CARE HOMES FOR OLDER PEOPLE
Alderwood Nursing Home Rectory Place Bensham Gateshead NE8 1XD Lead Inspector
Katie Tucker Unannounced Tuesday, 5 July 2005 :10:00
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 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. Alderwood Nursing Home B52-B02 S18167 Alderwood V219516 5 Jul 05 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Alderwood Address Rectory Place, Bensham, Gateshead NE8 1XD 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) 0191 477 7833 0191 478 3212 Mental Health Concern Mr Philip Green Care home with nursing 32 Category(ies) of DE Dementia (6) registration, with number MD Mental Disorder (9) of places DE(E) Dementia - over 65 (23) MD(E) Mental Disorder -over 65 (9) Alderwood Nursing Home B52-B02 S18167 Alderwood V219516 5 Jul 05 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: None Date of last inspection 1 March 2005 Brief Description of the Service: The local authority first built Alderwood nursing home in the late 1960’s. In the 1990’s it was leased by Mental Health Concern and registered to provide nursing and personal care for people with mental health needs and dementiatype illnesses. Last year Mental Health Concern purchased the property and the staff who remained on NHS contracts transferred under TUPE arrangements to the organisation payroll. The home is divided into three units. The downstairs unit provides nursing care for people who require long term care because of the nature of their mental health needs. The upstairs contains a unit for the long term nursing care of older people with dementia type illness. The other unit on this floor provides respite nursing care for older people with dementia type illnesses. Alderwood nursing home is in the Bensham area just off the main road leading to Gateshead. There are local shops and bus stops on this main road. The home stands on an elevated site and is surrounded by a mix of houses. Alderwood Nursing Home B52-B02 S18167 Alderwood V219516 5 Jul 05 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection of Alderwood Nursing Home, which was conducted as part of the routine yearly programme. An inspector spent 5.5 hours at the home and spoke to 12 service users and visiting relatives. A sample of assessments, care plans and risk assessments were examined. The staff were asked about the service user plans, the complaints procedure, access to training and any changes to working practices, as were the service users. The general maintenance of the building was checked. Alderwood provides a service for people with a dementia-type illness (memory loss) as well as for people with mental health needs. Some of the people have difficulty making their views known. Therefore staff practice, attitude and approach were observed and judgements were made on how well the approaches that were used were working. This type of observation formed a part of the inspection process as well as what people said and was backed up through the examination of records, comments made by service users, staff, relatives and the manager. During this inspection key standards were focused on but not all were checked. What the service does well:
Relatives commented that the staff were always very welcoming and caring. They said that the care their loved one received was ‘top rate’. Relatives said they found the staff helpful and would go out of the way to ‘go that extra mile’. Staff discussed the range of activities that they arrange for the people living both on the dementia care units and the unit for people with mental health needs. The high level of motivation staff have towards ensuring people are able to go out and used facilities in the local community is a consistent feature. Mental Health Concern’s staff training department is extremely active and all of the staff have access to a wide range of training. The type of training offered includes access to degree and masters level courses as well as secondments onto nurse training. Also one of the deputy managers has taken on the responsibility of ensuring staff receive all of the mandatory training and have access to appropriate training. Staff spoke highly of the level of access and range of courses that they could complete. Mental Health Concern is not only the owner of Alderwood but also a charity. Headquarters and Alderwood staff actively promote the recognition of people with mental health needs as full citizens. They run service user boards and provide opportunities for people with mental health needs to access
Alderwood Nursing Home B52-B02 S18167 Alderwood V219516 5 Jul 05 Stage 4.doc Version 1.40 Page 6 employment. Recently the manager has employed some people to work as domestics at Alderwood and this has both benefited the home and employees. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office.
