CARE HOMES FOR OLDER PEOPLE
Burford House Rickmansworth Road Chorleywood Hertfordshire WD3 5SQ Lead Inspector
Hazel Wynn Key Unannounced Inspection 14th August 2006 11:00 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 Burford House DS0000060211.V309662.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Burford House DS0000060211.V309662.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Burford House Address Rickmansworth Road Chorleywood Hertfordshire WD3 5SQ 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) 01923 282818 01923 286008 Westgate Healthcare Limited Care Home 30 Category(ies) of Old age, not falling within any other category registration, with number (30) of places Burford House DS0000060211.V309662.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. This home may accommodate 28 older people who require personal care This home may accommodate 30 older people who require nursing care 2nd June 2006 Date of last inspection Brief Description of the Service: Burford House is a care home with nursing, registered for both nursing and residential residents. The home is situated in Chorleywood, close to a junction of the M25 Motorway and to both Rickmansworth and Chorleywood rail stations. The building is a period house with modern additions. There are 27 single bedrooms and three double bedrooms, let as single rooms or to couples (by arrangement). There are four day rooms available on the ground floor, including a television lounge and a library. The attractive landscaped rear garden is accessible to the residents. Many of the bedrooms overlook the gardens and residents enjoy the seasonal changes if they are too unwell to leave the house. Staff however make a concerted effort to assist people to enjoy the garden, even if just for a short space of time. There are parking facilities to the front of the home. The fee range is £600 -£700. Burford House DS0000060211.V309662.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. On the 14th August 2006 two inspectors carried out a key inspection, during a visit to the service the inspectors met with several service users to gain their views and to observe care provision. users said they felt cold. What the service does well: What has improved since the last inspection? What they could do better:
The service users guide needed updating as this carried the name of the previous manager and stated that there was NVQ assessor on site, which is not currently correct and does not provide up to date information for prospective service users to make an informed decision about the type of home they are looking for. Fire safety records must be maintained to show that all regular interval tests have been carried out. Every service user’s room must be well equipped and TV or radio is well positioned for enjoyment. Infection control procedures must be adhered to, especially in relation to ensuring waste disposal units are in good condition and fit for their purpose, bars of soap and skin applications such as sudocreme and emulsifying creams must not be left in bathrooms where there could be a risk of these being used as communal items.
Burford House DS0000060211.V309662.R01.S.doc Version 5.2 Page 6 Commodes must be maintained in a hygienic condition. All records in the home should be audited to ensure they are up to date, satisfactory and remain so. Adequate supervision for all staff must be in place and a record of this maintained. Risk assessments must be carried out and where risk assessments have been carried out these must be kept reviewed to ensure continued safety. 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. Burford House DS0000060211.V309662.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Burford House DS0000060211.V309662.R01.S.doc Version 5.2 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 3. The service does not provide intermediate care (Standard 6). The service user guide does not provide prospective service users with up to date information they need to make an informed choice about where to live. An assessment is carried out prior to a service user moving and service users feel assured that their needs will be met. The quality in this outcome group is adequate; this judgement has been made using all available evidence including a visit to the service. EVIDENCE: The service user guide states that an individual who resigned from her post some time ago manages the home. The service users guide also states that the home has an NVQ assessor on site; this is not currently the situation. The incorrect information being provided does not assist prospective service users with up to date information from which to make an informed choice about the home. All care plans looked at during this inspection had a record of the initial assessment and the manager stated that following the assessment a
Burford House DS0000060211.V309662.R01.S.doc Version 5.2 Page 9 prospective service user would be informed whether the home was in a position to meet their needs. The service does not provide intermediate care. Burford House DS0000060211.V309662.R01.S.doc Version 5.2 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7 - 10 The service users health, personal and social care needs set out in the individual care plan are not a full reflection of needs in at least some instances. There was some concern in how health care needs were being met. Medication was being managed in line with the homes policies and procedures. There were concerns regarding service users being treated with respect and the upholding of their privacy. The quality in this outcome group is poor; this judgement has been made using all available evidence including a visit to the service. EVIDENCE: Some of the care plans examined did not contain up to date risk assessments and in one care plan there was no risk assessment completed to rationalise not using bed rail covers, a risk assessment had not been carried out for the use of a recliner chair, whilst in another the risk assessment had not been reviewed following a fall. Whilst attending to the needs of a service user with continence needs one of the inspectors observed that the nurses were not being discreet and had to remind the nurses that they must always be discreet. The same service user
