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Inspection on 27/11/06 for Springfield Residential Care Home

Also see our care home review for Springfield Residential Care Home for more information

This inspection was carried out on 27th November 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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

Staff in the home were very patient with service users and showed full respect to them. They called them by their preferred names, as seen for one of the case tracked service users and several others. Helping and supporting users that was observed, matched the instructions in service users care plans. The home offered a range of activities that service users could join if they wanted. Forthcoming Christmas events were organised at various times during the day, allowing service users to choose the time of the day that suited them to join activity. Service users` comments about the care and support they were receiving were very positive. A case tracked service user stated: "Excellent, that`s how I would describe it." A visitor made similar comments stating: " This is an excellent home, they (staff) are brilliant. They are kind, they offer us a cup of tea whenever we come. We had to wait for the place to become available for my mother." A service user, present at the time, added: "This is a good place indeed." Staff spoken to felt the same about their work conditions and support. A staff member commented on training: "We get all training we want. And our training is relevant to the work we do here."Another service user was please with the Jesus picture above her bed that she brought in: "Jesus looks after me. These people here, they are marvellous. I could not go anywhere better."

What has improved since the last inspection?

The home responded to the requirements set on the previous inspection. The kitchen was improved by the replacing required facilities. The provider was visiting service regularly on a weekly basis and the reports were sent to the inspector in a month preceding site visit. Staff training was improved and as a part of response to the requirement, all staff attended training on protection (POVA). Care plans contained staffing signatures, but there was a room for further improvements whereby care plans should be offered to service users to sign. Maintenance book contained elements reported that needed attention. The records also showed when the reported work was completed, demonstrating relatively fast response. Fire book demonstrated that fire alarm tests were carried out on a weekly basis. The basic information sheet in front of the service users` files provided very good description of service users and their needs.

What the care home could do better:

Based on the findings of inspected standards for wider studies, the provider should ensure that letters with information of yearly adjustments of the fees should be given to service users one month prior to their effectiveness. Copy of the contract should be given to all service users. Although care plans were signed by the person writing them, service users should be offered the opportunity to sign them, too.

