CARE HOMES FOR OLDER PEOPLE
Adeline House Nursing Home Queen Street Thorne Doncaster South Yorkshire DN8 5AQ Lead Inspector
Valerie Hoyle Key Unannounced Inspection 25th November 2008 08:45 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 Adeline House Nursing Home DS0000015848.V373169.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. Adeline House Nursing Home DS0000015848.V373169.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Adeline House Nursing Home Address Queen Street Thorne Doncaster South Yorkshire DN8 5AQ 01405 815512 01405 813594 adeline.house@fshc.co.uk None provided County Healthcare Ltd, a wholly owned subsidiary of Four Seasons Health Care Ltd Siegfred Laguio Care Home 40 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) Category(ies) of Old age, not falling within any other category registration, with number (40), Physical disability (40) of places Adeline House Nursing Home DS0000015848.V373169.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The registered person may provide the following category of service only: Care home with nursing - Code N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP, maximum number of places 40 2. Physical disability - Code PD, maximum number of places 40 The maximum number of service users who can be accommodated is: 40 27th November 2007 Date of last inspection Brief Description of the Service: Adeline is situated in the heart of Thorne village, and is in easy reach of local shops and amenities. Grounds are well maintained usually by the handyman and a gardener and the drive leading to the entrance is block paved leading to the conservatory entrance. A quadrangle in the centre of the home is easily accessed by a sloping ramp and is a popular location for people who use the service, and their visitors. The home has three lounge areas; one is designated as the smoking area. The main entrance is a conservatory area with domestic type seating including sofas and coffee tables. Qualified nurses provide the necessary care to those with nursing needs, and trained care staff provides care to the residential service users. Information gained on the 25th November 2008 indicated the current fees range from £533.88 up to £561.29. Additional charges include hairdressing, newspapers and outings. The home provides information to people who use the service and their relatives prior to admission into the home. Service Users Guides are available on request from the manager. The last published inspection report is available on request and a copy is available for visitors to read. Adeline House Nursing Home DS0000015848.V373169.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means that the people who use this service experience adequate quality outcomes.
This unannounced inspection took place over 8.5 hours 8:45am to 5:15pm; this included a partial inspection of the home. Seven people who use the service, five staff and three relatives were spoken to during the visit; their views were included throughout the report. A random unannounced inspection was carried out on 27th June 2208 following CSCI (Commission for Social Care Inspection) receiving a complaint about the lack of hot water in areas of the home. The outcome of the inspection is included in the report. Twenty seven of the forty beds were occupied on the day of this visit. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. Recruitment, health and safety, medication, safeguarding adults and complaints policies were looked at to assess the agencies ability to protect people who use the service. The office premises were looked at to ensure people’s records were stored safely. Four peoples care plans were looked at to assess how they receive their care. Four staff recruitment and training records were looked to ensure they had the required competencies and to assess how people were protected. The registered manager, Siegfred Laguio has a number of years experience and qualities to run the home. The AQAA (Annual Quality Assurance Assessment) was returned to us on time (September 2008), which demonstrates responsiveness and cooperation. An Annual Quality Assurance Assessment is a self-assessment and a dataset that is filled in once a year by all providers whatever their quality rating. It is one of the main ways that we will get information from providers about how they are meeting outcomes for people using their service. The AQAA also provides us with statistical information about the individual service and trends and patterns in social care.
Adeline House Nursing Home DS0000015848.V373169.R01.S.doc Version 5.2 Page 6 The inspector would like to thank everyone who agreed to be interviewed as part of the inspection process, and the friendliness of staff. What the service does well: What has improved since the last inspection?
Care plans for newly admitted people were in place, which has improved since the last inspection of the service. People said they were confident that their needs can be met. One person said, “staff understands how I need to be supported to get in and out of bed to maintain my comfort, they are very caring”. There had been a number of concerns/complaints regarding the administration of medication, which has been investigated by the organisation. Action plans following the investigation has improved the way medication was recorded, stored and administered has made the procedures safe for people who use the service. Since the last inspection the organisation had replaced the care call system, which was required previously. The manager should monitor the response time by staff as the inspector noted that is was sounding for long periods of time throughout the day. Refurbishment of the home continues and a number of areas had been decorated and new furniture and lounge chairs had been purchased.
