Care Home: Spring Gardens

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What the care home does well In the surveys people told us that "staff are friendly and helpful" and "staff are jolly and kind." One of the professionals who sent us a survey back said that. "It is very well organised home providing good care for people." People who live at the home have their needs assessed before they come to stay. This makes sure that the home can meet their needs. Staff are caring and respect people`s privacy and dignity. Routines in the home are flexible and people can exercise choice in their lives, for example choosing getting up and going to bed times, clothes and activities. Visitors are encouraged and made welcome. This helps people maintain contact with family and friends. People who live at the home have regular meetings and have been able to make changes so that their needs are met. What has improved since the last inspection? People now have access to up date information about the home and the services it provides. This helps them to make an informed choice. The manager has done some interim moving and handling training with staff. She said further training would be provided by the Social Services Occupational therapist. Issues identified in the last inspection report relating to repair work such as redecoration of the building have all been resolved. The manager arranged for the repair of the loop system, used for people with hearing aids. Staff have started terminal illness training, which help them to provide care and meet the needs of people who are terminally ill. The medicine trolleys are now fastened to an outside wall and stored in the medicine room when not in use.Hand sluicing of soiled laundry has stopped, to make sure infection control is not compromised. There is now additional heating in the dining room, which people said has made the room much warmer. The work for the recommendations made by West Yorkshire Fire Service regarding fire safety in the home has been completed. CARE HOMES FOR OLDER PEOPLE Spring Gardens Westbourne Grove Otley Leeds LS21 3LJ Lead Inspector Valerie Francis Key Unannounced Inspection 23rd November 2007 09:30 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 Spring Gardens DS0000033235.V356352.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. Spring Gardens DS0000033235.V356352.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Spring Gardens Address Westbourne Grove Otley Leeds LS21 3LJ 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) 01943 464497 01943 467420 angela.mosby@leeds.gov.uk Leeds City Council Department of Social Services Mrs Angela Mosby Care Home 30 Category(ies) of Old age, not falling within any other category registration, with number (30) of places Spring Gardens DS0000033235.V356352.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 1st March 2007 Brief Description of the Service: Spring Gardens is a purpose built local authority care home situated in the small market town of Otley in West Yorkshire. It provides personal care and support for up to 30 older people who are not in need of nursing care. There are 28 permanent places and two places for residents who come for respite care. The home also provides Day Care for three people from the community who use the home for respite. The home is run by Leeds Social Services Department and managed on its behalf by Angela Mosby. The two-storey building enables residents to have bedrooms and utilise communal seating areas on either floor. The fees range from £70.85 to £ 458.86 per week additional charges are made for chiropody, hairdressing, daily papers, toiletries, some activities and transport. This information was provided to the Commission during this inspection. Spring Gardens DS0000033235.V356352.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection report is divided into separate sections for each outcome group for example Choice of Home. An overall judgement is made for each outcome group based on the findings of the inspection. The judgements reflect how well the service delivers outcomes to the people using the service. The judgements categories are “excellent”, “good”, “adequate” and “poor”. The judgements are recorded within the main body of this report. More detailed information about these changes is available on our website – www.csci.org.uk One inspector carried out an unannounced inspection on the 24 November 2007 with feedback given to the manager. The purpose of this inspection was to make sure the home was providing a good standard of care for the people living there. The term people who use the service will be used throughout the report when referring to the people who live at the home. No arrangement was made with the home to carry out the inspection. The home was sent an Annual Quality Assurance Assessment (AQAA) selfassessment form to complete. This form gives the home and the organisation an opportunity to put forward their views on how they provide their service to people using it or wanting to use it. The methods used at this inspection included looking at care records, observing working practices and talking with people who live there, visitors and staff. Before the visit, questionnaires were sent out to the home for people who use the service, relatives and staff. The names and address of the visiting professionals to the home were requested from the manager, survey questionnaires were sent to each of the names given, only one responded. One of these have been returned and this information has also been used in this report Twelve people who use the service, five relatives and 6 staff responded by completing their form. Visitors were spoken to during the inspection. Spring Gardens DS0000033235.V356352.R01.S.doc Version 5.2 Page 6 Thank you to everyone for the returned survey questionnaires and for the hospitality and assistance on the day of the visit. Requirements and recommendations made during this visit can be found at the end of the report. What the service does well: What has improved since the last inspection? People now have access to up date information about the home and the services it provides. This helps them to make an informed choice. The manager has done some interim moving and handling training with staff. She said further training would be provided by the Social Services Occupational therapist. Issues identified in the last inspection report relating to repair work such as redecoration of the building have all been resolved. The manager arranged for the repair of the loop system, used for people with hearing aids. Staff have started terminal illness training, which help them to provide care and meet the needs of people who are terminally ill. The medicine trolleys are now fastened to an outside wall and stored in the medicine room when not in use. Spring Gardens DS0000033235.V356352.R01.S.doc Version 5.2 Page 7 Hand sluicing of soiled laundry has stopped, to make sure infection control is not compromised. There is now additional heating in the dining room, which people said has made the room much warmer. The work for the recommendations made by West Yorkshire Fire Service regarding fire safety in the home has been completed. 