CARE HOMES FOR OLDER PEOPLE Springfield Residential Care Home 63 The Causeway March Cambridgeshire PE15 9NY Lead Inspector Dragan Cvejic Unannounced Inspection 27th November 2006 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Springfield Residential Care Home DS0000037329.V321708.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 Residential Care Home DS0000037329.V321708.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Springfield Residential Care Home Address 63 The Causeway March Cambridgeshire PE15 9NY 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) 01354 652451 01354 652451 Orchid Care Homes Ltd Mrs Carole Wood Care Home 29 Category(ies) of Dementia - over 65 years of age (29), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (29), Old age, not falling within any other category (29) Springfield Residential Care Home DS0000037329.V321708.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 20th February 2006 Brief Description of the Service: Springfield provides accommodation, care, and support for up to 29 older people including those with dementia or a mental disorder. The home is a large detached property near to the centre of March. The building has been extended and equipped to meet the needs of older people, some of whom may have difficulty with mobility. Accommodation is on two floors, the upper floor being accessed via a stair lift. The home has 25 single and 2 double rooms; four bedrooms have en suite facilities. Service users have access to 8 toilets and there are 4 bathrooms, though a number are unsuitable for their purpose and the proprietor plans to remove one bath and provide a walk-in shower. Shared accommodation comprises 4 sitting rooms and 3 dining areas. There is a large well-maintained garden, which is enclosed and suitable for the needs of older people. Care staff are employed to support service users by day, and two waking staff are on duty overnight in case help is needed. Springfield Residential Care Home DS0000037329.V321708.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection that lasted for 7 hours. As part of this unannounced inspection the quality of information given to people about the care home was looked at. People who use services were also spoken to, to see if they could understand this information and how it helped them to make choices. The information included the service user’s guide (sometimes called a brochure or prospectus), statement of terms and conditions (also known as contracts of care) and the complaints procedure. These findings will be used as part of a wider study that CSCI are carrying out about the information that people get about care homes for older people. This report will be published in May 2007. Further information on this can be found on our website www.csci.org.uk. Inspection of other standards was carried out by case tracking 3 service users, speaking to them, as well as two other users, checking their files that contained details of care they received and checking environment in which they spent their time. The person in charge, the senior carer provided information for the inspection, as the manager was on annual leave. Two more staff commented on their perception of care for service users and staff’s satisfaction. The files of three staff were also checked. A visitor invited the inspector and gave an overview of the home and standards of care for her relative, service user in the home. What the service does well: Staff in the home were very patient with service users and showed full respect to them. They called them by their preferred names, as seen for one of the case tracked service users and several others. Helping and supporting users that was observed, matched the instructions in service users care plans. The home offered a range of activities that service users could join if they wanted. Forthcoming Christmas events were organised at various times during the day, allowing service users to choose the time of the day that suited them to join activity. Service users’ comments about the care and support they were receiving were very positive. A case tracked service user stated: “Excellent, that’s how I would describe it.” A visitor made similar comments stating: “ This is an excellent home, they (staff) are brilliant. They are kind, they offer us a cup of tea whenever we come. We had to wait for the place to become available for my mother.” A service user, present at the time, added: “This is a good place indeed.” Staff spoken to felt the same about their work conditions and support. A staff member commented on training: “We get all training we want. And our training is relevant to the work we do here.” Springfield Residential Care Home DS0000037329.V321708.R01.S.doc Version 5.2 Page 6 Another service user was please with the Jesus picture above her bed that she brought in: “Jesus looks after me. These people here, they are marvellous. I could not go anywhere better.” 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. The summary of this inspection report can be made available in other formats on request. Springfield Residential Care Home DS0000037329.V321708.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Springfield Residential Care Home DS0000037329.V321708.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4,5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users were given opportunity to decide if the home was be the place they wanted to move in and that their needs would be met if admitted. EVIDENCE: The group of standards inspected here were part of the wider inspection process for the national study. The service had their statement of purpose and service user’s guide. Two service users could not remember whether they were given user’s guide and another user stated that was given the guide and gave it to her niece. Written documents kept in users’ files contained terms and conditions of the residence, but there was no written evidence of giving new users the service user’s guide. Springfield Residential Care Home DS0000037329.V321708.R01.S.doc Version 5.2 Page 9 A visitor stated that she was given the user’s guide when her mother was admitted to home. Two users stated that changes were communicated to them verbally, while the third user commented that she received a letter and gave it to her niece. Written contracts with terms and conditions, including the fee, were kept in service users’ files. One file contained an additional letter, originally sent to a grandson of service users, confirming that the home had a telephone contact with him too. The documents demonstrated that upon admission, users were