Inspection on 10/12/08 for Avalon

This inspection was carried out on 10th December 2008.

CSCI found this care home to be providing an Good service.

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Avalon 18/04/07

Avalon 24/01/06

Avalon 21/12/04

Avalon 05/07/04

Avalon 27/01/04

Similar services:

1 Marten Road

Daubeney House

Three Gables

Aldwick House

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The Springs Community

Crossways Community

Belle Vue Country House

Extracts from inspection reports are licensed from CQC, this page was updated on 27/02/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Avalon 43 Woodfield Lane Ashtead Surrey KT21 2BT     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Kenneth Dunn     Date: 1 0 1 2 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 28 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 28 Information about the care home Name of care home: Address: Avalon 43 Woodfield Lane Ashtead Surrey KT21 2BT 01372278039 Telephone number: Fax number: Email address: Provider web address: pm-avalon@together-uk.org Name of registered provider(s): Type of registration: Number of places registered: Together Working for Wellbeing care home 8 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 mental disorder, excluding learning disability or dementia Additional conditions: Date of last inspection Brief description of the care home Avalon is a registered care home for people with mental health needs. Together Working For Wellbeing manages it in partnership with Richmond Churches Housing Trust. The property is located in a quiet residential area in Woodfield Lane, Ashtead and is close to public amenities. Buses run to nearby Epsom, Leatherhead and Guildford that has good shopping and sporting facilities. The property is a large, two storey, detached building and provides accommodation for eight service users. The house has a drive with private parking available and a large garden at the back of the property that is private and secluded. The home has a communal area, a conservatory, eight single bedrooms, adequate bathing and washing facilities, a laundry, a kitchen and dining area. 8 Over 65 0 Care Homes for Adults (18-65 years) Page 4 of 28 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The Commission has, since the 1st April 2006, developed the way it undertakes its inspection of care services. The inspection of this Care Home for Younger Adults was an unannounced Key Inspection. The inspector looked at how well the service is doing in respect to the National Minimum Standards for Care Home for Younger Adults. The site visit took into account detailed information provided by the registered provider and the manager, and any information that Commission for Social Care Inspection has received about the service since the last inspection. The inspector looked at how well the service was meeting the standards set by the Care Homes for Adults (18-65 years) Page 5 of 28 government and has in this report made judgements about the standard of the service. Documents sampled during the inspection included the care plans, daily records and risk assessments, medication procedures. The service has submitted the Annual Quality Assurance Assessment prior to the inspection, some details of which have been added to the report. No complainant has contacted the Commission for Social Care Inspection with information concerning a complaint made to the service since the last inspection. From the evidence seen by the inspector and comments received, the inspector considers that Avalon would be able to provide a service to meet the requirements of individuals who have diverse religious, racial or cultural needs. The inspector would like to thank the people who use the service and the staff for their time, assistance and hospitality during this inspection. Weekly fees 770 pounds sterling. The quality rating for this service is 2 star. This means the people who use this service experience a good quality outcome. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 7 of 28 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and health care 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 8 of 28 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has robust assessment and review procedures to ensure that they are able to meet the individual needs of the people who live there. Evidence: The home has a large corporate statement of purpose and service users guide which was subject to a good practise recommendations from the previous inspection report 18/04/2007. It was recommended during the previous inspection that each resident should be offered service users guide in a user friendly format. There is still a need for the home to undertake a reviews of these documents to ensure that they can effectively meet the needs of the people who live at the service. In addition the documents should be fully reviewed to ensure that appropriate contact details for regulatory agencies and professional bodies are accurate. The documents should also contain an appropriate staff structure with details of only current employees. All prospective service users have a full pre admissions assessment prior to being offered a place at the home. A member of staff stated that during the admissions Care Homes for Adults (18-65 years) Page 9 of 28 Evidence: procedures prospective service users is invited to the home to meet with other service users and staff. A random sample of three service user files was undertaken as part of the inspection process. Two files sampled contained details of pre admission assessments being carries out by the home however the file of the most recent person to move into