CARE HOMES FOR OLDER PEOPLE
Bierley Court 49 Bierley Lane Dudley Hill Bradford BD4 6AD Lead Inspector
Barbara Grell Unannounced Inspection 28th September 2005 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Bierley Court DS0000034010.V253784.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Bierley Court DS0000034010.V253784.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Bierley Court Address 49 Bierley Lane Dudley Hill Bradford BD4 6AD Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01274 680300 01274 680303 Southern Cross Healthcare (Kent) Ltd Care Home 40 Category(ies) of Dementia - over 65 years of age (10), Old age, registration, with number not falling within any other category (5), of places Physical disability over 65 years of age (25) Bierley Court DS0000034010.V253784.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection Brief Description of the Service: Bierley Court was designed as a care home and provides a service to older people. There is level access, a passenger lift and secure garden. There are a variety of communal rooms, assisted bathrooms and communal toilets to both floors. The bedrooms are single and all are provided with an en-suite WC. Bierley Court is situated three miles from Bradford city centre. Public transport can be accessed close by and parking is provided within the grounds. The home is registered to provide care to a maximum of 40 service users. The home is able to provide for up to twenty-five older people with a physical disability and up to ten with dementia. Bierley Court DS0000034010.V253784.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. One inspector unannounced undertook this inspection on 28 September 2005 commencing at 9:30. An additional inspection was undertaken on 18 October in order to investigate a complaint made. This inspection was unannounced and commenced at 14:00. A summary report of the findings and requirements made will be included in this report. Previous reports and information and reports pertaining to other care services care can be found on the Internet on www.csci.org.uk. Statutory inspection of care homes is undertaken twice annually and of domiciliary cares services annually. Below is a list of methods used during this inspection. Four case records were inspected. All documentation including assessments, care plans, reviews and daily records were inspected. Four personnel files were looked at. The recruitment documentation was inspected. Training and supervision arrangements were discussed with the acting manager and any documentation inspected. The inspector spoke to eight of the staff on duty. assistants, domestic and kitchen staff. This included care Ten service users had discussions with the inspector and were able to comment on the care and services provided. The service users comments contributed in making judgements about the standards achieved by the home. Six of the service users visitors were able to comment about their experience of the service. With regard to the complaint investigation one case study was undertaken and staff from Bierley court and another care home interviewed. What the service does well: What has improved since the last inspection?
Bierley Court DS0000034010.V253784.R01.S.doc Version 5.0 Page 6 Service users were happy that the furniture had been promptly moved into the original position after the last inspection. Two of the communal rooms now have dining and lounge space. This allows service users to sit in comfortable chairs after a meal for a chat. Door retainers have been fitted as required since the previous inspection. The ongoing maintenance programme is improving the cosmetic appearance of the home. Service users felt that the bathrooms and lounges had been much improved. What they could do better:
The current care plans are in need of review and at times amendment in order to record how these changing needs are met. More care must be taken to ensure that good hygiene practices prevail. The dietary intake records must be improved when risk assessment shows that there is a risk to give a clear and detailed picture of diet and fluids offered and taken. Pressure care records must be improved to show if and when an individual has been turned or repositioned in order to relieve pressure and ensure better skin viability. The activities provided must take full account of individual’s religious needs and records kept of how these needs are met and choices offered in the home. Bierley Court DS0000034010.V253784.R01.S.doc Version 5.0 Page 7 ADDITIONAL INSPECTION IN RESPONSE TO A COMPLAINT Name of establishment/a gency:
Address of establishment/agency: Telephone number: Name of establishment/agency representative present at the time of additional inspection: Name of Inspector: Date of additional inspection: Time of additional inspection: Details of what prompted the additional inspection: Bierley Court Bierley Lane Bradford 01274 680300 Francis White (Acting Manager) Barbara Grell 18.10.05 14:00 1) Staff professionalism (wording used) 2) Named service user looking neglected on a specified time and date. 3) Named service user dehydrated and unkempt on specified time and date. 4) Two pressure sores apparent. 5) Concerns and complaint not acted upon. 6) Lack of assistance with diet. 7) Lack of continuity of managers and staff 8) Insufficient activities. (this should include the elements of the complaint described in broad terms e.g. complaint in relation to medication, staffing levels for care staff, cleanliness of premises etc) Bierley Court DS0000034010.V253784.R01.S.doc Version 5.0 Page 8 9) Specific service user unkempt at a specified time and place. Bierley Court DS0000034010.V253784.R01.S.doc Version 5.0 Page 9 Please provide details of each element of the complaint and the outcome of each element:
Element of complaint 1. Staff professionalism (wording used) 2. Named service user looking neglected on a specified time and date. 3. Named service user dehydrated and unkempt on specified time and date. 4. Two pressure sores apparent. 5. Concerns and complaint not acted upon. 6. Lack of assistance with diet. 7. Lack of continuity of managers and staff 8. Insufficient activities. 9. Specific service user unkempt at a specified time and place. Outcome i.e. upheld, not upheld, unresolved Upheld Not upheld Partially upheld Unresolved Not upheld Partially upheld Upheld Upheld Upheld Requirements arising from additional inspection (if any) 1. 1. Standard 7 Regulation 15 Timescale for action 01.12.05 A service user plan must be drawn up based on the assessment undertaken and this must set out in detail the action to be taken by staff in meeting the assessed needs. 2. Standard 8 Regulation 12(1), 13(1), 14(1), 16(1) and 17(1) 01.12.05 The registered person must ensure that when service users are assessed as at risk of pressures sores adequate preventative equipment is provided promptly and preventative action recorded in the care plan.
