CARE HOMES FOR OLDER PEOPLE
Clemsfold House Guildford Road Broadbridge Heath Horsham West Sussex RH12 3PW Lead Inspector
Elizabeth Dudley Unannounced Inspection 1st November 2007 10:00 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 Clemsfold House DS0000014459.V353978.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. Clemsfold House DS0000014459.V353978.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Clemsfold House Address Guildford Road Broadbridge Heath Horsham West Sussex RH12 3PW 01403 790312 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) clemsforldhouse@sussexhealthcare.org Dr Shafik Hussien Sachedina Mr Shiraz Boghani Mrs Doreen Rebecca Holmes Care Home 48 Category(ies) of Dementia (8), Dementia - over 65 years of age registration, with number (48), Mental Disorder, excluding learning of places disability or dementia - over 65 years of age (48) Clemsfold House DS0000014459.V353978.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. 4. 5. 6. Forty eight (48) persons in the category Dementia Elderly (DE) (E). Forty eight (48) services users in total may be accomodated. To include up to eight (8) persons in the category Dementia (DE) over the age of Forty (40) to sixty five (65) years. To include up to forty eight (48) persons in the category Mental Disorder Elderly (MD) (E). No further service users in the category old age not falling within any other category (OP) will be admitted. Current service users in the category old age not falling within any other category (OP) may continue to be accommodated. 31st August 2006 Date of last inspection Brief Description of the Service: Clemsfold House is registered to provide personal care for up to forty-eight people. Registration categories allow for forty-eight people who have dementia (DE)(E) and mental disorder (MD)(E) over sixty-five years of age. This includes up to eight service users in the category (DE) over the age of forty and under sixty-five years. Current service users over the age of sixty-five not falling within any other may still be accommodated but no others in this category may be admitted. The categories of registration will undergoing review by the South East Registration Team as part of the ‘Modernising Registration Agenda’ Clemsfold House is a detached property situated in a rural area about three miles from Horsham. It has a well-maintained, accessible garden. Dr S Sachedina and Mr S Boghani privately own the service. Mrs D Holmes is the registered manager responsible for the day-to-day running of the home. The weekly fees for the home range from £492.24 to £650 for an en-suite single room, the CSCI was informed of the current fees on the 1st November 2007. Fees do not include charges for extra services such as chiropody and hairdressing; details of these are available from the manager. Clemsfold House DS0000014459.V353978.R01.S.doc Version 5.2 Page 5 Clemsfold House DS0000014459.V353978.R01.S.doc Version 5.2 Page 6 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced key inspection took place on the 1st November 2007 over a period of six hours and was facilitated by Mrs D Holmes, registered Manager. Judgements made at this inspection were made by touring the home, examining various records, which included care plans, medication records personnel files, staff training records, health and safety documents and catering documentation. Interaction between staff and residents was observed and eight residents, three visitors and six members of staff were spoken with. The CSCI requires services to complete and return an Annual Quality Assurance Assessment; this identifies the current status of the home and the achievements of the home in the past twelve months and plans for the future. The Annual Quality Assurance Assessment received accurately stated developments that had taken place in the service and the areas which the manager wishes to improve. Prior to the inspection, questionnaires were sent to residents and relatives and twenty six were returned, these provided information about the daily life in the home and whether this was meeting the needs and expectations of the residents in the home. Generally the comments made were favourable with residents and relatives stating that ‘the home is more than satisfactory in looking after my relative, there are activities and she is well fed, clean and healthy’. ‘ Nice meals, the care is good and I am happy here’. ‘ Would find it helpful to have a monthly meeting regarding my relatives progress, good variety of food and the trips out and activity mornings are excellent’. ‘ My children told me about this home and the care is really good’. However some comments were also made about the perceived lack of staff at weekends and the perceptible odour in the home at times. Two health care professionals were visiting the home on the day of the inspection and both stated that the thought the standards of care in the home were ‘good’ with one saying that ‘ the home manages the residents well without the need to administer a lot of medication’. Clemsfold House DS0000014459.V353978.R01.S.doc Version 5.2 Page 7 What the service does well: What has improved since the last inspection?
