CARE HOME ADULTS 18-65
68 Bescot Road 68 Bescot Road Walsall West Midlands WS2 9AE Lead Inspector
Patrick Wright Unannounced 5 August 2005
th 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 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 Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary 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. 68 Bescot Road E55 S62047 68 Bescot Road V237186 Unannounced 5-8-05 PW Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service 68 Bescot Road Address 68 Bescot Road Walsall West Midlands WS2 9AE 01922 648758 01922 724378 N/A Lonsdale (Midlands) Limited Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Ms Jane Anderson Care Home (with Nursing) 8 Category(ies) of Learning Disability - 8 registration, with number of places 68 Bescot Road E55 S62047 68 Bescot Road V237186 Unannounced 5-8-05 PW Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: None Date of last inspection N/A Brief Description of the Service: 68 Bescot Road is a care home which is owned and managed by Lonsdale Midlands Ltd. The home offers nursing care and personal support to up to eight individuals with a learning disability with health and/or complex social care needs, plus degrees of behavioural challenge. The service is divided into two areas. A respite unit is situated on the ground floor and a long term unit on the first floor. A passenger lift is available. The two units have the same layout and comprise of four single occupancy rooms, (some with ensuite shower facilities) a shared bathroom and two separate toilets, lounge, dining room, and kitchen. The two units operate independently of each other. The external area of the home comprises of a car park at the front and small rear garden. Entrances and exits are ramped to ensure access by those mobility difficulties. The home aims to provide its residents with a secure, relaxed and homely environment in which their care, well being and comfort are of prime importance. This is stated to be achieved through a programme of activities designed to encourage mental alertness, self esteem, social interaction with other residents and with recognition of core values which are fundamental to the philosophy of the home. The core values being Privacy, Dignity, Rights, Independence, choice, and fulfilment. 68 Bescot Road E55 S62047 68 Bescot Road V237186 Unannounced 5-8-05 PW Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was the first statutory unannounced inspection, which was conducted to assess the level of compliance in meeting some of the core National Minimum Standards. Methods used to make judgements and obtain evidence included discussion with the Manager and examination of service user files and associated records. The Inspector felt that this first inspection by the Commission for Social care inspection was constructive and positive. There were five residents living at the home at the time of this visit. All residents were about to be involved in various community activities during the inspection. However the inspector was able to meet the residents who were at home for a short period. Formal interviews were not appropriate, therefore the inspector relied upon general discussion, body language and observations of interactions between staff and residents. The home is registered to provide care for young people with learning disabilities, who may display behaviour that challenges in addition to other complex needs. Generally conditions throughout the home are very comfortable and offer residents a pleasant and homely environment. The atmosphere at the home is friendly and relaxed. At the time of inspection, staff appeared to be developing a good rapport with the service users and the brief observation of care practices, directly and indirectly, were good. The staff were observed during this visit to be sensitive and positive. Requirements from this inspection report include the need to provide documentary evidence of practice currently being developed and to establish the systems put in to place since registration. The inspector would like to thank the Manager, staff and service users for their assistance and co-operation throughout this unannounced inspection. What the service does well:
The Manager and staff are making satisfactory progress with regard to implementing systems and identifying records and documents which are required to be held for the purpose of regulation. The home appears to be responding appropriately to situations, which require review and amending practice which is not conducive to the quality and style of service as stated in the homes Statement of Purpose. For example, following specific incidents of challenging behaviour the Manager has evaluated the
68 Bescot Road E55 S62047 68 Bescot Road V237186 Unannounced 5-8-05 PW Stage 4.doc Version 1.40 Page 6 situation and made alterations to the individuals care management guidelines and to the homes procedures. The `long stay` unit has begun to identify individual needs and wants and to offer a stable and consistent service to the occupants. The short stay unit is being utilised by the placing authorities on a regular basis. Records of care plans and risk management strategies are being put into place and service users files are beginning to demonstrate the level of service being provided. Staffing levels are high which reflects the dependency levels of those accommodated and are flexible in order to deliver a needs led service. What has improved since the last inspection? This is the first inspection of the service since registration, which was initially granted in January 2005. However the service was operating prior to this date, which was identified as an Offence under the Care Standards Act 