Inspection on 25/01/06 for Springfields

This inspection was carried out on 25th January 2006.

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

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

Other inspections for this house

Springfields 19/09/06

Springfields 27/07/05

Springfields 16/11/04

Springfields 06/04/04

Springfields 29/08/02

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

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

CARE HOMES FOR OLDER PEOPLE Springfields 11 Langdale Road Hove East Sussex BN3 4HQ Lead Inspector Elizabeth Dudley Announced Inspection 25th January 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 Springfields DS0000014059.V265751.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 DS0000014059.V265751.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Springfields Address 11 Langdale Road Hove East Sussex BN3 4HQ 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) 01273-735784 01273-738260 Mr Joginder Singh Vig Mrs Beant Kaur Vig Mrs Colleen Hutton Care Home 32 Category(ies) of Old age, not falling within any other category registration, with number (32) of places Springfields DS0000014059.V265751.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. The maximum number of service users to be accommodated at any one time is thirty two (32). Service users should be aged sixty five (65) and over on admission. That the home is registered to admit three service users aged over sixty-five years on admission, with a dementia-type illness. Only older people who have been assessed as requiring nursing/residential care are to be accommodated. 27th July 2005 Date of last inspection Brief Description of the Service: Springfields is a care home providing nursing and personal care for up to thirty-two older people. It is owned by Mr & Mrs Vig, who also own four other care homes in East Sussex. The home is situated in the centre of Hove, within close walking distance of the sea front. There are local shops and transport links nearby. Accommodation is provided over two floors in a large property that has been converted from three houses. A passenger lift enables residents to access all parts of the home. There is a pleasant garden at the rear of the building that is accessible to residents. Springfields provides eighteen single and seven shared rooms, eight of which are en-suite. There is a lounge/dining area on the ground floor, and a small sitting area in the foyer of the home. Springfields DS0000014059.V265751.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This announced inspection took place on the 25th January 2006 over a period of seven and a half hours and was facilitated by Mrs C Hutton, home manager. During the course of the inspection a tour of the home was undertaken, records including personnel files, care plans, medication charts and health and safety records were examined and eight members of staff, two visitors and twenty residents were spoken with. What the service does well: Springfields provides a pleasant, comfortable home for residents. It was apparent that there was good, friendly interaction between staff and residents and residents spoken with said that ‘ the staff are very friendly’, ‘ its lovely here, they are so good’, ‘ we have a good lifestyle’ and ‘ it’s a pleasant place to come to’. Staff stated that they were happy in their work and that they found the ethos within the home good. Most staff have worked at the home for a number of years and there is a low staff turnover which has the benefit of residents being looked after by staff with whom they are familiar. Residents spoke highly of the catering, saying that there was a ‘good choice of menu’, ‘ if you don’t like something they make you something else’ and that they had fresh fruit and vegetables. It was noted on the day of inspection that pots of fresh fruit were given to each resident during the morning, and residents confirmed that this happened on a daily basis. Staff undertake training to ensure they are familiar with the nursing needs of the older person and positive comments were received from the Older Persons Nurse Specialist relating to the care given within the home. This is identified in the main body of the report. All residents appeared well cared for. Positive comments only were received both on the day of inspection and from the questionnaires given to residents prior to the inspection. All residents identified that ‘ this is a lovely home we enjoy living here’. Springfields DS0000014059.V265751.R01.S.doc Version 5.1 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Springfields DS0000014059.V265751.R01.S.doc Version 5.1 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 Springfields DS0000014059.V265751.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4,5 The home produces sufficient documentation to ensure that prospective residents have the necessary information to make an informed choice of whether Springfield’s is the right home for them. All residents are assessed by the manager or registered nurse to allow both the manager and the prospective resident to determine whether the home can meet their needs. EVIDENCE: A statement of purpose and service users guide contain sufficient information to enable prospective and existing residents to make an informed choice as to whether they wish to make Springfields their home. All prospective residents are assessed by the manager, or a registered nurse, to ensure that the home will be able to meet the health care needs of the resident and to give the prospective resident the opportunity to meet the manager and discuss the home. The preadmission assessment forms the basis of the care plan. Springfields DS0000014059.V265751.R01.S.doc Version 5.1 Page 9 Residents