Staff now receive regular supervision, with most staff receiving this at two monthly intervals. Decoration and maintenance in the home is ongoing and rooms are redecorated and in some instances re-carpeted when a resident leaves. Safety issues raised in a fire officer’s report have now been addressed with modifications made to the doors to comply with the requirements made. Clemsfold House DS0000014459.V353978.R01.S.doc Version 5.2 Page 8 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Clemsfold House DS0000014459.V353978.R01.S.doc Version 5.2 Page 9 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 Clemsfold House DS0000014459.V353978.R01.S.doc Version 5.2 Page 10 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4,5,6 People who use the service experience good quality outcomes in this area The information produced by the home informs representatives of prospective residents about the home, but is not produced in a manner that would be of use to the individuals being admitted to this home. Thorough preadmission assessments take place, which will confirm whether the home can meet the needs and expectations of the individual. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Statement of Purpose complies with the regulations, and is available on request. Prospective residents or their relatives receive an information pack prior to their admission to the home. This is currently referred to as the Service User
Clemsfold House DS0000014459.V353978.R01.S.doc Version 5.2 Page 11 Guide, but does not meet the criteria for this document as required by the National Minimum Standards and regulations. The manager or a senior member of care staff assesses residents prior to their admission to ensure that the home is able to meet their needs and expectations. Three preadmission assessments were examined and these were comprehensive, addressing the psychological, physical and social needs of the individual, providing sufficient information to be used as a basis for the care plan. Residents and their representatives are encouraged to visit the home and are initially admitted for a four-week trial period. Following admission all residents receive a copy of the Terms and Conditions of residence. The home admits residents for both permanent and respite care but not for intermediate care. Clemsfold House DS0000014459.V353978.R01.S.doc Version 5.2 Page 12 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10,11. People who use the service experience good quality outcomes in this area. Care plans are reviewed regularly to ensure that the care that residents receive is relevant to their current needs, there was no evidence that residents or their representatives are involved in the formation of the care plans. The standard of medication administration safeguards the residents with the staff aiming to maintain residents psychological health without recourse to sedative medication. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Four residents care plans (10 ) were examined. These were quite comprehensive particularly around physical care needs and to a lesser extent
Clemsfold House DS0000014459.V353978.R01.S.doc Version 5.2 Page 13 psychological needs; there was sufficient documentation to inform the staff of the key behavioural issues involved. Care plans had been reviewed monthly but there was no evidence of resident or relative involvement and this was highlighted by comment cards received by the CSCI and comments received by two relatives spoken with during the inspection. Care plans contained a good amount of information relating to nutritional, personal care, wound care and continence care needs, with clear instructions to staff on how to meet these needs. The instructions to guide carers on the giving of personal care were not so clear in some care plans and risk assessments did not give sufficient guidance to staff on minimising risk. Daily records were in place and these showed that care staff were giving the care in accordance with the instructions in the care plan. The home has a retained General Practitioner and a retained Psychiatrist Community Psychiatric nurses are brought in as required and on the day of inspection a review of a resident was taking place with a visiting Psychiatrist, the Community Psychiatric nurse made positive comments about the home as did the homes’ regular psychiatrist who was also visiting on this day. There is a visiting Dentist, Optometrist and Chiropodist and District Nurses and Continence Nurse Specialists are accessed as required. Some wheelchairs were being used without footrests, although the home has policies to prevent this. The manager stated that many footrests were broken and that they were no longer provided with wheelchairs by the relevant authority. The manager should ensure that residents’ safety is maintained in this area. Residents were being treated in a dignified, understanding and respectful manner. Records of medication supply, disposal and administration were complete, all medications signed for on administration. Medication administration practices observed safeguarded the residents. Eye drops and other external medication should be marked with the dates of opening. Care staff that take responsibility for administering medication have undertaken a recognised training course, and have also received extended training which includes the administration of eye drops, ear drops and some other invasive procedures. The manager and the senior care staff have received training in blood glucose monitoring. Clemsfold House DS0000014459.V353978.R01.S.doc Version 5.2 Page 14 The manager and two senior care staff are undertaking training to implement the Liverpool care pathway and Gold standards framework in the home and one care staff has attended training on terminal care. Residents can stay in the home when very ill and nursing is provided by District and Macmillan nurses. Clemsfold House DS0000014459.V353978.