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. Spring Gardens DS0000033235.V356352.R01.S.doc Version 5.2 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 Spring Gardens DS0000033235.V356352.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1 & 3. 6 is not applicable to this home. People who use the service experience good quality outcomes in this area. There is up to date information about the home, which is available to people to make sure they can make a choice about living at the home. The admission process is good and includes introductory visits. We have made this judgment using available evidence including a visit to this service. EVIDENCE: Since the last inspection the home’s information has been reviewed and information about staff and their training is now available. The information is written in a font size, which could be difficult for some people to see. The manager said the possibility of providing the information in different formats is being looked at. The home written information does not say that the home provides care for people with dementia. However, there was evidence that several people living at the home has a diagnosis of dementia. It is acknowledged that staff have had training on dementia, and the home works closely with the community Spring Gardens DS0000033235.V356352.R01.S.doc Version 5.2 Page 10 psychiatric nurse to make sure people get the care they need, and to provide staff with training on dementia and other related mental health illness. The two people recently admitted to the home files were looked at. One contained a detailed assessment of that person’s needs, the other very little information. The manager said this person had been getting respite care and was known to the staff team before they moved to live at the home. Spring Gardens DS0000033235.V356352.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 & 10. People who use the service experience good quality outcomes in this area. Peoples’ health and personal care needs are met. We have made this judgment using available evidence including a visit to this service. EVIDENCE: During the visit we looked at 3 life style plans containing the care plans for people who live at the home. Although there was some good information, there were shortfalls. The ways in which people’s care were to be delivered were not recorded. Some more work needs to be done to make sure that people’s written plans give information about how people’s individual needs, likes, dislikes and preferences will be met. We were told that social Services are looking at the format used to record people’s needs and action is to be taken to make sure people’s care needs are clearer. Spring Gardens DS0000033235.V356352.R01.S.doc Version 5.2 Page 12 The files looked at contained: • Assessments • Needs identified using activities of daily living • Monthly weight recording • Nutritional screening and risk assessments • Fall risk assessments and fall management and accidents record • Medication review • Moving and handling assessments • Personal property registers. • Pen picture of the person life history • People’s interest. • Visits by health care professionals. • People’s information was kept in order of the files seen, which meant that information is easier to find and records were easier for staff to see if there is something missing. However although risk assessments were carried out for moving and handling of those seen, reviews were out of date. Although people had been assessed and there was evidence that pressure relieving equipments were being used, there were no written records in peoples’ care file. In response to the survey, people who use the service indicated that they were well supported by the staff team. One relative indicated that the home let her know any problem her mother was having and said “ the care home looks after people in its’ care efficiently in all aspect of need and welfare.” The home has recently changed the monitored dosage system for medication with a new dispensing chemist. There are two trolleys one for day and one for night, both are fastened to the wall. There are no photographs on peoples’ individual medication pack that would identify them to the member of staff administering medication, to reduce the risk of the wrong person getting the medication. During the visit we saw people’s dignity was preserved when they were about to be supported with bathing or be assisted to the toilet. People were spoken to with respect, staff were seen to be always talking to people getting their opinion on any assistance they needed before the task is started and during the process. This is good practice. Spring Gardens DS0000033235.V356352.