Inspection on 19/05/06 for Springfields

This inspection was carried out on 19th May 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Springfields 03/05/07

Springfields 24/01/06

Springfields 03/10/05

Springfields 29/09/04

Similar services:

The Vicarage

Fairfields Country Rest Home

7 Hyde Road

5 Seafield Road

Queensmount

Poldhu

Trevaylor Manor

Didsbury Court Rest Home

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

CARE HOMES FOR OLDER PEOPLE Springfields Bridestowe Okehampton Devon EX20 4ER Lead Inspector Anita Sutcliffe Key Unannounced Inspection 19th May 2006 08:30 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 Springfields DS0000003808.V290041.R01.S.doc Version 5.1 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. Springfields DS0000003808.V290041.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Springfields Address Bridestowe Okehampton Devon EX20 4ER 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) 01837 861430 01837 896430 springfields.bridestowe@virgin.net Mr Byrne Mrs Byrne Mrs Byrne Care Home 34 Category(ies) of Dementia - over 65 years of age (34), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (34), Old age, not falling within any other category (34), Physical disability over 65 years of age (34) Springfields DS0000003808.V290041.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 24th January 2006 Brief Description of the Service: Springfields is an old Rectory on the edge of the village of Bridestowe, 7 miles from Okehampton. The village has a vibrant community and facilities including, shop/post office, pub and church. The home provides accommodation and personal care for 34 older people who may have additional physical disabilities, dementia or mental disorders. It is privately owned and managed. The district nursing service provides nursing input as necessary. Many of the bedrooms have sufficient space to be used as sitting rooms. All have en-suite toilets and some also have en-suite shower rooms. A number of the bedrooms have French windows on to balconies or patios. There are three large lounges, one with a conservatory extension that is used for dining. A separate dining room and a separate seating area are located at the front of the house. Level access is available throughout the home. Information provided April 2006: Fees are between £380 and £430 per week. Additional charges are made for items other than accommodation, meals, personal care and laundry. This includes personal lockable storage and key operated door locks in bedrooms. Prospective residents are sent copies of the Service User Guide. Then they are invited to visit if they wish, and are informed that CSCI reports are available for inspection either in the office or online. Springfields DS0000003808.V290041.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Information gathering towards this key inspection began on April 1st. Comments were received from three service users (residents), one family representative, four staff, a senior district nurse and a community psychiatric nurse. The manager / providers completed a questionnaire providing current information about the service. The inspection visit to the home took place over one day, with feedback to some residents on the same day and the providers on a subsequent day. During the visit all parts of the home were visited, the care of three residents examined in detail and fifteen met with in the lounge and dining rooms, where group discussion was held. The care records of a recently deceased resident were also examined. The lunch of the day was sampled. Staff answered questions and were observed working. Recruitment, care, training and medication records were examined and discussion held with both providers. What the service does well: What has improved since the last inspection? What they could do better: Safe recruitment practice has not been followed. This puts residents at risk from people who may be considered unsafe to care for them. No CRB Springfields DS0000003808.V290041.R01.S.doc Version 5.1 Page 6 disclosure check was requested for one employee; others had started work in the home before theirs were returned. The POVA list, which is of people classed as unsafe to work in care homes, had not been checked. The employment history of staff was minimal and staff applying for posts have not been required to mention any ‘spent’ criminal convictions they may have. These points were being addressed before the inspection was complete. The safe handling of medication should be further assured when the provider’s purchase a lockable trolley. This is currently being researched. Medicines will not then be openly available to confused residents if staff are distracted whilst administering them. All medicines must be checked into the home on arrival, and where the entry on the medicines record is hand written, it is recommended that two staff check and sign that the information is correct. The medicines policy should include what staff must do in the event of a mistake being made. All written care plans should be kept up to date so that staff are able to deliver care consistently to standards agreed with the resident. More detail and breadth of information is recommended, particularly where the needs of a resident are complex. There should also be a record of any end of life wishes, and a process for reviewing those wishes. To protect residents all staff should receive training in the protection