CARE HOMES FOR OLDER PEOPLE
Bedford Charter House 1a Kimbolton Road Bedford Beds MK40 2NT Lead Inspector
Dragan Cvejic Unannounced 06 & 11 May 2005 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. Bedford Charter House I51 s14999 BED CHARTER HOUSE v226755 060505.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Bedford Charter House Address 1a Kimbolton Road Bedford MK40 2NT 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) 01234 359313 Bedford Citizens Housing Association Denise Hookham Care Home 64 (64) (64) (64) Category(ies) of OP - Older people registration, with number DE(E) - Dementia over 65 of places PD(E) - Physical disability over 65 Bedford Charter House I51 s14999 BED CHARTER HOUSE v226755 060505.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 04/11/04 Brief Description of the Service: Bedford Charter House was a purpose built home for older people situated next to the entrance to the Bedford hospital. This location ensured easy access to Bedford town centre and the roads leading to the centre. The home provided accommodation to 65 service users, 8 of those were reserved for intermediate care and two for respite care, and the rest for permanent service users. The home accommodated older people with dementia, some with physical disabilities and some generally affected by old age. The home was divided operationally into 3 areas: intermediate care unit, and one unit per each floor. Service users from the intermediate care unit were invited to use a dining room and activity room in the main part of the building, if they wished. The fact that home did not provide furniture, (except in circumstances of real hardship) for service users’ bedrooms, was used to advantage in creating a homely environment. Service users’ bedrooms were individualised and the communal areas provided a comfortable and pleasant home. A large and nicely maintained garden contributed to the homely atmosphere and provided an outdoor space for service users in safe surrounding. Bedford Charter House I51 s14999 BED CHARTER HOUSE v226755 060505.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection. It was carried out during two days, 7 days apart. The first day the inspector spent a working day in the home and was assisted by the manager and the deputy manager. The inspector case tracked 6 service users, checked their files, records related to them, spoke to them and spoke to the key-workers: three staff that worked with particular service users. During the visit the inspector spoke to a further 6 service users.. The inspector looked into the records, files, and working practices: such as use of hoist’s and manual handling. The second day of the inspection was carried out during the morning hours by two inspectors. Case tracking methodology was used continuously from the first day. One inspector looked at the intermediate care unit, as well as records and talked to 9 service users, one visitor, the hairdresser and the management team. The second inspector checked the medication, staff documentation and kitchen. On both days the management team was co-operative, staff talked openly to the inspectors, and service users were so kind to talk to the inspectors in an informal way and to point out the outcomes of the home’s provisions of care. What the service does well:
This inspection showed that new service users were given good and detailed information about the home. A new service user admitted recently into the intermediate care unit commented: “They came to my home to see me before I was admitted. My GP referred me.” Her relative confirmed the assessment was made in their home prior to admission. He stated: “Mum is much better here. I speak to a staff member every day and they keep me well informed.” Another service user said: “ I have been referred here as I had lost a lot of weight. I am getting on much better here, I eat regularly. They are looking after me very well.” A service user spoken to on the second day of the inspection commented: “I have hip problems, and a few falls at home, so the hospital referred me here. I am much safer here. I have not had any falls here, staff are here to help me. I was here just to get better, but now, I will apply to stay here. They are kind, I can choose food, and I am quite happy here.” “They have activities here, but I prefer to stay in my room and watch TV. They respect that.”, stated a service user. Another service user said: “I am going to hospital for my hearing aid. It is written down in my care plan”. Communal areas were tastefully arranged and offered a pleasant environment to be in. The dining room was done up in the style of a hotel. The home had a separate smoking room. The kitchen was well equipped, but equipment needed cleaning.
Bedford Charter House I51 s14999 BED CHARTER HOUSE v226755 060505.doc Version 1.30 Page 6 The home was operating through three area-units: an intermediate care unit, with it’s own lounges which was separate from the main areas of the home only by it’s position in the corners of the building. The main part of the building was divided into two operational areas, a ground and a top floor. The staffing would be adjusted after the proposed changes so that each unit would have a team leader. Each unit would have a trolley with care plans. With this arrangement, the staff would have easy access to files. A notice board contained information about the daily routine showing the menu for the day, activities, staff on duty and any other relevant information. Service users from the intermediate care unit were regularly invited to join activities in the main activity room. “The laundry is much better now. They found my missing cardigan” stated a service user. A laundry worker stated that the situation with laundry had been much better and that many mixed up clothing items from the past had been identified and returned to the right people. A visitor confirmed there was good laundry service. Some bedrooms had locks, some service users held their keys, while some had privacy locks. Some service users held a small amount of their personal money with them and stated that they could spend money as they liked. When staff assisted someone, all records were accurate and receipts were given to service users or their relatives. What has improved since the last inspection? What they could do better:
The home should continue with the changes they were introducing. Reorganising the staff rota was very promising, and would need to be monitored to show the actual effects on quality of service.