Alderwood Nursing Home B52-B02 S18167 Alderwood V219516 5 Jul 05 Stage 4.doc Version 1.40 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Alderwood Nursing Home B52-B02 S18167 Alderwood V219516 5 Jul 05 Stage 4.doc Version 1.40 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 and 6 A wide range of records are available and staff are in the process of ensuring these are completed in full. Therefore some minor shortfalls will continue to exist until these are completed. EVIDENCE: The manager has not yet included the recent inspection report in the service user guide. These reports are designed to assist people to make informed choices about the care they or their relative received. A new assessment document has been introduced in the home. This has been specifically designed to provide information on the needs and experiences of those people with a dementia- type illness. This is a very comprehensive tool, which is starting to generate comprehensive information about all aspects of people’s lives and needs. A second assessment tool is in place for the younger adults who experience long-term mental health needs. Staff are in the process of completing the assessments for all of the residents. The staff team are working hard to ensure all of the pertinent information is recorded. They see the development of the assessment tools as an ongoing process whereby amendments can and will be made and reviewed. The assessment tool is starting to become a very valuable and useable tool, which is assisting staff to
Alderwood Nursing Home B52-B02 S18167 Alderwood V219516 5 Jul 05 Stage 4.doc Version 1.40 Page 9 meet the needs of the residents. Most people have a dementia-type illness and the generation of life histories for these people must be treated as a priority. The life history tool is in the process of being revamped and relatives are assisting staff to redesign this tool. Questions on the life histories are going to cover people’s personality traits when they were younger, events that occurred and their feelings at that time, routines and jobs or roles. People with dementia tend to revert to previous routines and patterns of behaviour and having this information allows staff to work more effectively with people and reduce the challenges that may be presented. By understanding how people have lived and their lifestyles, what often seems to be unusual behaviour when seen in the context of what people previously did becomes perfectly reasonable. Thus staff can work around a routine such as a person who has always worked nightshift may have what seems to be a disturbed sleep pattern but in fact it is the norm for this person. Therefore staff can ensure that meals and activities are provided during the night. Staff are also looking to see if they can use people’s old photographs to make these histories more pertinent and useable. Thus reminiscence sessions can be tailored around people’s lives and therefore be much more appropriate and stress-free. Alderwood runs a respite service. This is provided in a dedicated unit with it’s own staff team. The manager is currently exploring how to extend access to this unit from GP services across the Gateshead area. Alderwood Nursing Home B52-B02 S18167 Alderwood V219516 5 Jul 05 Stage 4.doc Version 1.40 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7 and 9 Although the staff in practice help service users to make decisions about their lives, are aware of associated risks and plan people’s care, this is not always reflected within the care plan or risk assessments. EVIDENCE: Over the last six months staff have been revisiting the style of writing they use to complete care plans. These are becoming clearer in the range of actions staff need to take to meet individuals needs. Some shortfalls in care planning remain, particularly around meeting people’s emotional well-being. The risk assessment for manual handling are to be revisited with the health and safety representative to ensure they are compliant with good practice. Also risktaking assessments are not sufficiently detailed. These types of plans identify the strengths people have and the common day risk that would be still acceptable for someone to take. Staff need to be confident that people can continue to safely use their skills. It is vital that the level of risk presented to resident’s from continuing an activity would be outweighed by the service users level of skill and the quality of life it would lead too, is recorded. The assessment tool for bedrails is incomplete and the health and safety representative is in the process of redesigning them. Bedrails are also
Alderwood Nursing Home B52-B02 S18167 Alderwood V219516 5 Jul 05 Stage 4.doc Version 1.40 Page 11 classified as mechanical restraints and appropriate care plans around this type of physical intervention have to be in place. Some of the residents because of the nature of there needs have limitations imposed upon them by the service such as needing someone to accompany them when they leave the building. Staff have started to record limitations in place for individuals. The manager is also aware that should generic limitations be in place because of Alderwood’s rules this would be recorded in a standard contract. Residents, who we able discussed their care and how staff involved them in planning what they did and the activities they were involved in. The medication records are the ground floor unit were examined. The check of the medication confirmed that auditable trials of medication could be completed. However when ‘as required’ medication is carried over from one month to the next it would be useful if the amount of medication left was recorded on the new sheet. The staff are very aware of the side effects of medications and new developments. Staff were aware of the research showing the use of neuroleptic medication (used for mental health needs, behavioural issues and anxiety) in the elderly population often exacerbated anxiety and agitation rather than reducing these symptoms. Staff were also following guidance around routinely using pain relief for people who were prescribed this for chronic pain but could not express verbally when they were in pain. By adopting this type of approach to current practice the quality of life people in Alderwood have will continually be at an optimum. Alderwood Nursing Home B52-B02 S18167 Alderwood V219516 5 Jul 05 Stage 4.doc Version 1.40 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 13 and 14 Written evidence is not provided to justify why restrictions and limitations in place for residents at Alderwood. Residents are able to maintain links with their family. EVIDENCE: Relatives said they were able to visit the home at times that suited them. Also that a very active relatives group operate at Alderwood and they were encouraged to share their views about the service and how it could be developed. People said they always found the staff to be very approachable and supportive. The people living at Alderwood have either dementia-type illnesses or mental health needs. At times to protect people’s well-being limitations may be imposed such as not being able to leave the home unless accompanied by a staff member. Also some people may have previously been subject to detention at hospital under a section of the Mental Health Act 1983 and conditions of residency may still be in place. The manager was aware of the need to be mindful of issues around safeguards but also not imposing unnecessary restrictions on people’s liberties that are discussed in the Bournewood Judgement. Verbally staff can outline why actions such as locking all the bedroom doors are in place and why no one has access to their own key. But the reason for these restrictions and others are not written down.