2000. This resulted in Lonsdale Midlands Ltd being issued with a Formal Caution by the Commission for Social Care Inspection (CSCI). Details of the offence are as follows: That between 17th November 2004 and 7th January 2005 Lonsdale Midlands Ltd did provide accommodation and care to 5 service users at the service known as 68 Bescot Rd Walsall, without registration. This was deemed to be in contravention of Part 2, Section 11 (1) of the Care Standards Act 2000. The Commission for Social Care Inspection was satisfied that there was incontrovertible evidence that the company committed the offence as detailed above. On this occasion the Commission for Social Care Inspection was minded to give Lonsdale Midlands Ltd the opportunity to deal with this particular matter by way of a Formal Caution. The provider agreed to this action and the CSCI did not therefore, seek a prosecution through the Magistrate’s Court. The service was subsequently registered and conditions of registration were imposed. This was to prevent any further service users being admitted to the home until the CSCI was satisfied that all necessary systems had been adhered to with regard to the registration process. This included the registration of a suitably qualified and competent manager. A new Manager was appointed following conditions being imposed and went through the `fit person` registration process. At that time, the conditions of registration were then lifted and the service was able to continue with the admission process. 68 Bescot Road E55 S62047 68 Bescot Road V237186 Unannounced 5-8-05 PW Stage 4.doc Version 1.40 Page 7 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. 68 Bescot Road E55 S62047 68 Bescot Road V237186 Unannounced 5-8-05 PW Stage 4.doc Version 1.40 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection 68 Bescot Road E55 S62047 68 Bescot Road V237186 Unannounced 5-8-05 PW Stage 4.doc Version 1.40 Page 9 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1,2, 4 and 5 The homes Statement of Purpose and Service User Guide do not contain all of the information needed to make an informed choice about where to live. Prospective users needs and aspirations are assessed.Trial visits and introductory meetings are arranged. A statement of terms and conditions is available. EVIDENCE: 68 Bescot Road E55 S62047 68 Bescot Road V237186 Unannounced 5-8-05 PW Stage 4.doc Version 1.40 Page 10 For the purpose of registration the home produced a Statement of Purpose and Service User guide. The management of the home should review these documents and ensure the Service User Guide contains all of the necessary information as detailed in Standard 1 of the National Minimum Standards for Younger Adults, and the Statement of Purpose contains details as listed in Schedule 1 of the Care Homes Regulations 2001. Attention is drawn to ensuring the Statement of Purpose clearly sets out the physical environmental standards met by the home and that a summary of this is included in the service users guide. Each of the service users need to be issued with a copy of the service user guide. Recent service user admissions to the home have been via a number of local authorities, and the manager has secured the appropriate care management documentation, but not all in the form of a needs assessment. The home must ensure that a process of periodic review is implemented covering the areas listed under standard 2.3 of the National Minimum Standards for Younger Adults, and that the assessments are regularly updated. The manager needs to confirm in writing to the service users, that having regard to the assessment the care home is suitable to meet their individual needs. Trial visits and introductory meetings at the home have been arranged previously for the prospective service users. Not all of these were documented in past daily notes and files. For service users new to the home visits must be arranged and recorded. A statement of terms and conditions has been produced and needs to form part of the homes Service Users Guide. This document must be discussed or vocalised with the service users, relatives or representatives, and evidence of this be recorded in personal files. 68 Bescot Road E55 S62047 68 Bescot Road V237186 Unannounced 5-8-05 PW Stage 4.doc Version 1.40 Page 11 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6 and 9 The home is developing its care plan and risk management systems to ensure service users needs are met. Risk management strategies, do not fully ensure that service users are supported to take risks in their lives. EVIDENCE: At the time of the inspection a random selection of care plans were reviewed. The manager has begun to implement a care planning system. The documentation will take time to develop and build upon to provide a full picture of the care needs of each individual. Ultimately a Person Centred Planning approach should be aimed for, however the manager has made steady progress since registration in producing the current records. The registered manager is developing a system for recording risk assessments and risk management strategies. Documentary evidence seen was satisfactory. However the system will benefit from further development. Individual risk assessments need to be established with regard to all users’ activities within the home and in the community. 