Bedford Charter House I51 s14999 BED CHARTER HOUSE v226755 060505.doc Version 1.30 Page 7 With the new format of care plans the information won’t be scattered throughout the file and would be presented in a consistent way, easy to follow for staff, service users and relatives. The dates on risk assessments would be recorded correctly and accurately. The new file would also contain a date column for possessions brought into the home and would make sure all new personal items brought in would have a date recorded, which current files did not have. Individual care plans would need to be up-dated when they did not correspond to actual care given. The home would need to consider how to minimise the effects of noise in the dining room for those service users with hearing aids. The home would need to review the use of smoking room, as the smoke spread through corridors and some bedrooms. The recruitment procedure was appropriate, but there was one staff file where the second reference was missing. However, the chief executive and the manager were determined to obtain all necessary documents prior to appointing new staff. Administration of medication was appropriate, but the home needed to maintain accurate documents, including risk assessments, that covered all medication for individuals that were self-medicating. There was a discrepancy in the amount of medication in the home and records of it. Also, the home needed to record the fridge temperature for a medication fridge. A self medication form was signed by a relative but did not show the service user’s name. Catering was appropriate, menus were regularly reviewed, although some service users still commented on the limited choice, the majority stated that the food was good, that they had a choice and could require anything else as an alternative. The home, however, did not record when service users chose alternatives. The kitchen equipment needed deep cleaning. An unused, old alarm cord bell point should be removed from the bathroom, as a service user pointed out to the inspector. 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. Bedford Charter House I51 s14999 BED CHARTER HOUSE v226755 060505.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Bedford Charter House I51 s14999 BED CHARTER HOUSE v226755 060505.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 2,3,4,5,6 The home provided sufficient and efficient information to potential users to allow them to make an informed choice of home they wanted to move into. EVIDENCE: A contract for service users contained terms and conditions and clearly explained expectations, rights and obligations. The home obtained documents from other sources about any potential service user prior to admission. The service users’ files contained details that demonstrated that assessments were done appropriately and thoroughly. Some of these initial risk assessments did not have dates and some reviews of risk assessments were not dated. The needs identified and recorded in care plans were met. The order of documents in service users’ files was inconsistent, but the new suggested folder had dividers after each section making it clearer. The admission procedure was appropriate and this was confirmed by the service users spoken to, by a relative and by staff comments. The intermediate care unit was separately organised from the rest of the home.. Although the staff did not receive any specialist training for working in this unit, the senior staff, currently in charge, had had a broad and extensive
Bedford Charter House I51 s14999 BED CHARTER HOUSE v226755 060505.doc Version 1.30 Page 10 experience of working in this unit and stated that she trained staff allocated to work in this unit. Care plans in this unit were reviewed at least weekly to ensure the needs and progress were assessed according to the rapidly changing conditions of service users. The service users from this unit were given the opportunity to apply for permanent residence in the home if they wished and their needs indicated the appropriateness for permanent residential care. Bedford Charter House I51 s14999 BED CHARTER HOUSE v226755 060505.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7-10 A present inconsistency among care plans could be avoided when the home starts using the new care plan and users’ files format. The home recognised the need and developed the new format, and this was seen as major progress in offering individually centred care. There were discrepancies and some shortfalls in the area of administration and recording of medication and the home did not meet this standard. EVIDENCE: The service users’ files were arranged in an inconsistent way. However, the home had identified a new format for users’ files. The risk assessments were not accurately dated. Some minor changes were not recorded accurately in care plans, such as in one care plan that did not accurately state who was offering nail care to a particular individual, or where the problems with hearing aids were identified and addressed, the final outcome was not recorded. The noise in the dining room that affected hearing aids for many service users was not addressed in care plans or other documents. Service users knew about the plans and were looking forward to the implementation and progress in the care process. Obviously, all these changes needed to be carefully planned and executed through phases in a home of this