Adeline House Nursing Home DS0000015848.V373169.R01.S.doc Version 5.2 Page 7 Training has improved since the last inspection, and the organisation has established a rolling programme of mandatory training which means staff can access training when required. 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. Adeline House Nursing Home DS0000015848.V373169.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 Adeline House Nursing Home DS0000015848.V373169.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): 3 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service were assessed before moving into the home to ensure their needs can be met. EVIDENCE: All new people receive a full comprehensive needs assessment before admission; this was carried out by the manager who had the required skills and competencies. The service was efficient in obtaining a summary of assessments undertaken by the placing authority, and insists on receiving a copy of the care plan before admission. Staff confirmed that information contained in the assessment was essential to understand what staff needed to do to ensure people’s needs were met. Adeline House Nursing Home DS0000015848.V373169.R01.S.doc Version 5.2 Page 10 Four assessments were looked at and they focused on achieving positive outcomes for people who use the service. Before agreeing admission the manager and staff carefully considers the needs assessment for each individual prospective person and the capacity of the home to meet their needs. People said they had visited the home prior to admission, and found the staff to be very warm and friendly. One person who was receiving respite care from the home said, “I have found the experience very positive and I am now considering my long term future”. Adeline House Nursing Home DS0000015848.V373169.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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans provide staff with sufficient information to meet the needs of people who use the service, although some health issues were not followed to a conclusion. Medication policies and procedures were well managed ensuring the safe administration of medication. EVIDENCE: Four care plans were looked at to ensure care was delivered as described. The information was sufficient, although the plans were cumbersome and difficult to navigate. Care staff had good understanding of the needs of people who use the service. People said they were happy with the care provided although one person said, “I sometimes have to wait a long time for staff to help me get up in the morning, which upsets me”. The Inspector noted that the call system was sounding for long periods throughout the day. In particular it sounded for
Adeline House Nursing Home DS0000015848.V373169.R01.S.doc Version 5.2 Page 12 25 minutes, although the manager said the alarm was sounded by more than one person at the same time. Daily records were seen on all care plans looked at, most of the entries were of a good standard, although some were difficult to read, due to the style of hand writing. The manager should give some guidance to staff with regard to the standards expected when recording information. Risk assessments had been completed to ensure people could maintain their independence while remaining safe. The healthcare needs of people who use the service were generally met; however some records had not been completed. It was difficult to find evidence to confirm the outcome of a person’s skin condition. Procedures to gain consent before administering the flu injection had not been followed. Records looked at confirmed people had received the injection but the forms had not been completed, this means potentially people could be a risk it they had a reaction to the drug. An audit of medication stocks and records were examined and were found to be correct ensuring the health and safety of people who use the service. Nurses had responsibility for administering medications and they had attended training to update their knowledge, to ensure medicines were administered safely. The local pharmacist is contracted to undertake periodic checks to ensure the stock levels are maintained and procedures are followed. Medication was stored securely; there were separate, locked rooms for storing medication that contain a locked fridge and a controlled drugs cabinet. There were good examples of people being treated with respect, staff spoke quietly to people and informed them about meals and activities in an appropriate manner. People were addressed by their preferred name and this was clearly recorded on the care plans looked at. One relative said he was pleased with the way the home cared for his mother. He said staff always kept him informed about changes to his mother’s condition. Adeline House Nursing Home DS0000015848.V373169.