the home did not contain a assessment compiled by the home. The home was using the residents mental health assessment to compile and design a suitable care package for this indavidual. During a discussion with the manager it was stated that the most recent person to move into the home was still in the process of being assessed prior to moving into the home on a permanent bases. Care Homes for Adults (18-65 years) Page 10 of 28 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this 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 people who use this service are provided with an individual care plan, which records their individual needs and goals. People are supported to make decisions about their lives with assistance of a well trained staff group. Evidence: A random sample of care plans of three people who live at Avalon were looked at. They included detailed information, necessary for staff to be able to meet their needs and to work towards their individual goals. Care plans included comprehensive assessments for each person which note any equality and diversity issues and any other special needs they might have as a result of a specific diversity. Care plans also have detailed personal support plans which include personal care, eating and drinking, household activities, community activities and any specialist needs relating to individuals specific needs. Care plans are reviewed regularly by key workers who write a monthly summary and the service cunducts a minimum of one annual multiCare Homes for Adults (18-65 years) Page 11 of 28 Evidence: disciplinary review for all its residents. Two people spoken to said that they attend their reviews and any meetings about themselves, they can make choices about what they do, what time they get up and most other things. One person said I am happy because I can now choose my own food and make my own snacks. The home has robust risk assessments which cover all the necessary areas for individuals, these include any areas of activity within the home that could be a risk such as kitchen,laundry, and activities that may be a risk to individuals such as money management,medication. Risk assessments are regularly reviewed and up-to-date. The risk assessments seen promote independence, access to new activities and experiences for people. People who live at the home are encouraged to attend house meetings which are held jointly between staff and residents and discuss all aspects of the running of the home, residents are supported to participate in the meeting. Staff were observed interacting positively with people and appeared to have a good understanding of their mental health needs and the support they require on a day-today bases. Care Homes for Adults (18-65 years) Page 12 of 28 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this 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 people who use this service are provided with an individual care plan, which records their individual needs and goals. They are supported to make decisions about their lives with assistance. Individuals are supported by staff. Evidence: Individuals living at the home have an activity programme that is designed to meet their diverse mental health, emotional, and social needs. A review of the weekly activity schedules reflect the activities participated in by individuals as they are very flexible and people can make daily choices, within reason. The daily notes are of a very good standard and fully reflect the activities participated by individuals living at the home. The daily note include peoples choices with regard to activities such as planned activities declined and what was chosen instead. People have a varied activity schedule Care Homes for Adults (18-65 years) Page 13 of 28 Evidence: and attend external day services and activities within the home. The manager stated that the service uses home activities as a method of enhancing, teaching and maintaining skills such as domestic tasks including baking and cleaning. Residents were observed participating in activities without a staff presence and confirmed that this was their choice . The people who live at the home are fully supported and encouraged to access the local community, going out for meals, leisure facilities and specialist community rehabilitations services. Risk assessments are completed on all activities undertaken by the service users. A review of the risk assessment identified a area where the service must improve, the mental health needs of one service user had become problematic and the risk assessments did not reflect these issues. During the site visit the staff on duty were observed treating people with respect and dignity. Two people who live at the home stated that the staff are supportive and treat us well they liked living there and it is a good place to live. The manager was aware and alert to cultural issues and differences between residents and staff and confirmed that it did not cause any problems, she described some work that had been done by herself and the team in this area. There was sound documentary evidence within individuals files that the service fully supports the people who live there to have appropriate family contact. The manager explained that the contact individuals have with friends and family varies with some having constructive active contact while others have little or no contact with families. The service had recently embarked upon a process of supporting the people who live there to carry out their own food purchasing, meal preparation and cooking. The manager stated the change in the way the home undertakes meal delivery is in line with a potential change to the future registration of the