Bedford Charter House I51 s14999 BED CHARTER HOUSE v226755 060505.doc Version 1.30 Page 12 size. Therefore, there are no requirements regarding these new measures following this inspection, and full support from the regulation authority would be given. However, some elements must be addressed and acted upon straight away, such as the administration and recording of medication. There were missing or inaccurate self medicating forms for some service users. The amount of some medication did not match the records held in the home. The temperatures of the medication fridge were not recorded. Apart from the mentioned elements relating to a small number, the majority of other records and stocks of medication were accurate and appropriate. A new operational practice was going to further improve respect for service users’ privacy and dignity. Staff would be in the position to respond to users needs faster and peak periods, including handover time, would be much better covered. Clothes care had been much better and service users noticed this improvement and pointed this out to the inspector. The relatives also noticed the improvement of the laundry service. Bedford Charter House I51 s14999 BED CHARTER HOUSE v226755 060505.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12-15 Despite the size of the home and individual differences, the home tried to organise the daily routine according to the wishes of the majority. The staff tried to respond to individual preferences which resulted in a greater satisfaction for service users. EVIDENCE: The home offered a range of activities and all service users, including those from the intermediate care unit, were invited to jointly take part. The conditions of service users determined their ability to take an active part in the activities, so some service users did not find the activities appropriate for their taste. Some more capable users stated that would like to see more entertainers in, but admitted that the home did provide regular entertainment. The list of activities did not clearly demonstrate any special activity for visually impaired or for deaf and blind service users. A service user commented: “yesterday one carer took me out to the garden. It was wonderful. The carer is a wonderful person. They take me out for lunch even when they are off. We also went to St Paul’s church for an exhibition.” Relatives spoken to during the inspection, as well as a hairdresser, stated that provisions had improved. General comments about food were positive and individual wishes were respected as far as possible, but alternative orders, when served, were not recorded.
Bedford Charter House I51 s14999 BED CHARTER HOUSE v226755 060505.doc Version 1.30 Page 14 Food from the menu was nutritious and varied. Bedford Charter House I51 s14999 BED CHARTER HOUSE v226755 060505.doc Version 1.30 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16,18 The home displayed a clear and simple complaints procedure that ensured good protection of service users.. The home had robust policies and procedures in place which ensured that service users were protected from the risk of abuse, neglect and self-harm. EVIDENCE: The home showed determination to operate openly and to involve service users and their relatives into the operational process by displaying and simplifying the way that anyone could complain or express their concerns about the services, provisions and protection of service users. The procedure on display did not contain the CSCI telephone number, but the chief executive reacted straight away when this was pointed out and added the missing detail. The home did not have any formal complaints. The staff were also more open and felt empowered to express their concerns relating to the operational procedures in the home, which ensured better protection of service users. The home minimised the risk of potential financial abuse by referring service users’ financial support to their families and appropriate legal representatives. Bedford Charter House I51 s14999 BED CHARTER HOUSE v226755 060505.doc Version 1.30 Page 16 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) 19,20,22,23,24,25,26 The home was suitable for its purpose and provided a nice and pleasant environment for service users. It was well maintained and equipped. EVIDENCE: The home’s location next to the entry to the hospital and close to all the amenities of the town centre was appropriate for its purpose. The home was maintained according to the organisations plan and any urgent renewals or repair were dealt by in a timely manner. The garden looked very nice. The manager was considering the ways of improving the security of the garden gate that faced the street. The building was regularly inspected by other relevant regulation authorities. Shared facilities were arranged in a domestic style. A dining room looked like a restaurant in a nice hotel and was fitted with a large push button for opening the door to allow weaker service users to open the door easily without physical efforts. A dining room could accommodate all service users, but their preferences to eat in their rooms were also respected.