68 Bescot Road E55 S62047 68 Bescot Road V237186 Unannounced 5-8-05 PW Stage 4.doc Version 1.40 Page 12 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 13 and 14 The home is developing links with the community and providing social inclusion to enrich service users social, leisure and educational opportunities. EVIDENCE: 68 Bescot Rd is striving to ensure that service users have access to, and choose from, an appropriate range of leisure activities and are supported to pursue interest/hobbies which are geared to the individual’s choice. These are being documented in daily notes and activity records/reports. The manager told the inspector that staff at the home are trying to provide access to appropriate in house and community based recreational pursuits. Individual outings and group trips are being arranged, and will include day trips and holidays. Staff need to evidence that they enable and support service users to use the facilities and that the client group are positively encouraged and assisted to undertake a variety of activities in addition to their main and regular routines. The home benefits from having its own transport. 68 Bescot Road E55 S62047 68 Bescot Road V237186 Unannounced 5-8-05 PW Stage 4.doc Version 1.40 Page 13 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19 and 20 The home is developing an understanding of how to meet the healthcare needs of service users. There is a safe system for the management of service users medication EVIDENCE: Examination of records indicated that the home is putting systems in place to plan for the healthcare needs of service users. Some records of health care checks/correspondence were seen, although this was minimal due to the length of time the home has been registered. Medication in the custody of the home was stored and appeared to be handled according to the requirements of legislation. One plan for a service user receiving PRN, (when required) medication was seen and demonstrated dosage, frequency, under what circumstances to be administered/readministered. It is recommended that the home also obtain a copy of the Royal Pharmaceutical Society guidelines with regards to managing service users medication, as is good practice. 68 Bescot Road E55 S62047 68 Bescot Road V237186 Unannounced 5-8-05 PW Stage 4.doc Version 1.40 Page 14 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) No standards from this section were assessed at this inspection EVIDENCE: Not applicable 68 Bescot Road E55 S62047 68 Bescot Road V237186 Unannounced 5-8-05 PW Stage 4.doc Version 1.40 Page 15 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) No standards from this section were assessed at this inspection EVIDENCE: Not applicable 68 Bescot Road E55 S62047 68 Bescot Road V237186 Unannounced 5-8-05 PW Stage 4.doc Version 1.40 Page 16 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33 Staffing levels are high and staff are flexible in order to deliver a needs led service. EVIDENCE: The home provides in excess of the minimum staffing numbers as recommended by the Department of Health, but this is required due to the service offering specific packages of care, which include/require a higher ratio of staffing levels to meet the assessed needs of the service users. In addition to the qualified nurses, staffing levels are maintained generally at a minimum of four support staff per shift during the day on the respite unit, and three on the longer stay unit. At the time of inspection there appeared to be sufficient staff on duty during the day to meet the needs of the service users. This will be explored in more detail at the next inspection when the service is established and records of the care needs of service users are more detailed. The home operates a recruitment procedure, which includes exploring employment history with the applicant, taking two written references prior to appointment, securing a health declaration and evidence of Identity. The Manager is aware that all new staff must have enhanced checks with the Criminal Records Bureau (CRB) prior to commencement, and that evidence is available for inspection.
68 Bescot Road E55 S62047 68 Bescot Road V237186 Unannounced 5-8-05 PW Stage 4.doc Version 1.40 Page 17 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 39 and 41 The Manager has a clear understanding of the development needs of the service and will need to plan and effectively communicate this vision to those living and working at the home. The quality of record keeping does not safeguard service users rights or interests in some instances. EVIDENCE: The Manager appears to be developing an open and positive management style, including staff in decisions that are made within the home. The manager indicated she is attempting to create an open atmosphere and a clear sense of direction within the home, offering the best standard of care possible. She understands the aims and values of the home and strives to develop the service for the future. The registered manager must continue to demonstrate strategies for management planning and practice, which encourages and rewards innovation, creativity, development and change. 68 Bescot Road E55 S62047 68 Bescot Road V237186 Unannounced 5-8-05 PW Stage 4.doc Version 1.40 Page 18 The majority of records required at this inspection, by regulation, and for the effective running of the home were available, but varied in detail. Any shortfalls can be found in the requirements section of this report. Individuals and home records were being held securely, up to date, and maintained, used in accordance with the Date Protection Act 1998. Risk assessments should continue to be developed for all safe working practices, as detailed in this standard 42 of the National Minimum Standards for Younger Adults, and to ensure that records contain all potential hazards identified and the relevant action to be taken. Residents’ personal information and correspondence is held in individual files but the quality of information in records varied. There was also clear evidence that a minority of staff were making subjective and assumed statements in documentation such as service user plans and daily notes. For example, one service user was described as “going mad”, and staff had to “tell him off”. Another example in the records stated that staff “told him to calm down or he would not be going on holiday” and another that someone was about to be “sent to his room”. The Manager was told such recording and practice is unacceptable and needs to be explored further. Documentation must not include records of an inappropriate, subjective or discriminatory nature. Terminology used in reports must be regularly audited and reviewed against the practice within the home. 68 Bescot Road E55 S62047 68 Bescot Road V237186 Unannounced 5-8-05 PW Stage 4.doc Version 1.40 Page 19 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 2 2 x 2 2 Standard No 22 23