and their relatives or representatives are invited to visit and look around the home prior to making a decision over whether they wish to live there. A statement of terms and conditions is given to all residents on their admission to the home and this meets this standard. Springfields DS0000014059.V265751.R01.S.doc Version 5.1 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10,11 Documentation identified that the manager and staff are knowledgeable about the assessed needs of the individual residents and the care interventions required. All residents appeared comfortable and well cared for. EVIDENCE: A sample of six care plans were examined and these were seen to be comprehensive, addressing the assessed physical, psychological and social care needs of the residents. There was evidence of resident or representative involvement in the formation of the care plans, and evidence that they had been reviewed on a regular basis. The care plans contain much information relating to the resident’s needs and the care to be given, the manager could give some thought to simplifying the amount of information given in the plan to facilitate ease of use, and this was discussed with her. There was evidence that the home has involved other health care professionals as required, including the wound care specialist nurse and incontinence Springfields DS0000014059.V265751.R01.S.doc Version 5.1 Page 11 specialist nurse. The home has also been involved in a trial involving the older persons nurse specialist team who have been assessing residents and the home’s management of the chronic disease spectrum. Following this trial, the conclusion was drawn by the Older Persons Nurse Specialist Team felt that there was “little that they could add to improve on what the home was already doing, apart from arranging for the Speech and Language Therapist to visit”, and further stated that “As a team we were impressed with the home”. Administration of medication complied with NMC guidelines and there was evidence of stock control. Records were in place to evidence that the drug fridge and other equipment in the clinic room received regular checks from staff to ensure its viability, and the clinic room was clean. There was a British National Formulary, Medical Alerts Documentation and policies and procedures relating to the administration of medication were in place. It is considered good practice to record the dates of opening of external medication and eye and eardrops, and a recommendation has been made around this. Recent information received from the pharmaceutical society states that MAR charts must be signed following the administration of external medication and ointments. This was discussed with the manager. Residents spoken with said that staff treated them with respect, and that they received medical and nursing treatment in the privacy of their own rooms. There were no residents that were very ill on this day, but evidence of staff attending training at the local hospice was available. Letters were seen from relatives of residents that had received care at the home at the end of their lives, showing that relatives were pleased with the care given to the resident and praising the kindness of the staff both to the resident and their relatives. Staff spoken with stated that they had undertaken training relating to the care of the dying resident, which included the use of syringe drivers and other analgesia. Residents being nursed in bed, appeared comfortable, clean and well looked after. Springfields DS0000014059.V265751.R01.S.doc Version 5.1 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 The standard of catering, the provision of choice in activities of daily living, and] a range of activities, enables residents to experience a satisfactory quality of live EVIDENCE: The home employs an activities co-ordinator for ten hours a week, during which time a variety of activities take place. These include viewing old films and the “ Pathe News”, discussing the newspapers, the provision of library books and Bingo. Parrots were recently brought in to entertain the residents and the home has had musical entertainment from a harpist. A reminiscence session was taking place on the day of the inspection with a selection of newspapers dating back to the 1930’s and various packaging and adverts for products which people would recall. Residents had also had a painting session with a visiting artist. Discussions with the manager identified that residents responded well to the activities, many of them choosing to join in, and that she felt provision of more hours would be beneficial. One resident stated that the “lifestyle provided by the home is very good” and that the “ Jazz music that we had recently was excellent. Records are kept of who attends which activities, and a care plan relating to the social needs is available. Springfields DS0000014059.V265751.R01.S.doc Version 5.1 Page 13 Residents stated that they had freedom of choice as much as possible in their activities of daily living, and that they could have visitors at any time. They said that the home welcomed their visitors and “ always gives them a cup of tea, without being asked”. Residents were seen to move around the home freely choosing which rooms they wished to be in. The kitchen was clean and records were seen relating to the fridge, freezer and food temperatures and cleaning. The menu showed a good variety of food and there was evidence of fresh fruit and vegetables being served. Residents were given small pots of cut, mixed, freshfruit during the day, and they received this on a daily basis. The meal on the day of inspection was cottage pie or jacket potatoes with various fillings, followed by chocolate pudding, jelly or raspberry cream. A