of vulnerable adults from abuse, and policies should contain the contact details of the Local Authority Vulnerable Adults team so that staff have the option of contacting them if they have concerns. The procedure to be followed in the event of an allegation of abuse should be changed to more clearly reflect the local authority ‘No Secrets’ guidance. This is so that any allegation is handled in the resident’s best interest. All dementia care delivered should be based on current good practice. To this end information from a specialist source, and including on-going training, should be available to staff and inform both the care and service planning. This will be in the best possible outcome is available for residents. Window restrictors in first floor rooms and radiator covers, where not already in place, should be fitted to further protect residents from the risk of harm, unless individual risk assessment deems this unnecessary. Springfields DS0000003808.V290041.R01.S.doc Version 5.1 Page 7 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Springfields DS0000003808.V290041.R01.S.doc Version 5.1 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Springfields DS0000003808.V290041.R01.S.doc Version 5.1 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 & 4. 6 does not apply Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Care needs are met following thorough assessment and planning. The home fully meets the needs of its residents who have age related conditions, physical disability or mild dementia. It is less experienced in managing complex behaviour associated with advanced mental health conditions. EVIDENCE: Assessment is undertaken diligently. It includes an assessment of any perceived risk. A plan of how the care will be provided is then written in consultation with the resident whenever possible, or a family member or representative if not. All personal and physical health care needs are met to a high standard. The building is very suitable to accommodating the needs of residents with a physical disability; equipment is available to increase independence. The ethos Springfields DS0000003808.V290041.R01.S.doc Version 5.1 Page 10 of Springfields ensures that the emotional needs of residents with mild dementia are well met. However, the home should ensure it has current, researched based information on how to care for residents with dementia, so that good practice can be followed as the condition becomes more advanced. (See also Standard 7). Staff have the skills, will and professionalism to deliver a high standard of care to all residents at the home. Springfields DS0000003808.V290041.R01.S.doc Version 5.1 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 & 11 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Health and care needs are met by staff, which are knowledgeable, skilled and caring. Privacy and dignity are upheld. Medicines are handled diligently, but safety could be further improved. Plans of care were satisfactory, but could be improved. EVIDENCE: Comment received from a health care professional included: “Residents are cared for and looked after in the home with kindness, respect and a great understanding of all their needs”. A senior district nurse feels the home’s management of health and personal care are excellent and adds: “communication between carers, owners and the district nursing team is also excellent”. Springfields DS0000003808.V290041.R01.S.doc Version 5.1 Page 12 Residents confirmed that all their health care needs are met and that they are treated with respect and dignity. Care records further confirmed that the home calls on health care professionals, such as consultants, chiropodist and opticians, on a regular basis. The planning of care is done in consultation with the resident and / or family, and is reviewed on a monthly basis. However, for one resident the review stated ‘No Changes’ despite deterioration due to advancing dementia, clearly causing her distress. (See Standard 4). Neither did the plan give clear instructions to staff in how best to help the resident at this time; a staff member confirmed that this would be useful. Professional help had already been sought in the resident’s best interest. A community psychiatric nurse felt that the home care for people with mild to moderate dementia very well, but are less able to help residents with more advanced dementia and challenging situations associated with this. End of life care is delivered expertly and with dignity and caring. However, the home should record the end of life wishes of a resident and give every opportunity for them to be expressed. Staff are well trained in handling medication and do it diligently. Storage is safe, but medicines are taken to residents on an open trolley. The senior carer said that the home has already decided to buy a lockable trolley for safety. The recording of all information about medicines was clear. However, where information had been hand written there was no signature, date or record of the quantity of medicines on arrival, which affects the ability to audit their use as a safety measure. It is also recommended that two staff check and sign information which is hand written so as to limit the possibility of error. The drugs and medicines policy provides good detail, but should include what to do in the event of a mistake being made. Springfields DS0000003808.V290041.R01.S.doc Version 5.1 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are