ENVIRONMENT Score x x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10
LIFESTYLES Score 2 x x 2 x
Score Standard No 24 25 26 27 28 29 30
STAFFING Score x x x x x x x Standard No 11 12 13 14 15 16 17 x x 2 2 x x x Standard No 31 32 33 34 35 36 Score x x 3 x x x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
68 Bescot Road Score x 2 3 x Standard No 37 38 39 40 41 42 43 Score x x 2 x 1 x x E55 S62047 68 Bescot Road V237186 Unannounced 5-8-05 PW Stage 4.doc Version 1.40 Page 20 N/A Are there any outstanding requirements from the last inspection? 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 1 Regulation 4,5 Requirement 1) To review the Statement of Purpose and ensure that all details are included as required by Schedule 1 of the Care Homes Regulations 2001. 2) To review the Service User Guide to ensure all relevant information is contained as in Standard 1.2 of the National Minimum Standards for Younger Adults. 1) The home must ensure that it secures copies of the service users needs assessments from the placing authority. 2) A process of periodic review must be implemented for assessments, covering the areas listed under standard 2.3 of the National Minimum Standards for Younger Adults, and the assessments are to be regularly updated. The registered person must be able to demonstrate that they have confirmed in writing to the service user that having regard to the assessment, the care home is suitable for the purpose of meeting the service user’s needs in respect of his health
E55 S62047 68 Bescot Road V237186 Unannounced 5-8-05 PW Stage 4.doc Timescale for action 31/12/05 2. 2 14 1)30/11/05 2)28/2/06 3. 2,3 14 30/11/05 68 Bescot Road Version 1.40 Page 21 and welfare. 4. 4 14 To ensure all prospective service users are enabled to visit the home and records maintained of the visit. Provide and issue service users with a statement of terms and conditions/contract which meets standard 5.2 of the National Minimum Standards for Younger Adults. 1) Ensure that service user plans cover all areas of assessed need and include all aspects of care: (emotional needs, healthcare, social needs, financial assistance, personal care etc.) 2) To produce care plans in a formats suitable for service users. 3) To ensure daily reports reflect goals identified in care plans. 4) To introduce effective evaluation, monitoring and reviews of service users plans which must be sufficiently detailed to reflect the changing needs of service users, and the objectives set. 5) Ensure that the care plans are compiled with the service user and/or their representative, and are dated/signed. To develop detailed individual risk assessments with regard to all service users’ activities within the home and in the community, i.e. personal hygiene/bathing, use of transport, day care, use of kitchen/laundry equipment, access to community resources etc. and ensure each one is regularly reviewed and updated. The home must evidence that service users are enabled and supported to pursue interests/hobbies which are geared to the individuals choice 28/2/05 5. 5 5 30/11/05 6. 6 5 31/12/05 7. 9 13 31/12/05 8. 13,14 12,16 31/12/05 68 Bescot Road E55 S62047 68 Bescot Road V237186 Unannounced 5-8-05 PW Stage 4.doc Version 1.40 Page 22 9. 19 12 10. 39 24 11. 41 17 and use the local facilities to undertake a variety of activities in addition to their main and regular routines. 1) The management must evidence that service users healthcare needs are being met, and procedures for routine screening and the monitoring of service users’ health with regard to potential complications, are adequate. 2) All service users must be enabled to receive annual health checks, such as attending `well person clinics` and records maintained. To produce an annual development plan, which is based on a systematic cycle of planning-action-review and reflects the aims and outcome for service users. 1) All records required by regulation for the protection of service users and the effective/efficient running of the business must be available for inspection. 2) Documentation must not include records of an inappropriate, subjective or discriminatory nature. Terminology used in reports must be regularly audited and reviewed against the practice within the home. 31/12/05 30/11/05 1) 28/12/05 2) 30/9/05 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 20 Good Practice Recommendations It is recommended that the home obtains a copy of the
E55 S62047 68 Bescot Road V237186 Unannounced 5-8-05 PW Stage 4.doc Version 1.40 Page 23 68 Bescot Road Royal Pharmaceutical Society guidelines with regards to managing service users medication. 68 Bescot Road E55 S62047 68 Bescot Road V237186 Unannounced 5-8-05 PW Stage 4.doc Version 1.40 Page 24 Commission for Social Care Inspection Mucklow Office Park West Point Mucklow Hill, Halesowen West Midlands B62 8DA National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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