Alderwood Nursing Home B52-B02 S18167 Alderwood V219516 5 Jul 05 Stage 4.doc Version 1.40 Page 13 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 The complaints procedure is available and has proved to work effectively. EVIDENCE: Mental Health Concern developed a complaints procedure, which complies with the requirements of both the national minimum standards and Care Home Regulations 2001. This is reproduced in the service user guide and made available to residents or their representative. The manager recognises the importance of dealing with minor concerns in a proactive manner. Where people have raised concerns she has dealt with these to the satisfaction of all concerned and ensured the actions have been sustained. Alderwood Nursing Home B52-B02 S18167 Alderwood V219516 5 Jul 05 Stage 4.doc Version 1.40 Page 14 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19 Once the refurbishment programme of Alderwood has been completed the environment will more readily meet the needs of the residents. EVIDENCE: The local authority originally built Alderwood and the building is accessible for those with a wheelchair plus it is close to local amenities. However the road leading to Alderwood is on a slope as is the main road leading to the turning for Alderwood. Thus accessing shops for those using wheelchairs will at times be difficult. Alderwood will be fully refurbished in the near future and all communal areas will be redecorated. Recently all of the windows have been renewed and residents, staff and relatives were complimentary about the changes these had created. Planning permission is being sought to extend the size of the lounge downstairs so that a kitchenette and more space can be provided. The bedrooms on this unit are also going to be fully refurbished and where possible more space provided.
Alderwood Nursing Home B52-B02 S18167 Alderwood V219516 5 Jul 05 Stage 4.doc Version 1.40 Page 15 Mental Health Concern will also redevelop the upstairs facilities. Changes will include improved bedrooms, communal areas and signage. Also consideration is being given to using colour, as this has been proved to assist people with dementia-type illness orientate to the building. The option of providing similar domestic facilities upstairs has been discussed as research completed by the University of Stirling advocates maintaining everyday activities, such as completing domestic task because it follows peoples lived experiences and reduces anxiety plus provides meaningful activities for people. The manager is also aware of the research that J Rowntree Foundation and Stirling University have completed. These organisations provide information and guidance about environments plus how poorly planned living areas created challenging behaviour. Blending locked doors into the decoration schemes via the use of matching wallpaper and reminiscence pictures has been shown to reduce the level of frustration people have when confronted with an inaccessible area. The use of texture and items of interest along walls also offers people a focus and for those with sensory impairments an alternative means of locating where they are within the building. On the upstairs units windows are located above bedroom doors. These mean that during the night light will always penetrate rooms and can lead to disturbed sleep patterns and disorientation. The manager feels that on the whole this does not cause problems for people but will complete work over the next six months to check this premise out. Mental Health Concern is also planning to develop the grounds and provide decking for the dementia care unit. The staff feel that this development will provide even greater opportunities for residents to spend time outside. Alderwood Nursing Home B52-B02 S18167 Alderwood V219516 5 Jul 05 Stage 4.doc Version 1.40 Page 16 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 and 30 The high care staffing levels and introduction of domestic staff will further enhance the care service provided and the quality of life experienced by the residents. However currently work needs to be conducted to improve the general level of activity and stimulation provided within the home. Staff have access to a wide range of training and learning opportunities, which ensures residents will receive the most up-to-date service. EVIDENCE: The staffing levels at the home remain well in excess of those required by the previous registering authority and this greatly benefits the residents. The organisation has set their staffing level at a minimum of 2 first level nurse (RMN) and 8 care staff during the day. During the night 1 first level nurse (RMN) and 4 care staff are provided. Domestic staff are now being employed to complete tasks around the home and this has given opportunity for care staff to take people out more regularly. Staff were highly motivated and arrange a lot of access into the community. Also they discussed the forthcoming charity event they are organising for the home. However at present activities co-ordinators are not in post and staff tend to consider activities to be those run outside the home and not one-to-one engagement or those tailored to people’s previous experience. Thus staff have very limited knowledge about the roles and lifestyle people would have followed in their younger years. The manager is hoping to be able to employ an activities co-ordinator so this type of positive development can be put in place and staff can receive information about in-house occupation.