home. Care Homes for Adults (18-65 years) Page 14 of 28 Personal and health care support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this 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 has consistent documentation to evidence that the people who use the service, health care, mental health, general wellbeing and welfare are supported. The homes medication procedures are robust to ensure the safety of the people living in the home. Evidence: A random sample of three care plans demonstrated that the personal support needs were well documented and had been agreed with the resident, families and health care professionals. The review of individual care plan indicated that all residents are registered with a local general practitioner (GP) and are supported to access all other relevant mental health professionals. There was clear documentation that the people who use the service have access to dentists, chiropodists and opticians. The staff support the residents to access these services with minimum assistance unless the residents specifically asked for more support. A member of staff stated that good observation of the residents helps in the quick identification of the changing needs of the individuals, this enables us to request specialist in-put from additional health professional. Care Homes for Adults (18-65 years) Page 15 of 28 Evidence: All medications managed by the service are stored in a locked cupboard and there is documentation to indicate that the medication is reviewed and audited regularly. Three residents had been risk assessed to manage their own medications. The manager stated that the policy for self medication is to conduct regular spot checks to ensure that the individuals are safeguarded. A review of the medication records of the three individuals who self medicate demonstrated that the systems in place for regular reviews was robust and designed to safeguard the residents. The homes Medication administration practises were examined. Protocols were in place for service users receiving As required medication. Care Homes for Adults (18-65 years) Page 16 of 28 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this 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 people who live at the service are listened to and their views are acted upon. Individuals are kept and feel safe from any forms of abuse and staff are fully aware of safeguarding polices and procedures. Evidence: The complaints procedure is robust and has been produced in a user friendly format . Two people spoken to said that they knew who to tell if they were not happy and were very confident that they would be listened to one person said of course they listen to me they have to, I live here. There has been five complaint received by the home since the last inspection. Appropriate action had been taken by senior staff in investigation and resolving all of the complaints. A review of the complaints log and records provided evidence that the investigation and outcome of the complaints were well recorded. There have been no Protection of Vulnerable Adults (safeguarding) issues recorded by the home since the last inspection. Two people spoken with said that they felt safe and that staff make them feel safe in the home and out of the home. All staff receive safeguarding training and were able to describe what action they would take in event of them suspecting that a resident was at risk. The Commission for Social Care Inspection has received no information with regard to complaints or safeguarding Care Homes for Adults (18-65 years) Page 17 of 28 Evidence: issues, since the last inspection. The financial records of two people were seen and they were in good order, all necessary receipts are kept. The organisation audits all financial records annually. Care Homes for Adults (18-65 years) Page 18 of 28 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this 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 offers people a pleasant, clean and comfortable environment , which meets their individual and group needs. Some areas could be presented in a more homely way. Evidence: As part of the site visit a tour of the premises was undertaken. The accommodation consists of eight single bedrooms set over two floors, a large kitchen, sitting room and a conservatory. The bedrooms were individual and decorated in a way that meets the needs of the person occupying the room. The communal areas are designed to be flexible and to meet the individual and group needs of the people who live at Avalon. The since the previous inspection the home has converted one bathroom into a walk in shower room in order to meet the changing needs of the residents. The new shower however is not fully walk in, it requires the residents to step up into the cabinet and could be a trip hazard. This was discussed with the manager during the site visit and a recommendation was made. The residents are fully supported to participate in the day-to-day cleaning of the service. The service has developed a cleaning rota to offer the residents guidance Care Homes for Adults (18-65 years) Page 19 of 28 Evidence: when they are taking care of the home. In addition to the residents cleaning rotas the service has a contract with an industrial steam cleaning company. on the day of the site visit the service was clean, tidy and free from any offencive odours. The home has an infection control policy, which should be reviewed to ensure that it is fully compliant to current good working practises. Care Homes for Adults (18-65 years) Page 20 of 28 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this 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 staff group appeared