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 &15. People who use the service experience good quality outcomes in this area. People have the opportunity to take part in recreational activities inside and outside of the home and maintain contact with families. We have made this judgment using available evidence including a visit to this service. EVIDENCE: During the visit we saw people being engaged in some kind of activities. People were watching television, reading the newspaper, playing board games or talking to each other. One member of staff was giving manicures to people who wanted one. Despite this they were still some people who were sitting not taking part in any activities and looked bored. Some people’s response in the survey indicated that they did not want to take part in any activities. One person indicated that she would only take part in activities depending on what was happening. Another person said, “ I can participate, but I think due to staff shortage we have not been used to being taken out, only one trip to the park in 18 months is not sufficient.” People’s relatives indicated that “sometimes people looked bored, and it was obvious that more activities are needed.” Spring Gardens DS0000033235.V356352.R01.S.doc Version 5.2 Page 14 The manager told us that there has been an improvement in social recreation activities since the last inspection. Discussion had taken place with people about the places and things they would like to do. A monthly activity plan has been made and was displayed on the notice board in the main sitting area. This included visits from outside entertainers that have been discussed with the people living at the home. The home has contact with the nearby sheltered housing complex whose residents visit the home and take part in social events with the people living at Spring Gardens. Although most people had life history information and their hobbies and interest identified there were no plans in place how these would be met. It was obvious from the constant flow of visitors to the home that people’s relatives and friends are encouraged to visit them and take them out if that’s what people wanted. People had a choice to see their visitors privately in their bedroom, or use the main sitting areas with other people or one of the small communal sitting rooms, which are rarely used. Relatives said, ” Visitors are always made to feel very welcome in a friendly homely atmosphere.” Positive comments were made about the food served, the menu is made with the people who live at the home. Food is discussed with people at their meeting. During the day of the inspection people were offered a selection of home made cakes and buns, and hot drinks. Special meals and any food is given for those people who needed it. People have a choice of food, which is served from the three week rotating menus. People can also have something else other than the food on the menus if they request. One visitor to the home said in their survey response “ residents whom I come into contact with love the food, there is a definite sense of humour around the place, it is very well organised.” Spring Gardens DS0000033235.V356352.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18. People who use the service experience good quality outcomes in this area. People know that any complaints they have will be responded to and that staff are trained to keep them safe from abuse. We have made this judgment using available evidence including a visit to this service. EVIDENCE: Leeds City Council Social Services complaint procedure was displayed on the notice board in the main sitting area, it was in several different languages. Compliments and complaint leaflets were also available to people and their relatives. The leaflet gives information about the policy and can be used by anyone to make a complaint. A record is kept of any complaint received and any compliments, all complaints and incidents are logged and sent monthly to the complaint section in Social Services for them to monitor. This shows that people’s complaints are taken seriously and responded to. Although most staff have had Safeguarding Adult protection training many have not had up to date training, the manager said this was part of the home’s training plan to make sure all staff receive the training. Staff are aware of what to do if an issue occurred. Spring Gardens DS0000033235.V356352.R01.S.doc Version 5.2 Page 16 In their AQAA (Annual Quality Assurance Assessment) the home told us that they have up-to-date policies on reporting abuse and bad practice. (Whistle blowing) Spring Gardens DS0000033235.V356352.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 &26. People who use the service experience good quality outcomes in this area. People live in surroundings that are homely, clean and free from odours. We have made this judgment using available evidence including a visit to this service. EVIDENCE: There is a rolling programme of redecoration in place. During the inspection of the premises we found that the chairs in the main sitting areas were showing signs of wear and tear with sunken cushions. We were told some new chairs had been ordered. The external wooden window frames were rotting or paintwork was peeling. Several rooms and communal areas had been redecorated. The visitor’s kitchen still needs redecorating. Spring Gardens DS0000033235.V356352.R01.S.doc Version 5.2 Page 18 People’s room were highly personalised with family photo pictures and personal soft furnishings. Some people brought their own furniture. There was security lighting around the outside of the building; part of making sure the building was safe. Social Services property department carry out repairs to the building. The layout of the laundry met with infection control guidance, there is a door, which leads to the washing machine and another door where laundry is dried, ironed and stored. Laundering of bed linen is carried out by an external agency, people’s own bedding is washed by the home staff. Each communal bathroom and WC had hand washing and drying facilities i.e. paper towels and liquid soap and sanitizer. People’s relatives said “ the home provides a safe and friendly environment for those who now not able to live independent lives in their own homes.” One health professional said “ Spring Garden is extremely clean.” Spring Gardens DS0000033235.V356352.