Alderwood Nursing Home B52-B02 S18167 Alderwood V219516 5 Jul 05 Stage 4.doc Version 1.40 Page 17 The manager and deputy managers on the whole work in a supernumerary capacity. The deputy managers have a wide range of knowledge and skill. The manager has run Alderwood for a number of years and he is very aware of current developments and how to move the service forward so it keeps abreast of changes in practice. One of the deputy managers is responsible for training and ensures that all of the mandatory training is in place. Currently she is in the process of ensuring that sufficient staff hold the four-day at work first aid certificate to cover the 24-hour period. Also she has organised further learning opportunities for staff around different and pertinent needs within the home. Thus staff have recently completed training around managing conflict, dementia and core training. Staff continue to complete NVQ level 2 and 3 training and over 80 of staff now hold this qualification. Mental Health Concern has supported one of the care staff to commence their nurse training so she will continue to receive a wage and is guaranteed a job within the organisation once she has completed her training. Also one of the qualified nurses discussed how the organisation supported her to complete a further degree, in which she majored on dementia care. This continued level of support and training ensures that staff continue to reflect on their practice and keep abreast of developments. Thus the overall quality of care people receive will constantly be improving. Alderwood Nursing Home B52-B02 S18167 Alderwood V219516 5 Jul 05 Stage 4.doc Version 1.40 Page 18 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33 and 38 Some measures need to be taken to improve the safety precautions used at Alderwood. The quality assurance system meets the needs of Alderwood and the organisation. EVIDENCE: Mental Health Concern has developed a robust quality assurance system, which includes a service user board. This board is made up of residents and relatives and they actively review the care being offered across all of the services operated by the organisation. Also a number of the operational managers visit each home to conduct different audits of the service being offered and this information is provided to the local CSCI office. Following the last inspection a number of high/low beds have been provided so staff no longer need to use bed rails or nurse people on a mattress on the floor, which greatly improves the quality of life and outcomes for people using the service. However still a large number of people need to use bedrails, as the
Alderwood Nursing Home B52-B02 S18167 Alderwood V219516 5 Jul 05 Stage 4.doc Version 1.40 Page 19 number of bed supplied at present does not cover the number of people who need this type of support. Some of the communal and bedroom doors were chocked open with furniture, which posed a fire risk. The manager has provided door guards and undertook to ensure sufficient were available and staff used them. Alderwood Nursing Home B52-B02 S18167 Alderwood V219516 5 Jul 05 Stage 4.doc Version 1.40 Page 20 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 2 x 3 x x 3 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 x 9 3 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 3 14 2 15 x
COMPLAINTS AND PROTECTION 2 x x x x x x x STAFFING Standard No Score 27 3 28 x 29 x 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x x x x 3 x x x x 2 Alderwood Nursing Home B52-B02 S18167 Alderwood V219516 5 Jul 05 Stage 4.doc Version 1.40 Page 21 Yes 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 5 (1) (d) Requirement A copy of the most recent inspection report must be included in the service user guides. (required at the previous inspection - timescale 7.06.05) Records must continue to be developed, which information about individuals’ rights, decision-making skills and outline where they are limited. (required at previous inspections -timescale 5.07.05) The windows above bedroom doors must be covered unless information provided indicates good reason for them to be in place.(required at previous inspections - timescale 7.03.05) The decoration within the dementia care units must meet the requirements of the Disability Discrimination Act 1995 and be user friendly for people with a dementia. Activities co-ordinators must be employed to ensure personcentred approaches are used so culturally and individually appropriate activities are provided in the home. Timescale for action 11.10.05 2. 6 12 (2) Schedule 3 (3) (q) 6.12.05 3. 19 23 (2) (a) 28.03.06 4. 27 16 (2) (n) 6.12.05 Alderwood Nursing Home B52-B02 S18167 Alderwood V219516 5 Jul 05 Stage 4.doc Version 1.40 Page 22 5. 38 13 (4) (a) 23 (2) (c) Bed rails must only be fitted when appropriate risk assessments have been completed and action taken to ensure they are fitted appropriately and a routine maintenance programme are in place. 5.07.05 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 12 27 Good Practice Recommendations Staff should gather a range of information about peoples lifestyles when they were younger. Alderwood Nursing Home B52-B02 S18167 Alderwood V219516 5 Jul 05 Stage 4.doc Version 1.40 Page 23 Commission for Social Care Inspection Baltic House Port of Tyne South Shields NE34 9PT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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