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. We have made this judgement using a range of evidence, including a visit to this service. People are able to socialise with family and friends and mealtimes were well managed. EVIDENCE: People were able to join in a variety of activities including outings to Cleethorpes and a zoo. Staff were employed with the specific role to organise activities and there was evidence to confirm arts, crafts and outings takes place. Notice boards and photographs showed people enjoying outings and there was a wall covered with memorabilia from the war and old photographs. They have produced a newsletter to inform people of forthcoming Christmas events. People were involved in games of bingo in the afternoon and some enjoyed a massage in the morning. One person described how the massage had made her feel pampered. She said she was able to move her arm a lot more and looked forward to the next massage. Adeline House Nursing Home DS0000015848.V373169.R01.S.doc Version 5.2 Page 14 Visitors to the home described staff as very caring and supportive. They said “they were always informed of changes to their relative’s condition”. They confirmed they were always welcomed and could visit at any time. Mealtimes were organised and staff were available to offer support to people in an appropriate manner. A number of people received their meal in their bedroom and staff made sure the meal was served with a warm drink. People said they had enjoyed their meal of steamed fish with potatoes and vegetables. Adeline House Nursing Home DS0000015848.V373169.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. We have made this judgement using a range of evidence, including a visit to this service. People who use the service could access the complaints procedures and the manager investigates concerns appropriately. Adult protection policies, procedures and training of staff promote the protection of people from abuse. EVIDENCE: There have been a number of complaints raised since the last inspection, which included two which was sent to CSCI to investigate. The AQAA confirmed that eight complaints had been made to the home using their complaints procedure. The AQAA confirmed that all the complaints had been upheld. A random selection of complaints were looked at and discussed with the manager to look at how the complaints procedure was implemented. A random inspection was undertaken in June 2007 to investigate one of the complaints. The complaint identified a possible risk to people from cross infection, as there was no hot water to a number of bedrooms. Repairs had taken place to rectify the problem, although action to move people to other bedrooms while waiting for repairs to take place had not happened. A second complaint involved several people who used the service, with regards to there care and the administration of medication. The registered providers were asked to investigate and have responded in appropriate timescales. The outcome included parts which were partially upheld, upheld and not
Adeline House Nursing Home DS0000015848.V373169.R01.S.doc Version 5.2 Page 16 substantiated. The registered providers have provided the home with some action points following the outcome of the investigation. There was a comprehensive Safeguarding Adults and Whistleblowing policy and staff follow the procedures to those standards. The registered manager would investigate fully any allegations of abuse and would follow the necessary procedures if any were substantiated. Two safeguarding referrals have been made by the home since the last inspection, although they have not reached a conclusion. Staff interviewed had a good understanding of safeguarding adults and they confirmed they had received training to recognise the signs of abuse and would feel confident to report any incidents to the manager. Adeline House Nursing Home DS0000015848.V373169.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. We have made this judgement using a range of evidence, including a visit to this service. The home provides a well-maintained safe environment suitable for people. The home provides a clean and hygienic environment to maintain the health and safety of people who use the service. EVIDENCE: The registered provider continues to improve the décor and furnishings at the home creating comfortable and safe environments for people. Since the last inspection a number of rooms have been decorated and refurbished. Some new lounge chairs have been replaced and a new care call system has been installed. A partial inspection of the building found it to be clean and fresh. Staff were commended for maintaining good hygiene standards. Bathrooms and toilets remain a concern as not all the facilities were fully working. Only
Adeline House Nursing Home DS0000015848.V373169.R01.S.doc Version 5.2 Page 18 one bathroom and one shower facility was being used. The working facilities were inadequate for twenty-seven people currently living at the home. Adeline House Nursing Home DS0000015848.V373169.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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff had the skills and knowledge to fulfil their roles within the home, and there was a stable staff group. Recruitment policies are generally followed ensuring the safety and protection of people who live at the home. EVIDENCE: Training records looked at show that staff had the required skills and competencies to deliver care to people who use the service. A training plan has helped the manager to identify when staff required refresher training. Most staff had attended training identified at the last inspection, although some staff still need to attend safeguarding training which the manager said had been arranged. Staff were commended for meeting the requirement of 50 NVQ level two qualified staff. A number of staff was progressing with NVQ level two. There was a robust induction and probationary package, which was service specific. The manager only confirms permanent employment when satisfied that competence and progress had been shown to be satisfactory against their induction standards.