Burford House DS0000060211.V309662.R01.S.doc Version 5.2 Page 11 had a dry mouth and the nurse could not find mouth swabs to moisten her mouth and had to go to fetch another nurse to locate these. As a nurse put the sponge into the service users mouth the inspector needed to ask if the service user would prefer to do this herself, which she did; notes for input and output in the service users room were poorly completed and did not appear to be a reflection of total input and output needs for the 2 days entered. One service user stated that although how staff approach her has improved, some staff still do not introduce themselves when they enter her room and therefore startle her; this was discussed with the manager during feedback and a recommendation is made that staff are formally reminded of how to meet this service users need. One service user said her bed had been left unmade once this week and once the previous week. Medication was well stored and recorded and being managed in line with the homes policies and procedures. The medication records were clear and accurate. The observation of nurses not using discretion in supporting a service user did not satisfy the inspectors that dignity, respect and the right to privacy is always upheld. Burford House DS0000060211.V309662.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12 - 15 The lifestyle experienced in the home matches service users expectations and preferences and satisfies their social, cultural, religious and recreational interest and needs. Contact with family/friends/representatives and the local community is supported according to the service users wishes. Staff need to be aware that they must provide every opportunity for service users to maintain the ability to exercise control and choice over their lives. Service users are served a wholesome and appealing balanced diet in pleasant surroundings at times convenient to them. The quality in this outcome group is adequate; this judgement has been made using all available evidence including a visit to the service. EVIDENCE: Service users spoken to stated that there is a reasonable amount of activities in the home including a musician who entertains them occasionally and an exercise programme. One service user said she would like to be involved in tending to the gardens, as this had been a favourite hobby in the past. A service user said that religious services are conducted at the home for those who wish to take part. Burford House DS0000060211.V309662.R01.S.doc Version 5.2 Page 13 Family members and friends visit at times convenient to the service users and those who are well enough can go out to the local community; this information was gained from speaking with service users. An example of a service user not being supported to exercise control over care being given to her is dealt with in the previous section. Improvement is needed in this area and identifies a training need. Service users spoken to were satisfied with the food served and stated that they are given choice. A meal being served appeared to be appetising and nourishing and those who required support to eat their meal were supported in a meaningful way. Burford House DS0000060211.V309662.R01.S.doc Version 5.2 Page 14 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 and 18 The complaints procedure needs improving to enable ease of tracking. Service users are generally protected from abused but risk assessments must be kept reviewed. The quality in this outcome group is adequate; this judgement has been made using all available evidence including a visit to the service. EVIDENCE: Although some of the service users said that they were confident their complaints would be listened to and acted upon, the inspectors found it difficult to track recorded complaints through to resolution. The complaints procedure needs reviewing so that a system is in place that allows for tracking of a complaint from the initial stage through to resolution. Abuse awareness policies and procedures are in place and the manager stated that all staff are provided with training in this area and the training record also showed that abuse awareness training for staff had taken place. See other areas of this report were concerns have been discussed and could lead to unintentional abuse through neglect i.e. poor record keeping and out of date risk assessments or no risk assessment, poor hygiene practices and the risk of the spread of infection. Burford House DS0000060211.V309662.R01.S.doc Version 5.2 Page 15 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 and 26 The environment is generally well maintained but to ensure the environment is safe improvement is needed. The home is generally clean and pleasant but there is room for improvement. There were some concerns regarding good hygiene practises. The quality in this outcome group is poor; this judgement has been made using all available evidence including a visit to the service. EVIDENCE: During a tour of the building one of the inspectors observed a stepladder placed on the top of the stairwell landing compromising a fire exit; the stepladder was removed during the inspection. There were no records of weekly fire safety checks; the handyman’s notebook provided evidence that some had been done but these were difficult to track and did not provide a clear record and a requirement was made in this respect. Most of the requirements made by the fire safety authorities made in May 2006 had been completed. An emergency plan in the event of a fire deeming the home uninhabitable has not yet been completed; no details provided for a place of refuge. The fire list needs updating to show current residents e.g. one room