Bierley Court DS0000034010.V253784.R01.S.doc Version 5.0 Page 10 A record must be maintained of nutrition, including weight gain and loss, and appropriate action taken. 3. Standard 12 Regulation 16 01.12.05 There must be a choice of appropriate activities provided that are based on the service users expectations, skill and interests. Service users must be assisted wherever practicable to meet their religious and cultural needs. 4. 5. Recommendations made at additional inspection (if any)
1. Standard 7 Regulation 17(1) When monitoring identifies weight loss appropriate records must be kept of the food offered and taken. This must provide sufficient detail to judge the diet/fluids taken by a service user. Appropriate and accurate measures must be used. 2. Standard 16 Regulation 22 Comments made during review that constitutes concern and complaint must be fully investigated and appropriately responded to. 3. 4. 5. 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.
Bierley Court DS0000034010.V253784.R01.S.doc Version 5.0 Page 11 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Bierley Court DS0000034010.V253784.R01.S.doc Version 5.0 Page 12 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 the following standard(s): #3 The assessment processes and practices pertaining to new admissions to the home ensure that service users needs, wishes and expectations are ascertained. The assessments were allowed to become outdated for some of the service users resulting in minor shortfalls being identified. EVIDENCE: Core social work or care management assessments are obtained when available. The core assessments seen varied in accuracy and level of completion. The manager or senior member of staff also undertakes an assessment of the service user in their current situation. A preadmission assessment is recorded and an initial care plan is based on this and any core assessment available. Details recorded by the homes staff include comments made by service users, professional such as hospital staff and relatives. A full assessment follows and is recorded within a template that includes appropriate and recognised tools. This assessment tool is in the process of being replaced with a new one. Staff were in the process of undertaking and recording new assessments for all the service users in the home. The inspector noted that some of the assessments seen during case studies dated back to 2003. The assessments were not subject to ongoing review. This left
Bierley Court DS0000034010.V253784.R01.S.doc Version 5.0 Page 13 some of them outdated and not taking full account of the changing needs of the service users over time. The newly appointed manager was aware of the need to review many of the assessments and welcomed the opportunity to review the care of all service users in line with the introduction of the new assessment formats by the organisation. The minor shortfalls noted are in respect of lack of ongoing review of assessments. Assessment undertaken prior to admission would meet the standard. Staff spoken to were aware that some of the documentation was outdated and were seen to be reviewing assessments and using the new assessment formats. Staff were able to discuss the individual service users care needs and how these are met. Bierley Court DS0000034010.V253784.R01.S.doc Version 5.0 Page 14 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 the following standard(s): 7, 8, 9 & 10 Due to some assessments becoming outdated some care plans are also outdated. Staff are in the process of updating assessments and care plans and this process must be completed promptly. The containers used to hold tablets given to residents during administration must be kept clean and dry. Service users benefit from a medicine risk management system that allows for self-administration. Service users spoken to felt that they were treated with respect and their privacy ensured by practices. EVIDENCE: Care plans are recorded and are based on the assessments ensured prior to admission. The service user or a representative signed documentation in the majority of cases. Some of the care plans seen were outdated in line with the outdated assessments. Monthly reviews recorded by staff are basic and a thorough review must be ensured periodically using the assessment tools available. Falls, manual handling, skin viability and nutritional assessments are recorded using recognised assessment tools. Again some assessments seen were
Bierley Court DS0000034010.V253784.R01.S.doc Version 5.0 Page 15 outdated and the reviewing process did not always ensure the appropriate and timely update of care plans seen. The complaint investigation undertaken showed similar evidence. One nutritional assessment seen clearly showed ongoing needs and high risk of malnutrition. Daily records must be kept in such a case of the daily food and fluid intake. Inaccurate measures such as “a sip”, “good diet”, “fair diet”, “poor diet”, and “fluids pushed” must be avoided, as they do not give sufficient detail of the dietary intake. Additionally there is a lack of ongoing monitoring of weight when needed. Ongoing weight gain and loss must be investigated. NHS nurses provide any nursing treatments and monitoring required. Staff and the manager stated that they have good relationships with the NHS nurses who provide services at Bierley Court. Staff spoken to say that they ask the nurses for advise and make them aware of any