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 & 30. People who use the service experience good quality outcomes in this area. People are looked after by staff who are trained to provide good quality care. We have made this judgment using available evidence including a visit to this service. EVIDENCE: The completed Annual Quality Assurance Assessment (AQAA) form sent to us said that care staffing level is now up to Social service staffing level proposal. There are two vacancies for domestic staff, 29 hours and 10 hours. Both post designated for the evening. One care staff that worked 28 hours was on maternity leave, this post is covered by overtime or reallocation of staff from a home. The staff rotas looked at, showed that during the day there is a minimum of three/ to four staff available to people living at the home and the day care people. The manager said there are sometimes five care staff available but this is an exception. In addition to these numbers there is the person in charge in the morning who is either the manager or a care officer, who work until 8pm Monday to Friday and 5pm on Saturday and Sunday. One of the care staff takes on the role of senior care worker and is in charge, of the home and handover to the night staff when the manager or the care officer goes home at 8pm during the week and 5pm at the weekend. Spring Gardens DS0000033235.V356352.R01.S.doc Version 5.2 Page 20 There are two staff during the night one is a senior care worker who is in charge with back up from the on call arrangement throughout the city. The people who use the service and their relatives indicated in their survey response that there were times when more staff was needed. We discussed again the ongoing concern about the night staffing level of two staff during the night, a recommendation was made at the last inspection that this is risk assessed and looked at constantly, to make sure that people have access to enough staff during the night and both them and staff safety is not compromised. We were told that there was a risk assessment for the staffing level at night and is discussed at the monthly meeting with line management to the home. Two staff files were inspected, we saw: • The completed front and back page of the application form, which gave information about the applicant and the names and address of referees. • Interview notes. • 2 references • A copy of terms and conditions • Proof of POVA check and CRB check. We saw a training matrix that is a plan of forthcoming in house training that will be carried out in the next six months. Training would involve the community nurses who will carry out short courses on topics related to the care of people living at the home. We were told that training is also done with staff from two other homes in the locality from Social services, to provide staff with accessible in house training. Plans are in place for training in record keeping, safeguarding adults, dementia, depression, medication and infection control. There has recently been a team building exercise in the home, staff said it was interesting, and gave them ways how they can work better together. There is over 80 of the staff with NVQ a National Vocational Qualification (NVQ) at levels 2 or above. Spring Gardens DS0000033235.V356352.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33, 35 & 38. People who use the service experience good quality outcomes in this area. Management of the home is good, policies and procedures are in place. We have made this judgment using available evidence including a visit to this service. EVIDENCE: The (AQAA) Annual Quality Assurance Assessment tells us that the manager ‘s qualifications exceed the National Minimum requirements and is experienced in staff management and working and supporting people in the home. The manager is supported by two care Officers who are part of the management team at the home. Staff have annual appraisals but no routine regular one to one supervision with the manager or designated care officer are in place. This would give staff time Spring Gardens DS0000033235.V356352.R01.S.doc Version 5.2 Page 22 to discuss any issues or training needs they may have in a one to one meeting. The manager said she has an open door policy so staff can have access to her or one of the Care Officers at any time. There are systems in place in the home and throughout social services to get the views of the people who use the service and their relatives about the service given at the home. Feedback of the survey is given through the home news letter which is available to people and their relatives. Good records are kept of all transaction made with people’s money, with dated receipts kept for any purchase. Risk assessments and information regarding the building is in place for any potential risks. They are reviewed annually or sooner if needs be. There is a system in place for any maintenance work that needs to be carried out. Spring Gardens DS0000033235.V356352.R01.S.doc Version 5.2 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 3 X 2 X X N/A 2 X X X X X X 3 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 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 X 3 X 3 X X 2 Spring Gardens DS0000033235.V356352.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP3 Regulation 14 Requirement The manager must ensure that the information gathered at the pre assessment is enough to put together a comprehensive plan of care. Last timescale 31/03/07 Although some work has started not all people have a comprehensive assessment. Staff must have access to plans of care that would give them details of clear actions to follow to meet peoples’ needs so that care needs are not missed. Discussion has started to ensure all people have a clear plan of care. Last timescale 31/03/07 Timescale for action 31/01/08 3. OP7 15 23/02/08 Spring Gardens DS0000033235.V356352.R01.S.doc Version 5.2 Page 25 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. Refer to Standard OP7 Good Practice Recommendations Care plans on the last wishes of residents should be in place. Some consideration should be given to provide staff with a course that provides them with much more information on the safe handling of medicines. The home could look at providing more social activities and stimulation for people. This would prevent people getting bored and lethargic. The manager must continually monitor the amount of staff working with the people who use the service, to make sure there are enough staff to meet their needs especially at nights. 2. OP9 3. 4. OP7 OP27 Spring Gardens DS0000033235.V356352.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Aire House Town Street Rodley Leeds LS13 1HP 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 Spring Gardens DS0000033235.V356352.R01.S.doc Version 5.2 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. 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