Burford House DS0000060211.V309662.R01.S.doc Version 5.2 Page 16 occupied is shown as vacant on the list and another vacant room is shown as occupied. Although the home was generally clean and pleasant, there were some small stains to carpets and to some seats on furniture. Some commode covers were in need of cleaning and a covered hot water bottle in a store cupboard was very dirty; the inspector did ascertain that this was in use. A pedal bin had a missing pedal and a broken lid providing a risk of the spread of infection. A pot of emulsifying crème and a tub of sudocreme (not prescribed for a named service user) were in communal areas with a risk of being used communally and, therefore, risking the spread of infection. Bars of soap were left on the sides of communal baths and at some communal hand basins and pose a risk of the spread of infection. A requirement was made for the soap and crèmes to be removed. The laundry door was unlocked and washing detergent easily accessible posing a safety risk. There was no soap dispenser over the hairdressers sink. Thermometers for checking bath water temperatures were inadequate for their purpose and there was no evidence of recording of bath temperatures. Room 46 needed a replacement light bulb as this did not work and there was no light operating in the wheelchair store area. Burford House DS0000060211.V309662.R01.S.doc Version 5.2 Page 17 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): 27 - 30 There are adequate numbers of staff with a good skill mix to meet service users needs. Up to date risk assessments were needed to ensure staff are provided with guidelines to ensure individual service user safety. The inspector needs further evidence that robust recruitment practices are observed for every member of staff recruited. Training is provided to enable staff to be trained and competent to do their jobs. The quality in this outcome group is adequate; this judgement has been made using all available evidence including a visit to the service. EVIDENCE: There were adequate numbers of staff on duty with a good skill mix between them. From observations made by one of the inspectors it was identified that some additional training was needed in the area of protecting dignity, respect and privacy (see earlier in this report). During the same observation it was also identified that staff failed to acknowledge that service users might be able to manage some of their care needs for themselves and control over this should be in place for service users (see earlier in this report where an inspector intervened to provide a service user with such opportunity). The staff files for staff recruited since the last inspection (June 2006) were looked at during this inspection. One staff file contained just one reference instead of two. One staff file contained neither criminal records bureau check nor protection of vulnerable adults check; the manager stated that these had been obtained and she would provide this evidence to the lead inspector. The
Burford House DS0000060211.V309662.R01.S.doc Version 5.2 Page 18 third staff file contained all of the data required for robust recruitment. A policy and procedure for the robust recruitment of staff is in place at the home. Induction training forms had been completed and provided evidence of the training given, the manager was advised to date these to show at which stage of the induction each part of the training had been given. A record of training for staff is maintained. Some of the staff are progressing at various levels of NVQ and nurses are maintaining their professional qualifications with ongoing training in line with their registration requirements. Burford House DS0000060211.V309662.R01.S.doc Version 5.2 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 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): 31, 33, 35, 36, 37 and 38 The manager is not yet registered and a fit person interview has not yet been conducted, therefore, a judgement cannot be made. Some improvement needs to be made to ensure the home is run in the best interests of the service users. Service users’ financial interests are safeguarded. Arrangements need to be put in place for the formal and adequate supervision of all staff. Improvement is needed to ensure that the health, safety and welfare of service users and staff are promoted and protected. The quality in this outcome group is poor; this judgement has been made using all available evidence including a visit to the service. EVIDENCE: The manager is not registered; a requirement has been made. Earlier in this report areas have been identified where improvement is need to ensure that the home is run in the best interest of the service users (these areas include the risk of the spread of infection from bars of soap, emulsifying crème and