supported to lead a fulfilled life. Residents receive a nutritious varied diet, which meets individual choice and health care requirements. EVIDENCE: The home works hard to provide choice and meet the diverse and individual needs of residents. Staff spoke enthusiastically of their role in this. One resident said “although it’s not my (original) home, they couldn’t do more to make you happy”. Bedrooms are very personalised, some like ‘mini apartments’ containing, for example, tea-making equipment. There is much evidence that hobbies and interests are promoted; musical equipment, bird feeders, books and needlework were seen. Outings are arranged and the home is part of the village community; some residents choose to attend the over 60’s club. Springfields DS0000003808.V290041.R01.S.doc Version 5.1 Page 14 Activities organised include a weekly sherry morning and a visiting ‘pet’ dog. Visitors are welcomed at the home. Staff are currently looking for additional ways to meet the challenge of improving residents’ lives, especially those who are more isolated because dementia has reduced their ability to communicate. The home provides a varied and nutritious menu. On the day of the inspection visit the main lunch offered was fish and chips, but some residents chose differently. The food was well-prepared and good quality. The pudding was either sponge roll and custard or various fresh fruits, again providing choice and variety. All but one resident was very complimentary about the food. Comments received included “good” and “excellent”. Two small points about the delivery of the food were raised with the manager who said changes would be put in place immediately. Where assistance was required with eating this was given in a sensitive manner, and where the diet was a medical concern this was well monitored. Springfields DS0000003808.V290041.R01.S.doc Version 5.1 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents benefit from the homes approach to complaints. Residents are protected from abuse, but this protection could be further improved. EVIDENCE: Residents confirmed that they felt safe at the home and had confidence in the staff and management. The majority felt there was no need to make any complaints. Residents and a visitor confirmed that any concerns or issues were dealt with promptly, and the providers use their quality measuring system to prevent problems arising. The Commission have received no complaints, concerns or allegations about the home and the one complaint received at the home had a positive outcome of benefit to other residents. It has been recommended at the previous two inspection visits that staff receive training in the protection of vulnerable adults. This has not yet been achieved, but is listed as future training planned. Two care staff spoken with were knowledgeable about types of abuse and knew what actions should be taken if they had concerns. They also knew where to find the Whistle Blowing and Prevention of Abuse policies at the home should they wish to consult them. These were examined to determine how useful they would be to the staff should they need to raise a concern. It was found that they did not include the contact details of the Local Authority Vulnerable Adults team, and the procedure to be followed in the event of an Springfields DS0000003808.V290041.R01.S.doc Version 5.1 Page 16 allegation was unclear. This could lead to an allegation at the home being poorly handled. Springfields DS0000003808.V290041.R01.S.doc Version 5.1 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is very clean, well maintained and meets residents needs. Safety could be further assured. EVIDENCE: The home is spotlessly clean and hygiene is very well managed. The space available throughout the building is excellent for residents who must rely on a wheelchair. Adaptations help independence and the manager said that coloured carpets help those with dementia to find their way about effectively. The home has a variety of sitting rooms and the bedrooms are very homely, well equipped and individual. Bedrooms do not have key styled locks or lockable storage space unless requested and paid for. Do date nobody had requested a lock for their door. Springfields DS0000003808.V290041.R01.S.doc Version 5.1 Page 18 The majority of radiators have been covered to protect residents from contact burns. The manager said the few remaining would be complete by next winter. Window opening restrictors, which would protect confused residents from falling out, have not previously been considered necessary, but the providers are now reviewing this. Springfields DS0000003808.V290041.R01.S.doc Version 5.1 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The numbers, knowledge, competence and skill mix of staff are appropriate to meet the needs of current residents. Recruitment practice does not fully safeguard residents. EVIDENCE: Staff receive regular training and are knowledgeable. They have a professional approach to their work and take a pride in the standard of care they provide. New staff receive appropriate training on arrival and then work with a senior carer whilst they learn the needs of individual residents. Staff are encouraged to undertake the NVQ qualification in care and to date 43 have achieved this to level 2 and some have achieved level 3. Both the Assistant Manager and a Senior Carer have achieved NVQ 4 in care and management. All residents