Bedford Charter House I51 s14999 BED CHARTER HOUSE v226755 060505.doc Version 1.30 Page 17 A smoking room was located on the first floor, and the fact that smoke was circulating outside it into the corridor and some nearby bedrooms needed careful review. A service user from the nearest bedroom commented that smoke was coming into her bedroom. A blind service user confirmed that he felt comfortable and could find his way around the home. A dedicated corner of the building provided separated accommodation for the intermediate care unit. The home had appropriate adaptations and facilities that met the needs of service users. An alarm call bell system was in place and there was a system in place to monitor it’s effectiveness. Some service users commented that they needed to wait, but understandably continued: “They might be dealing with an emergency, we don’t know, do we?”. The home had two shared rooms, one of which was used by a married couple which they had requested, and the other one was used for respite care and the agreement to share was obtained from both service users. Individual bedrooms were very personal, especially with personal furniture brought in by the service users as the home offered the accommodation originally unfurnished. The home was generally clean and infection control measures were in place. The kitchen equipment needed deep cleaning. The carpets in some areas had started to show signs of wear and tear, but the organisation’s phased maintenance programme was carried out and in some areas the flooring had already been replaced. One bedroom needed a re-touch of paint in the corners and replacement of the sealant on the window. Bedford Charter House I51 s14999 BED CHARTER HOUSE v226755 060505.doc Version 1.30 Page 18 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) 27,29,30 The home employed sufficient and skilled staff to work with service users. It was a question of effective deployment that determined the efficiency. The inspectors did not make a clear judgement on this at the time of the inspection, but were satisfied with the home’s action and approach to this important issue. EVIDENCE: The staff team were motivated and looked forward to the new proposal for reorganising the work and practices within the home. The new, proposed rota was discussed with staff individually and their preferences were respected as far as the plan allowed, without affecting the standards of care. The home employed non care staff, but their number was not sufficient. The manager stated that these vacancies had just been advertised. All new care staff were inducted by training based on TOPSS principles. The home followed the recruitment and employment procedures set by the organisation and the staff files, in general, confirmed it’s appropriateness. There was one reference missing at the time of the inspection, but the general practice to have two references and a CRB disclosure before starting new staff in their post, was respected. The other staff files inspected confirmed this statement. Training was appropriate and staff expressed their full satisfaction with the topics covered and the quality of training provided. Bedford Charter House I51 s14999 BED CHARTER HOUSE v226755 060505.doc Version 1.30 Page 19 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) 31-38 The home was well managed and was in the process of sorting out administration, both for service users and for their own purposes. EVIDENCE: The home was run by the experienced and skilled manager. The lines of responsibility within the home were clear. The staff expressed their satisfaction with this and service users were better informed of forthcoming changes. The continuous monitoring of practices and effectiveness that had been introduced recently, had already given positive results in raising staff motivation and commitment. Quality assurance review was carried out, service users’ comments were collated through questionnaires and the initial action plan was drawn up. The home used a Blue Cross quality assurance system. The home avoided dealing with service users’ money and referred those that needed support in this area to their relatives and appropriate external professionals. Some service users were confident in dealing with their personal
Bedford Charter House I51 s14999 BED CHARTER HOUSE v226755 060505.doc Version 1.30 Page 20 allowances and were encouraged to keep their small amounts safe and secure in provided lockable facilities. Staff were supervised and supported regularly. Records, especially about service users, that included care plans, risk assessments etc were in process of rearrangement. However, different charts relating to direct care items and monitoring of daily processes were accurate and up to date. Health, safety and welfare of service users were respected. A moving and handling training was provided and practices observed during the inspection were appropriate. Fire safety was implemented. Accidents incidents were appropriately recorded and monitored by the manager and the chief executive. A reporting system was in place and ensured that reportable events were recorded and reported appropriately. Bedford Charter House I51 s14999 BED CHARTER HOUSE v226755 060505.doc Version 1.30 Page 21 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 3 x 3 3 3 3 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 1 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 3 15 3
COMPLAINTS AND PROTECTION 2 2 x 3 3 3 3 3 STAFFING Standard No Score 27 3 28 x 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 3 3 4 3 3 3 2 3 Bedford Charter House I51 s14999 BED CHARTER HOUSE v226755 060505.doc Version 1.30 Page 22 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 9 Regulation 13 Requirement Timescale for action 09/07/05 2. 3. 9 26 13 23 Medication records must correspond to the actual amounts of medication held in the home. Disclosures of self medication must correspond to all self medicated medication and must contain the names of service users. The home must keep records of 09/07/05 monitoring medication fridge temperatures. The kitchen equipment must be 30/08/05 cleaned and kept clean as a part of the infection control measures.. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard 20 Good Practice Recommendations Even before introducing the new suggested care plan format, the home should record dates on risk assessments for all service users, including those in intermediate care, and regularly review and date risk assessments. Alternative meals provided to individuals should be recorded appropriately.
I51 s14999 BED CHARTER HOUSE v226755 060505.doc Version 1.30 Page 23 2. 15 Bedford Charter House 3. 4. 19 20 The service users bedroom need to be decorated appropriately and the window need to be re-sealed. The home should seek a solution to ensure the smoke from the smoking room does not affect service users bedrooms. Bedford Charter House I51 s14999 BED CHARTER HOUSE v226755 060505.doc Version 1.30 Page 24 Commission for Social Care Inspection Clifton House 4a Goldington Road Bedford MK40 3NF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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