Adeline House Nursing Home DS0000015848.V373169.R01.S.doc Version 5.2 Page 20 Staff rotas and observation during this visit show there was sufficient care staff to meet the needs of people who live at the home. However the nursing levels could be improved as there was only one nurse on duty for twenty-five nursing residents, many were cared for from bed and were very frail, and required more time and attention. Four staff recruitment files were looked at, they included application forms and contracts. One file did not include a reference from the previous employer, although the manager did obtain a faxed reference by the end of the inspection. Another file included evidence of a POVA first check although the Criminal Record Bureau Check (CRB) was not on the file. Where information is received about a conviction the manager must not allow the person to work unsupervised until the CRB is received. The manager should check the date on the CRB as good practise suggests that a new CRB check should be carried out every three years, to ensure the information is up to date. The registered manager said the nurses continue to develop their own knowledge, by attending relevant training courses. The PIN had expired for one of the registered nurses, although the nurse was able to confirm the renewal by bringing in his up to date PIN during the inspection. Adeline House Nursing Home DS0000015848.V373169.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. We have made this judgement using a range of evidence, including a visit to this service. The management and administration of the home is based on openness and respect, has effective quality assurance systems developed by a qualified, manager. EVIDENCE: Since the last inspection the manager has successfully been registered with CSCI. He holds the relevant nursing qualifications and attends professional and internal training courses to ensure he has the competencies and skills to lead a team of staff. People spoke fondly of the manager and staff said he was approachable and supportive.
Adeline House Nursing Home DS0000015848.V373169.R01.S.doc Version 5.2 Page 22 Monthly quality assurance audits take place to ensure people receive a service which is value for money. Staff was encouraged to take ownership of the audits and a representative of the organisation undertakes and monthly visits to assess the home against national minimum standards. The organisation takes the lead for obtaining the views of people who use the service and they collate the data from yearly quality assurance surveys. The last surveys saw responses from 45 of the people and satisfaction levels had risen from 78 to 83 . A monthly newsletter has been developed and there was evidence that joint resident’s relatives meetings take place. The meetings were used to inform people of forthcoming events and to gain peoples views on the service that is being provided. Arrangements for safeguarding people’s money were in place, and a number of financial records were looked at. The procedures were discussed with the administrator. Notifications (Regulation 37) received by CSCI from the home has informed us of a safeguarding adults referral. The incident was being investigated by the homes internal auditors, to ensure people’s money was protected. Accident reports were analysed by the manager to ensure risk assessments were developed where required, to minimise risks to people at the home. Maintenance and service records examined were up to date and current to the services provided. The manager had the required health and safety policies and procedures relevant notices were displayed. Adeline House Nursing Home DS0000015848.V373169.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 X X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 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 3 17 X 18 3 3 X 2 X X X X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Adeline House Nursing Home DS0000015848.V373169.R01.S.doc Version 5.2 Page 24 No 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 OP8 Regulation 15 Requirement Timescale for action 01/02/09 2. 3. OP8 OP29 15 18 Healthcare records must confirm the treatment and outcome of any incidents to its conclusion. i.e. where skin tears are noted it must record the treatment and state when the treatment has been completed. Consent must be gained from 01/02/09 people who use the service prior to administering the flu injection. References from the last 01/02/09 employer must be obtained to ensure the right people are employed at the home. Staff who has declared a conviction must not work unsupervised until a satisfactory CRB check has been received. Adeline House Nursing Home DS0000015848.V373169.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. 2. 3. 4. 5. Refer to Standard OP7 OP21 OP27 OP29 OP38 Good Practice Recommendations Care plan records must be clearly written so that staff can follow directions to deliver care to people who use the service. There must be adequate (working) bathing facilities, which are suitable to meet the needs of people who use the service. Nursing staff levels should be monitored to ensure they are sufficient to meet the needs of people who use the service. Staff files should be organised for auditing purposes. CRB checks should be renewed after 3 years to ensure the information is up to date. The manager should monitor the response times to people using the call system to ensure their health and welfare needs are met. Adeline House Nursing Home DS0000015848.V373169.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB 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
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