changes. Some of the case files seen included review records of meetings held with service users and their representatives. Some gave good detail of the individual’s opinion of the care and services received. Some included concerns. When concerns are noted an action plan documents the action to be taken to address the discussed concerns or shortfalls. Poor practice was observed in respect of medicine administration during this inspection. A container in which the medication was given to a service user was wet melting the tablet(s) contained therein. Medicine administration records were inspected during the previous inspection standards met. Several service users spoken to stated that they are able to administer part of medication. This included inhalers, ointments, bath oils and acute angina medicine/spray. Service users spoken to stated that the staff team are helpful and assistance provided is provided in privacy. Service users felt that the majority of staff know their jobs well and provided the type of assistance they needed and expected. Many service users spoken to know that a care plan was kept about the care they needed. Service users felt that the staff providing the care consulted them. A number of service users were able to name their key worker and those that did felt that they benefited, as the key worker was responsible for helping when bathing for example. Service users felt this increased continuity as individual cares got to know you and how you wanted things to be done. Service users confirmed staff’s comments that personal care is undertaken in private. Bierley Court DS0000034010.V253784.R01.S.doc Version 5.0 Page 16 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 the following standard(s): 12 Service users are satisfied with the routines and activities provided. EVIDENCE: The service users spoken to felt that they could chose their lifestyle for example when to rise and retire, when to have a bath and with which carer and to have a choice of food. Some of the service users joined in planned activities others prefer to spend time alone, in their own rooms. Many have their own TV or enjoy to read magazines and books. Service users were able to stated that the following activities are on offer; light exercise, shopping to the local shopping centre, outings to Morecombe & Pudsey Park, coffee mornings & Singers and Entertainers. It was unclear if and how the religious needs of service users are met. None of the service users spoken to made comments in respect of any visits from church representatives or services attended. Service users clearly benefited from flexible daily routines and were stated that they were satisfied with the type and regularity of activities provided. Service users and some of the visitors spoken to had attended service user and relative meetings held by the previous manager. All felt that these meetings should be continued and hope that the new manager will continue with meetings
Bierley Court DS0000034010.V253784.R01.S.doc Version 5.0 Page 17 Bierley Court DS0000034010.V253784.R01.S.doc Version 5.0 Page 18 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 the following standard(s): 16 The organisation misses opportunity for improvement as not all of the service users voiced concerns are addressed or responded to. Items recorded as part of reviews must be addressed and a record should be kept showing areas have been improved. The channels for complaint are good and service users felt that they can state concerns however felt that responses could be improved. EVIDENCE: There is a complaint procedure that meets this standard in content. This procedure is part of the statement of purpose and service user guide that is available for reference in the entrance of the home. Service users and visitors spoken to stated that they knew how to complain. Most stated that they had minor complaints at times and mostly these were promptly addressed by staff without becoming formal. One record was kept of a formal complaint made and the investigation findings were recorded. The complaint was unresolved and an agreement reached with the complainant that resolved the complaint. Another complaint was received by CSCI and investigated first by the provider and secondly by CSCI. A summary report is included in this report and requirements and recommendations made will be detailed as part of this report. Any concerns voiced during review meetings result in an action plan that becomes part of the care plan. Areas can be monitored and improved by the organisation. Bierley Court DS0000034010.V253784.R01.S.doc Version 5.0 Page 19 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 the following standard(s): 19 & 26 A maintenance and programme of redecoration is currently ongoing. This must be completed. The environment meets the needs of the service users and offers good facilities. The hygiene and infection control standards and practices must be improved EVIDENCE: The gardens were better maintained than during the previous inspection and a programme of redecorating has commenced. This had improved the communal areas and bathrooms. The redecoration is ongoing and all bedrooms are to be redecorated within a rolling programme. Two bedrooms seen during this inspection were clearly in need of redecoration. The manager was made aware of comments made by a small number of service users who felt that their rooms needed urgent attention with their agreement. The manager agreed to prioritise. The environment generally provides for comfortable surroundings that offer sufficient adaptations and equipment for the service users. Rooms are