Burford House DS0000060211.V309662.R01.S.doc Version 5.2 Page 20 sudocreme left in communal areas, lack of soap dispenser above hairdressers hand basin, a dirty hot water bottle verified as in use and stored in the communal linen cupboard, some commodes in need of cleaning, inadequate thermometers for the testing of hot water to bath and no record of temperature maintained, a broken pedal bin, a compromised fire escape where a step ladder had been left, some light bulbs needing replacement, risk assessments needed or updates of the same, a record to be maintained of weekly/monthly fire safety checks and drills and evidence of robust recruitment of all staff). Service users meetings take place to provide the opportunity for service users to be involved with the running of the home, a record is maintained of these meetings and was seen during the June 2006 visit. Service users make their own arrangements for the management of their financial arrangements; the home is not involved in supporting service users with their finances. Supervision arrangements for some of the staff had been put in place but the majority of the staff team had not received formal supervision; this requirement has been brought forward. The service user guide needs updating to reflect the current picture of the home. The health safety and welfare of service users and staff are compromised by all of the above issues and also where risk assessments have either not been carried out or have not been updated. Burford House DS0000060211.V309662.R01.S.doc Version 5.2 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 Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 1 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 3 9 3 10 1 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 1 X X X X X X 1 STAFFING Standard No Score 27 2 28 3 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 1 1 1 Burford House DS0000060211.V309662.R01.S.doc Version 5.2 Page 22 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 OP1 Regulation 6(a)&(b) Requirement The service users guide must be updated to reflect the current situation at the home and both the commission and the service users should be notified of any such revision within 28 days. Care Plans must contain risk assessments as appropriate, including recliner chairs, uncovered bed rails and falls and these must be kept reviewed. (An agreement was reached that risk assessments would be prioritised according to risk but all care plans will need to be reviewed within the time scales given in respect of risk assessments). THIS REQUIREMENT REMAINS UNMET AND HAS BEEN BROUGHT FORWARD. (Please also see regulation 13(7) (THERE IS A RISK THAT RECLINER CHAIRS COULD BE USED FOR RESTRAINT AND IT IS ESSENTIAL THAT THE RISK ASSESSMENT PROVIDES CLEAR GUIDANCE TO STAFF). Ensure staff support service
DS0000060211.V309662.R01.S.doc Timescale for action 15/10/06 2. OP7 & OP37 15 30/09/06 3. OP10 12.2 30/09/06
Version 5.2 Page 23 Burford House 4. OP19 23(2)(p) 5. OP19 13(4)(a) & (c) 6. OP19 13(4)(c) 7. OP26 16(2)(j) 8. OP26 13(3) 9. OP26 13(3) 10. OP26 16(2)(k) 11. OP29 19(1b) & users to make decisions with respect to the care they are to receive (providing opportunities for independence wherever possible) Ensure all area used by service users are well lit.The bulb in room 46 was not working. A replacement bulb was also needed in the wheelchair store area. The manager was requested to take action during the inspection Ensure all fire exits are kept clear at all times. A stepladder was removed from a fire exit pathway on the stairway landing during the inspection. The laundry must be kept locked, when the operator is not in attendance, in compliance with the Control of Substances Hazardous to Health. Feedback was given during the inspection. All staff hand washing facilities must be supplied with liquid soap dispensers and paper towels (this includes the hairdressers hand washing facility). Bar Soap must be for personal use only and must not be left in communal bathrooms or on communal hand basins. These were removed during the inspection. Emulsifying crèmes and other skin applications must be for personal use only and must not be left in communal use areas. These were removed during the inspection. Make suitable arrangements for the disposal of waste. This refers to the broken pedal bin in use. During the inspection, the manager said this would be taken out of use. An audit of staff files must be
DS0000060211.V309662.R01.S.doc 14/08/06 14/08/06 14/08/06 30/09/06 14/08/06 14/08/06 14/08/06 30/09/06
Page 24 Burford House Version 5.2 OP37 (c) 17(2) Schedule 4. Schedule 2. 12. OP36 18(2) conducted and the evidence that all documentation is in place must be sent to the Commission for Social Care Inspection. One file in particular did not have evidence that CRB and POVA checks had been carried out. Another staff file had only one reference. The manager stated that these documents had been obtained and evidence would be provided, this had not occurred to the time of writing this report. All care staff must receive adequate supervision (the national minimum standards state that this should be at least 6 times a year) and records of supervision must be maintained. This requirement has been brought forward from the previous inspection. 30/10/06 13. OP38 23(4)(c) (iii) 14. OP19 & OP38 15. OP19 & OP38 A full evacuation plan must be 30/10/06 drawn up for the safe evacuation of all persons in the care home and safe placement of service users. 17(2) Update the fire safety register to 30/09/06 Schedule show current rooms occupied 4.14 and by whom and to show vacant rooms. The register must be updated with every change. 23(4(c)(v) Fire safety precautions must be 30/09/06 kept reviewed and records must be maintained to evidence this. (This refers to regular interval checks of fire points and fire precautions). This was clearly explained as part of feedback and the administrator stated this would be put in place without delay). Burford House DS0000060211.V309662.R01.S.doc Version 5.2 Page 25 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard OP10 OP16 OP27 Good Practice Recommendations Staff should be formally reminded to ensure that the wishes of all service users are respected fully at all times. Review the procedure for recording complaints in order that a complaint can be tracked from the initial stage through to resolution. The appointment of a deputy manager remains strongly advised. Burford House DS0000060211.V309662.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Hertfordshire Area Office Mercury House 1 Broadwater Road Welwyn Garden City Hertfordshire AL7 3BQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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