spoken with, and family representatives, expressed full confidence in the abilities of staff at the home. Both residents and staff felt there were sufficient numbers of staff to meet residents’ needs. On the day of the inspection visit there were 5 care staff, the manager, cook, cleaner and maintenance worker to meet the needs of 30 residents, the majority with low needs. Springfields DS0000003808.V290041.R01.S.doc Version 5.1 Page 20 The recruitment records of the maintenance worker and 2 care staff were examined. There had never been a CRB check undertaken on the maintenance worker, as this has not been considered necessary, as the providers knew him previously. They had received 2 good references for him. However, he was observed working throughout the home and is clearly in regular contact with the residents and so CRB clearance is required. This had begun by the time the inspection visit was complete. Other recruitment records showed that CRB checks are not received prior to starting employment. Nor has the Protection of Vulnerable Adults list been checked to see if potential employees are listed as unsafe to work with vulnerable adults. The application forms used at the home do not include a full employment history, nor require ‘spent’ convictions to be disclosed. Although in each record examined 2 references were in place, which were followed up by telephone confirmation, recruitment practice was none-the-less insufficiently robust. Springfields DS0000003808.V290041.R01.S.doc Version 5.1 Page 21 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well managed, run in the bet interest of residents, and their health and safety are attended to in balance with their right to make choices. EVIDENCE: The registered providers / manager run the home efficiently and provide good leadership to staff. They aim to provide a quality service and to this end they survey opinion from all people who have connections with the home. A resident said: “you wouldn’t get a better place anywhere” and a visitor commented: “any queries or quibbles are dealt with promptly and satisfactorily”. The manager has achieved the Registered Managers Award, has 22 years experience of running a care home and maintains her registration as an Springfields DS0000003808.V290041.R01.S.doc Version 5.1 Page 22 Occupational Therapist. Staff are fully aware of the standards they are to achieve and how to achieve them. The home has no involvement is residents’ finances, but ensures that each has money in their pocket should they wish it and will keep valuables safe unless family can take them. Any money spent on a resident’s behalf is invoiced. The home is maintained to a safe standard. Care staff training in all aspects of health and safety is good. The providers aim to strike a balance between safety and choice for residents. To this end they have not automatically fitted window restrictors to first floor bedrooms so as to prevent falls. (See Standard 20). Springfields DS0000003808.V290041.R01.S.doc Version 5.1 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 2 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 4 9 2 10 3 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Springfields DS0000003808.V290041.R01.S.doc Version 5.1 Page 24 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP9 Regulation 13(2) Requirement A record must be made of all medicines received into the home. This must be dated and signed. The providers must ensure the safety of residents through robust recruitment. To this end persons must not be employed to work in the care home until the information and documents specified in paragraphs 1 – 9 of Schedule 2 have been obtained. Timescale for action 31/05/06 2. OP29 19 24/05/06 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 OP4 OP7 Good Practice Recommendations Dementia care information, based on current good practice, should to be available to staff and inform decisions made at the home. Care plans should be up to date, reviewed in a way that takes into account all aspects of health, personal and social care needs, and provide detailed actions to be taken DS0000003808.V290041.R01.S.doc Version 5.1 Page 25 Springfields 3. 4. 5. 6. 7. 8. OP9 OP9 OP9 OP11 OP18 OP18 9. OP19 by care staff so as to meet those needs. Medicines should be contained securely at all times, in this case when being carried around the home. The medicines policy should contain information on what staff must do if a mistake is made. Handwritten entries on the medication sheet should be checked and signed by two staff so as to confirm accuracy. End of life wishes should be recorded and opportunity for found for them to be expressed. Staff should be given the opportunity to update / refresh their knowledge concerning the protection of vulnerable adults from abuse. The contact details of the Local Authority Vulnerable Adults protection team should be available for staff use and the actions to be taken in the event of a concern or allegation should be clear and in line with the ‘No Secrets’ guidance. Window restrictors, in line with Environmental Health Department guidelines, should be in place at all upper floor windows unless individual risk assessment determines that this is unnecessary. Springfields DS0000003808.V290041.R01.S.doc Version 5.1 Page 26 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Springfields DS0000003808.V290041.R01.S.doc Version 5.1 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!