cooked breakfast is available every day and residents said that “ the food is very good, you couldn’t wish for better”, “ they come around with the menu and you choose what you want and if you don’t like it they will make you something else”, “ The food is terrific”, “ wonderful food and a lovely cook who understands if you cant remember what you ordered or change your mind” All catering staff are in possession of the food hygiene certificate. Springfields DS0000014059.V265751.R01.S.doc Version 5.1 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,17,18 Residents can be assured that the home will treat any complaints in an open and fair manner, and that staff are aware of the need to protect those in their care. EVIDENCE: The home has a complaints procedure and this is displayed in the main hallway and is also included in the service users guide. No complaints have been received by CSCI and the homes complaint records demonstrates that the home deals with complaints in an open manner. Residents spoken with stated that they knew to whom to make a complaint and that they were happy that if they had to make a complaint that it would be dealt with in an open and transparent manner. There are clear policies relating to the protection of the vulnerable adult. Staff have received training on, and were aware of, their role in this. Residents can take part in the civic process by postal votes and the manager can facilitate access to solicitors or advocates. Springfields DS0000014059.V265751.R01.S.doc Version 5.1 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,22,23,24,25,26. The home provides a clean pleasant environment for residents, which in general is well maintained. Residents stated that they felt that the home was comfortable and clean. EVIDENCE: A complete tour of the home was undertaken, including the garden area. The home is very pleasant to walk into, being approached from front entrance that is well maintained which leads into a small thoughtfully decorated hall and sitting area. The majority of the rooms were in good decorative order as they are redecorated when residents leave, some of the corridors need attention and this was discussed with the manager. Some cupboards in the kitchen are also in need of repair. Residents can bring their own possessions into the home and there are locked facilities and doors provided, with residents receiving keys within the auspices of a risk assessment. Springfields DS0000014059.V265751.R01.S.doc Version 5.1 Page 16 The home has a lounge/dining room which appears to become crowded some parts of the day, noticeable particularly whilst activities were taking place . There is a well-maintained garden which is accessible to all residents but the pathway needs attention as the uneven surface could prove to be a hazard. Accommodation is provided in eighteen single rooms and seven shared rooms. Five of the single rooms and three of the double rooms have ensuite facilities. One of the unused unassisted bathrooms has now been converted into an assisted shower room, the flooring in this needs attention as the grouting has disintegrated around the new floor tiles, leaving sharp edges which could cause injury, this has been made an immediate requirement. As the unassisted baths cannot be used by present residents due to various disabilities it is suggested that management gives thought to converting more of the bathrooms. There was evidence that routine checking of water temperatures of hot water outlets take place and these were within recommended parameters. All radiators were guarded and lighting was of a domestic style. All call bells were in place and those tested were working. One of the residents was complaining about her wardrobe as she found it difficult to remove her clothes. It was also noted that the headboard / backrest on the variable height bed in her room was unsteady. Both of these were originally made immediate requirements but both were addressed either during the inspection or on the following day. The home has been assessed by an occupational therapist and all recommendations made have been undertaken. There is sufficient equipment and aids within the home. The home is very clean and free from offensive odours and sufficient domestic staff are employed to ensure that these standards are maintained. Staff wear protective clothing when in the kitchen and residents stated that they were happy with the standard of laundry. Most residents mentioned that the laundry was good and that they were very satisfied with it, during conversation with them. It is suggested that thought be given to the purchase of a dishwasher which would enable dishes to be washed at very high temperatures and further aid infection control within the home. Springfields DS0000014059.V265751.R01.S.doc Version 5.1 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 The numbers, skill mix and training of staff ensure that residents assessed needs are met. The majority of personnel files have the documentation required by the regulation, however residents safety can be compromised if staff are employed prior to all this documentation being in place. EVIDENCE: Duty rotas evidenced that the manager, one registered nurse and five care staff work in the mornings, with 1 registered nurse and four care staff in the afternoons. Night duty is covered by registered nurse and two waking care staff. There are two members of domestic staff every day apart from weekends when one member of domestic staff is in the home. Specific staff for the laundry and kitchen are employed and the home has its own maintenance person. Registered nurses have undertaken various courses and study days and are encouraged to fulfil their PREP requirements whilst care staff undertake