skilled and in sufficient numbers to provide 24-hour care within the home. The systems for recruitment and training are designed to be robust and should protect the people who use the service. Evidence: The staff team is made up of both male and female care workers. The staffing arrangements should be six care workers and one domestic, however at the time of this site visit there were two staff vacancies and no domestic staff were employed. A review of the staff rota provided evidence that all shifts were covered by care workers employed directly by the organisation. The manager stated that the two vacant post are covered by internal relief and bank staff. The completed AQAA stated that all staff currently working at the home have undertaken a full induction programme. The staff on duty confirmed that they have completed an induction programme. A review of the individual staff training records provided evidence that all statutory training had been completed by the staff team, with specialist training in mental health support and legislation. The review of the training records however highlighted areas where the service must improve, at the time of the site visit the service had no staff Care Homes for Adults (18-65 years) Page 21 of 28 Evidence: with National Vocational Qualifications in care. The organisation has a robust set of recruitment policies and procedures. The policies require potential staff members producing all the relevant documents as detailed in Schedule 2 of The Care Homes Regulations 2001 are requested prior to starting in the service. The residents are fully supported and encouraged to participate in the interview process of any potential staff member. The manager stated that by encouraging residents to join in with the interviews they feel that they are involved and respected. One resident stated that she enjoyed taking part in the interviews, because they would be helping me so it was good to ask them questions and to talk to them before they started working The AQAA states that all staff has had a criminal record bureau (CRB) check and Protection of Vulnerable Adult (POVA) check prior to starting work in the home. Care Homes for Adults (18-65 years) Page 22 of 28 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this 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 people who use the service should benefit from home that is well run. There are procedures in place to self-monitor the services being offered. The health, safety and welfare of individual within the home are promoted and there are appropriate risk assessments in place Evidence: The service has recently appointed a new manager who is a qualified nurse and has over 15 years working in residential homes for both older adults and younger people. At the time of the site visit the manager had not completed her registration with the Commission for Social Care Inspection. The manager provides management stability, leadership and direction to the staff team. Further evidence reviewed during the site visit confirmed the home had a management structure with clear lines of communication and accountability. The home had a policy on quality assurance and used questionnaires to obtain feedback about the home from relatives and stakeholders. Further evidence indicated the provider carried out regular Regulation 26 (monitoring visits) with appropriate management action taken to safeguard the welfare Care Homes for Adults (18-65 years) Page 23 of 28 Evidence: of the people who live at Avalon. In line with a requirement from the previous inspection report the service retains copies of all Regulation 26 visit. A random review of the Regulation 26 reports however demonstrated that they were not signed and dated by the person undertaking the report but by the manager of the home. A recommendation was made to ensure that the person undertaking the report signs and dates the document. The home had a policy on health and safety and staff stated that they have received training in health and safety, fire safety, basic food hygiene and first aid. The AQAA stated that the home has a current gas safety certificate and service inspection reports for fire equipment, small portable appliances and emergency lighting. This was confirmed by the manager and the certificates reviewed. The home had information about health and safety displayed in the home and a policy on COSHH (Control of Substances Hazardous to Health) to promote safety. Care Homes for Adults (18-65 years) Page 24 of 28 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 25 of 28 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 32 18 The registered provider must develop a plan to ensure that staff are encouraged and supported to undertake National Vocational Qualifications in order to meet current good practise legislation. The residents must be supported by staff who are suitably qualified with suitable qualifications. 10/02/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 1 The statement of purpose and service users guide should be in a user friendly format. The documents should only contain the details of current employees. It is recommended that the registered provider ensures that hand grips are fitted to the inside of the walk-in shower cabinet. It is recommended that the manager applies to be registered by the Commission for Social Care Inspection. 2 24 3 38 Care Homes for Adults (18-65 years) Page 26 of 28 4 39 It is recommend that the person completing the registration 26 visit of the home signs and dates said document. Care Homes for Adults (18-65 years) Page 27 of 28 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. 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