provided with a trial period, that varied between 3 and 4 weeks. One of the case tracked users was initially admitted for respite care and after period of time was offered a permanent place, for which a new contract was made, approximately 4 weeks in advance. All files contained copies of letters informing them of fee changes on a yearly basis. The dates showed that these letters were given to users 3-4 weeks before becoming effective. A visitor also stated that she was sent the letter in advance to the effective date for change of fee. The contract was clear, understandable and looked fair. Admission documentation was well presented and demonstrated that the home undertook extensive assessment prior to offering places to service users. In all three inspected cases, there was a copy of a letter sent to users’ GP asking for specific health information. The home’s assessment form covered required areas of users conditions, abilities and preferences. Service users’ comments on admission assessment confirmed that the procedure was followed. One user stated that the manager visited him for the assessment. Another user stated: “The lady that brought me here has died. I came first as a respite, but than stayed.” The third user case tracked stated that she could not remember her initial assessment. Observation of care practices demonstrated that users’ needs were met. Records showed when external professionals were called to attend users’ needs. All three files inspected confirmed that service users were admitted with an initial trial period and that they had contact and two of them visited home prior to admission. Springfield Residential Care Home DS0000037329.V321708.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users health care needs were appropriately dealt with and recorded that enhanced the respect shown to users that exceeded minimum standard. EVIDENCE: Service users’ care plans were detailed and described the needs and the agreed method for meeting users’ needs. The front sheet in each file contained a summary of the needs and clear description of each user, allowing staff to effectively work with them and meet their needs. Care plans were reviewed at the intervals of one to two months, depending on users’ conditions. The files also contained relevant charts, where records of specific needs were closely monitored and changes were acted upon when the need for change was identified. Care plans were singed by the person writing them, but there was no specific place on the form for service users to sign. Springfield Residential Care Home DS0000037329.V321708.R01.S.doc Version 5.2 Page 11 The home had bedroom doors in different colours, although this method did not prove expected effectiveness and a hand-lady was redecorated the doors at the time of site visit. The staff were observed dealing exceptionally patiently with service users. Even those users confused by dementia were treated with high respect. Privacy and dignity were incorporated into objectives and, as observed and confirmed by users’ comments, exceeded minimum standards. The home’s medication procedure was safe and acted to protect service users. There were no service users who were able to use their medication independently. The medication records matched the number of tablets in checked case. Staff were observed checking with a user if she wanted her prescribed painkiller: “Do you want your aspirin?” “Yes, please, dispersible”, responded user, pleased with the respect shown to her. Medication was kept in a safe room. Springfield Residential Care Home DS0000037329.V321708.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Respect for individuals regarding their daily routine, autonomy and mealtimes evidently exceeded the minimum standards and determined users’ high satisfaction in the home. EVIDENCE: The notice board in the entrance hall was used to inform about planned activities. The forthcoming Christmas events dominated, although regular activity programme was present, too, showing variety and different timing of the events allowing users to fit activities into their preferred daily routine. All service users spoken to expressed satisfaction with the range and flexibility of the activities. This approach ensured that majority of service users could choose and decide for themselves whether they wanted to contribute. A special chart with Italian expressions was made available to staff to help with care process for the said user. This standard exceeded minimum expected outcome. Springfield Residential Care Home DS0000037329.V321708.R01.S.doc Version 5.2 Page 13 The home engaged an interpreter on a weekly basis and periodically for reviews and care planning meeting for a service user from Italian background. Breakfast time was observed and contributed to judgement about respect for service users. Users’ wishes and preferences were known to staff and were encouraged as part of promoting individuality. Many activities were open to visitors, relatives and other friends from the local community. Service users autonomy was also promoted. A service user stated: “My niece deal with my finances, but I always have a couple of ponds in my bag, just in case.” Service users possessions were recorded on admission and users could enjoy their favourites, as seen in a service user’s room who proudly showed Jesus’ picture and statue, among family photographs. Mealtimes seemed to be considered as social gatherings in the home and users were looking forward to spending time together. Staff sensibly helped those that needed help feeding. When users chose the meal outside pre-planned menus, the alternatives were recorded. Menu showed nutritional and varied diet. Service users commented on food summarising it as “Excellent”. Relaxed atmosphere and politeness dominated meal time, affecting the judgement of the standards to be exceeded. Springfield Residential Care Home DS0000037329.V321708.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service users felt empowered and trusted and were provided with clear opportunity to voice their potential concerns and complaints. EVIDENCE: The standard related to complaints was inspected for the purpose of the wider study. All three case tracked service users were confident that could complain if they wanted. They did not relate the written procedure with their opportunities to complain. The complaint procedure was clear with a time scale and was part of the users’ guide and also was displayed in the home. The home had policies and procedures in place to ensure protection of service users. Staff spoken to were fully aware of the whistle blowing policy. The main, predominant factor that ensured protection of service users was respect for them. They felt individuals and stated that they would say if there was anything or anyone that they did not like. Accidents/incidents were appropriately recorded and analysed to minimise reoccurrence, as reported in information sent to the CSCI. Springfield Residential Care Home DS0000037329.V321708.