Bierley Court DS0000034010.V253784.R01.S.doc Version 5.0 Page 20 generally well furnished and service users appreciated that they are able to individualise their own rooms. Service users feel that they benefit from their en-suite bathrooms though many criticised the small sinks fitted. Paper towels and antibacterial soap must be provided for use by staff in all bathrooms and toilets. Where service users are assisted with their personal care in their own en-suite the same provision must be made to ensure adequate hygiene and infection control. Staff were seen to handle cups by the rim rather than the handle and this practice is unacceptable. The manager was advised of this observation in order to take prompt remedial action. Bierley Court DS0000034010.V253784.R01.S.doc Version 5.0 Page 21 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 28, 29 & 30 The home follows good recruitment practices. The numbers of staff trained to level 2 NVQ in care or above must be increased to 50 of staff being qualified. Staff receive sufficient training to enable them to undertake their work with competence. EVIDENCE: Staff were seen to be enrolling onto NVQ training course during the second part of the inspection. An NVQ assessor was available to assist with this process. The manager informed me that the majority of the staff team who have not already undertaken and completed NVQ training would be starting on the new course. Four domestic assistants hold an NVQ level 1, two care assistants hold NVQ level 2 and the deputy manager NVQ level 3. There are twenty-five care assistants employed in total only about 10 are currently qualified. The previous requirement will be brought forward. 50 of staff must be qualified to NVQ level 2 or above. Recruitment files seen included the following documentation; application form, identification, evidence of CRB/POVA clearance, two written references and evidence of training courses attended. All new employees complete a medical declaration and declaration in respect of the Rehabilitation of Offenders Act informing employees of their responsibility to declare any offences. The training provided included induction training and core training to undertake the role of the employee. Some had attended specialist training in line with the aim of the home and this included dementia awareness training. Staff spoken to had received training in manual handling, food hygiene and
Bierley Court DS0000034010.V253784.R01.S.doc Version 5.0 Page 22 infection control. Areas that could affect the good health and safety of service users and staff are subject to annual refresher training. Bierley Court DS0000034010.V253784.R01.S.doc Version 5.0 Page 23 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 38 Risk management ensures that the environment is kept safe. EVIDENCE: Several of the service users bedrooms doors have been fitted with retainers. These are in working order at the present time and service users confirmed that these were fitted reasonably quickly. Service users stated that they report any faults. Service contracts are in place for the maintenance and servicing of equipment and services in the home. The handy person employed also record and undertakes checks on small electrical appliances and the hot water. Bierley Court DS0000034010.V253784.R01.S.doc Version 5.0 Page 24 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 2 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 X 3 X X X X X X 2 STAFFING Standard No Score 27 X 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X X X X 3 Bierley Court DS0000034010.V253784.R01.S.doc Version 5.0 Page 25 Are there any outstanding requirements from the last inspection? Yes 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 OP7 Regulation 15 & 17 Requirement A service user plan must be drawn up based on the assessment undertaken and this must set out in detail the action to be taken by staff in meeting the assessed needs. The registered person must ensure that when service users are assessed as at risk of pressures sores that additional to providing equipment repositioning records are kept to show that preventative practices are recorded. (Turn charts) There must be a choice of appropriate activities provided that are based on the service users expectations, skill and interests. Service users must be assisted wherever practicable to meet their religious and cultural needs. 50 of care staff must hold an NVQ level 2 or above. (Item outstanding from previous inspection.) Timescale for action 01/12/05 2 OP8 12, 13, 14, 16 & 17 01/12/05 3 OP12 16 01/12/05 4 OP28 18 31/12/05 Bierley Court DS0000034010.V253784.R01.S.doc Version 5.0 Page 26 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 OP7 Good Practice Recommendations When monitoring identifies weight loss appropriate records must be kept of the food offered and taken. This must provide sufficient detail to judge the diet/fluids taken by a service user. Appropriate and accurate measures must be used. Bierley Court DS0000034010.V253784.R01.S.doc Version 5.0 Page 27 Commission for Social Care Inspection Aire House Town Street Rodley Leeds LS13 1HP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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