undertaken. The registered person must ensure the nutritional screening is reflective of current needs and risks. Food and fluid records must be maintained where there is a risk. Where there has been significant weight loss appropriate actions must be taken. The registered person must take whatever action she considers necessary to ensure staff treat service users in a respectful and dignified manner at all times. The registered manager must ensure consideration is given to people with dementia and other cognitive impairments, those with visual, hearing or dual sensory impairments and those with physical disabilities when providing social stimulation It should be provided through seeking consent and suit their needs and preferences. The registered person must ensure that she conducts the home so as to maximise service users capacity to exercise personal autonomy and choice. Service users must not be bypassed in favour of relatives and representatives without establishing capacity of the individual. The registered person must ensure service users receive regular fluids and the necessary DS0000011519.V316828.R01.S.doc 01/01/07 01/01/07 30/11/06 01/01/07 01/01/07 01/01/07 Springfield Nursing & Residential Care Home Version 5.2 Page 38 12 OP15 12 13 OP16 22 14 OP17 12 15 OP18 12 support when eating and drinking. Review of the current system and timing of meals and any delay must be addressed. Service users must be able to choose where they eat. The registered person must ensure staff are ready to offer assistance in eating where necessary, discreetly, sensitively and safely while independent eating is encouraged for as long as possible. The registered person must improve the ways and opportunities for service users with disabilities to access and make a complaint. (house 74) The registered person must ensure where a service user lacks capacity there is some sort of advocacy to ensure they are safe, represented and well cared for. The registered person must address poor staff conduct and practice and monitor outcomes for service users to ensure they are safe and well looked after. Issues relating to abusive practice must be addressed through local adult protection policies. Poor staff conduct must be addressed through the home’s disciplinary procedures. 01/01/07 01/01/07 01/01/07 01/01/07 16 OP18 13 17 OP18 13 The registered person must 01/01/07 make arrangements by training staff or by other means to prevent service users being harmed or suffering abuse or being placed at risk of harm or abuse. The registered person must 01/01/07 ensure the policies and practices of the home ensure that behaviours, which challenge from service users is understood. DS0000011519.V316828.R01.S.doc Version 5.2 Page 39 Springfield Nursing & Residential Care Home 18 OP19 23(4) 19 OP20 23 20 OP22 23 21 OP22 23 22 OP26 13(3&4) Staff must have an understanding of how to approach service users without causing distress. The registered person must ensure the practices within the home comply with the recommendations of the fire service in respect of wedging open fire doors. The registered person must ensure service users with disabilities and using wheelchairs have adequate space to move in all communal areas, to sit with their relatives and be handled safely. Nursing beds must not be positioned against walls. The registered person must seek the professional opinion of an occupational therapist/ physiotherapist regarding the use of space, the provision of aids and for the safe manual handling of service users. The registered person must ensure there is appropriate storage for equipment and medical products. The registered persons must address the current practice of providing shared toiletries in bathrooms for residents. This has been raised previously and the timescale of 30/04/06 Has not been met Issues regarding the use of non disposable towels, storage of used soap in communal bathrooms, urinals placed on table tops and cushions on dining tables must be addressed in the interests of cross infection. You are required to contact the health protection infection 30/11/07 01/01/07 01/01/07 01/01/07 01/01/07 Springfield Nursing & Residential Care Home DS0000011519.V316828.R01.S.doc Version 5.2 Page 40 23 OP30 12,18 24 OP30 12,18 25 OP32 10,12,24 26 OP33 24 27 OP36 18 28 OP37 17 29 OP37 17 control nurse to seek any necessary advice The registered person must ensure staff have received training in dementia care, communication, and prevention of abuse and protection of vulnerable adults, manual handling and medication. The training must improve practice and have the desired outcomes. Staff must be observed in practice and deemed competent. The registered person must ensure the portfolios provided to staff for induction, training and supervision are completed. The registered person must implement a strategy which enables service users in house 74 to participate in the way the service is being delivered and must ensure the conduct of staff is within the code of practice from the Social care council. The registered manager must ensure there is continuous monitoring of quality of care received by service users in house 74 who do not have the capacity to complete in house questionnaire. The registered person must ensure staff are supervised in their everyday practice and formally at least six times a year. The registered person must ensure that there are accurate records of who is present in each house. The registered person must review the practice for placing a nurses station in the residents lounge area, using this area to give verbal accounts of care and not securely storing personal information regarding service DS0000011519.V316828.R01.S.doc 01/01/07 01/01/07 01/01/07 01/01/07 01/01/07 01/01/07 01/01/07 Springfield Nursing & Residential Care Home Version 5.2 Page 41 30 OP38 13 31 OP38 13(4) users. The registered person must address poor and unsafe practices identified in manual handling, fire prevention, use of wheelchairs and the lack of footplates, the storage of substances hazardous to health, the unlocking of certain doors which pose a risk to service users.. The registered persons must endure that notices on the fire doors accurately reflect whether they must be kept locked or not. This has been raised previously and the timescale of 23/04/06 has not been met 30/11/06 01/01/07 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 Standard Good Practice Recommendations Springfield Nursing & Residential Care Home DS0000011519.V316828.R01.S.doc Version 5.2 Page 42 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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