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19,24,25,26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provided a pleasant, clean and comfortable environment where service users could retain their level of independence. EVIDENCE: The kitchen, addressed on the previous inspection by requirements, now looked clean, tidy, well equipped and kitchen staff commented while making home made tea cakes: “It is better now. Everything works.” Maintenance book was used to report any faults within the home. The same book had records when the work was completed for each individual entry. The first floor was connected by stair-lift and those that needed access to this floor were able to use stair-lift. Springfield Residential Care Home DS0000037329.V321708.R01.S.doc Version 5.2 Page 16 The door to the garden was replaced during the site visit, after being reported to be “sticky”. Service users were pleased with an opportunity to bring their own pieces of furniture, equipment or memorabilia. The home was clean and bright, the cleaning staff attended immediately when the spillage occurred during the site visit. A maintenance lady commented that she was previously carer, but changed her role to housekeeping tasks. She enjoyed decoration and showed her work that demonstrated her attention to detail. Infection control measures were in place. The laundry room was clean and tidy with modern facilities that helped meeting users’ needs regarding their laundry. Although the bathroom on the first floor had a note: Out of order, the other bathing facilities that included some en-suite facilities were sufficient to meet the needs of service users. Springfield Residential Care Home DS0000037329.V321708.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Well trained and organised staff were able to meet the users’ needs and to feel satisfied with their terms and conditions of work. EVIDENCE: Staff rota demonstrated that there was a sufficient staff number on each shift. Staff were well organised and clear of their duties and tasks. A staff member stated: “We pay extra attention to the user whose health deteriorated.” Since the home was fully staffed, the use of the agency staff was minimised. Staff files demonstrated that all relevant checks were carried out when new staff were employed, including Criminal records and POVA checks, 2 references and exploring a gap in previous employment (seen in one file). The senior carer on duty stated that about 8 staff members had completed their NVQ and that a significant number of staff were currently working towards NVQ qualifications. Staff files contained training certificates and the training plan also demonstrated a significant improvement in training. All staff completed training on protection (POVA), as required on previous inspection. Springfield Residential Care Home DS0000037329.V321708.R01.S.doc Version 5.2 Page 18 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): 31,32,33,35,38 Quality in this outcome area good. This judgement has been made using available evidence including a visit to this service. Service users were well protected by the safe working practices in place. EVIDENCE: Although the manager was on annual leave during the site visit, her style and management skills were visible in the way how the home operated: well organised, knowledgeable and committed to the work with service users. The manager completed her Registered Manager’s Award and her certificate was displayed. Springfield Residential Care Home DS0000037329.V321708.R01.S.doc Version 5.2 Page 19 A very good staff atmosphere was seen during the site visit when most staff gathered together for a few minutes around the table showing the strength of the team work atmosphere. A visitor commented that she filled in quality assurance survey. She confirmed that essential information and changes were communicated to relevant people. The home encouraged service users to refer to their families financial matters, if they needed support to manage their finances. A service user stated: “My daughter deals with my money. I trust her. I always have a couple of pounds with me if I need them.” The letters informing users on changes of fees and copies of financial arrangements from social services, that were kept in users’ files clearly stated their entitlement and figures of their personal allowances. The home had safe working practices regulated in policies and, as observed implemented in daily work. The staff were trained in all mandatory training subjects. Staff were proud to say that training was relevant to their roles and implemented in their work. The home was inspected by fire department, environmental health and the records of testing small electrical appliances was checked during the site visit. Accidents/incidents records were also checked, as part of case tracking. Springfield Residential Care Home DS0000037329.V321708.R01.S.doc Version 5.2 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 4 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 4 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 X X 3 Springfield Residential Care Home DS0000037329.V321708.R01.S.doc Version 5.2 Page 21 Are there any outstanding requirements from the last inspection? no STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP2 OP2 Good Practice Recommendations When the fees change the letters should be made and given to service users one month in advance of the date when changes take place. The home should ensure that there is an evidence that contract was given to all service users and periodically remind service users of the existence of the contract that also described terms and conditions. Care plans should be offered to service users to sign in cases they were able to do so. 3. OP7 Springfield Residential Care Home DS0000037329.V321708.R01.S.doc Version 5.2 Page 22 Commission for Social Care Inspection Cambridgeshire & Peterborough Area Office CPC1 Capital Park Fulbourn Cambridge CB21 5XE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Springfield Residential Care Home DS0000037329.V321708.R01.S.doc Version 5.2 Page 23 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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