study days both in and outside the home, four members of care staff have attained their NVQ2, and some care staff are studying for NVQ 3. The home uses agency staff on rare occasions only, members of permanent staff covering any shifts required. Staff and residents spoken with stated that “there are always enough staff on duty” “ they are never short staffed”, “ staff stay because we enjoy working here”, “ we don’t have new staff very often Springfields DS0000014059.V265751.R01.S.doc Version 5.1 Page 18 because we all work together and we enjoy it, we can always cover each others shifts so we don’t have agency, its better for the residents”. The training records show training relevant to the needs of residents within the homes category of registration has taken place at regular intervals, that all staff have undertaken mandatory training and that the few recent staff employed within the past few years have had an induction course. Personnel files examined evidenced that all documentation required by the regulations was in place. There was evidence that one member of staff had been employed prior to their POVA First having been received and the manager is reminded that under the current legislation all staff must have two written references and a POVA First check prior to commencing work. The GSCC handbook has recently been obtained for staff Springfields DS0000014059.V265751.R01.S.doc Version 5.1 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,34,35,36,37,38 There is a good ethos and sense of leadership within the home therefore ensuring a well run homely environment for residents. Systems are in place to ensure resident’s safety. EVIDENCE: The registered manager, Mrs Colleen Hutton has worked at Springfields for ten years, three of those years having been as manager. She is a registered nurse (first level) with experience in the nursing needs of the elderly and will be commencing her Registered manager’s award in May 2006. Staff and residents spoke of the good atmosphere within the home. Staff turnover is low and residents said that they enjoyed living there with staff that they know well. One member of staff said “ the manager is wonderful, it is good to work here”. Staff and residents said that they felt “listened to” by Springfields DS0000014059.V265751.R01.S.doc Version 5.1 Page 20 management. Good unhurried interactions were seen between staff and residents. Some resident’s questionnaires have been sent out but strategies to allow visitors, healthcare professionals and other stakeholders to inform the way in which service in the home is delivered is ongoing. This was a previous requirement which still in the process of being complied with. Residents were aware of the forthcoming inspection and some questionnaires given to residents have been returned. Resident’s financial records were in place with good recording taking place. Arrangements to move resident’s monies to individual interest bearing accounts are in progress. Policies and procedures are reviewed yearly. Supervision takes place at intervals recommended by the standard and staff confirmed that this took place and that they found it useful. Registered provider visits are taking place and reports received by the commission are of a high standard. All staff have undertaken the mandatory training required by regulation and all care staff have either their food hygiene or food handlers certificate. Some resident’s doors are wedged open and residents have signed a disclaimer relating to this. However this is not considered sufficient to protect the provider, staff or residents and a way of ensuring these resident’s safety in case of fire must be found. All certificates relating to the maintenance of utilities and equipment were in place and in date. The electrical cupboard needs a lock or bolt to ensure the safety of residents and chemicals in the kitchen must be locked away when not in use. Springfields DS0000014059.V265751.R01.S.doc Version 5.1 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 3 3 x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 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 3 18 3 2 2 2 3 3 3 3 3 STAFFING Standard No Score 27 3 28 2 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 2 3 3 3 3 2 Springfields DS0000014059.V265751.R01.S.doc Version 5.1 Page 22 Are there any outstanding requirements from the last inspection? yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP33 Regulation Reg 21(1&2), 24(1) Requirement Timescale for action 01/04/06 2 OP19 Reg 23 (2) (c)(d) 3 OP38 Reg 13(4) That strategies are developed for enabling staff and other stakeholders to inform the way in which the service in the home is delivered. (This was a previous requirement 01.12.05) That general maintenance issues 01/04/06 including the repair of the kitchen cupboard are undertaken and a programme of decoration maintained. That maintenance to ensure 25/01/06 service users safety is carried out: The walkway to the garden made even. That the electrical cupboard is kept locked. That the chemicals in the kitchen are locked away once used. The tiles on the bathroom floor are made safe. That an alternative method of keeping those residents who wish their doors kept open, safe in case of fire is examined. Springfields DS0000014059.V265751.R01.S.doc Version 5.1 Page 23 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Springfields DS0000014059.V265751.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection East Sussex Area Office Ivy House 3 Ivy Terrace Eastbourne East Sussex BN21 4QT 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 DS0000014059.V265751.R01.S.doc Version 5.1 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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