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): 11,12,13,14,15. People who use the service experience good quality outcomes in this area. Residents are encouraged to make decisions relating to their daily life in the home and are able to participate in a range of leisure and social activities. Meals are attractively presented and menus are provided in both pictorial and written format to aid residents in their choice of food. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home offers a range of activities that are provided both mornings and afternoons during weekdays by an activities co-ordinator. There is an activities programme in place and residents receive a copy of this with records being kept of the activities taking place and residents who have participated. A sensory garden has been added to the home and residents can walk in this as they wish. Clemsfold House DS0000014459.V353978.R01.S.doc Version 5.2 Page 16 Residents spoken with said that they were able make choices over how they wished to spend their day and their times of rising and retiring. There is an open visiting policy with visitors able to participate in activities if they wish, Ministers of religion visit the home to see individual residents All residents spoken with, and comment cards received, confirmed that the standard of catering was good. Information for residents on menus is presented in a pictorial booklet along with the written menu and this is kept in the entrance hall. The chef produced this and he has won an award for this piece of work. Photographs of the meals for the day are put on menu boards in the dining room. This allows residents to make choices about what they wish to eat, there being three choices at lunchtime and two at supper. The chef said that he involves residents in putting up the daily photographs. Menus are changed on a monthly rolling basis and were seen to be nutritionally balanced and are based on information from the people living in the home. There were sufficient fresh fruit and vegetables, and homemade cakes are offered at tea and coffee times. Sandwiches are made up for the night staff to give out to residents. A cooked breakfast is offered daily. The presentation of meals, including pureed meals, was exceptionally good and dining room tables were set with tablecloths, napkins, condiments and teapots. Records as required by the Environmental Health Authority were in place and a recent Environmental Health Authority report made no requirements. Clemsfold House DS0000014459.V353978.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16,17,18. People who use the service experience good quality outcomes in this area. Residents and visitors to the home are confident that any concerns they may have will be dealt with in an open and satisfactory manner. The complaints procedure is not produced in a format, which promotes ease of use, by residents. Staff are aware of their responsibilities regarding the safeguarding of those in their care. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Three minor complaints have been received since the last inspection and substantiated. Complaints had been addressed within the timescales, and full information and records were available. The complaints policy, whilst being comprehensive and displayed around the home, is not in a format which is easily understood or read by residents to facilitate them being able to make a complaint. Some residents and one relative spoken with were aware that they could take concerns to management, but they were unaware of the complaints policy or how to make a complaint above the line of home manager. However all residents and
Clemsfold House DS0000014459.V353978.R01.S.doc Version 5.2 Page 18 relatives said that they felt confident that concerns raised would be dealt with in a satisfactory manner. The manager has said that she will address this. The staff and management have undertaken training in the safeguarding of adults and staff spoken with were aware of the correct reporting protocols and their responsibilities towards those in their care. There have been two incidents requiring reporting as adult safeguarding issues. Both of these related to incidents between residents, and were adequately dealt with by the manager following consultation with the relevant authority. Clemsfold House DS0000014459.V353978.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,22,24,25,26. People who use the service experience adequate quality outcomes in this area Whilst the home provides a spacious, clean and homely environment for residents, odours are apparent in some areas of the home. Some aspects of maintenance and safety to not fully protect the residents living in the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The entrance to the home is attractive with a duck pond and pathway around it. Further garden areas consist of an enclosed lawn and sensory garden. Both gardens were well maintained.
Clemsfold House DS0000014459.V353978.R01.S.doc Version 5.2 Page 20 There is a maintenance programme in place but tiles were missing from the roof, and the manager said this was a long-standing problem; a tile fell from the wall of the house onto the area in front of the building during the inspection. Parts of the home have been redecorated but the carpets in some communal areas of he home appeared well worn. Resident’s accommodation was clean and comfortable and lockable doors and drawers were provided. Five of the rooms have ensuite facilities consisting of a toilet and bath. Other rooms are adjacent to bathrooms and have a washbasin in the room. Water temperatures of washbasins and baths are monitored on a regular basis with records showing that these were within recommended parameters. Residents’ rooms had windows that had restricted opening but the staff room has a sky light which is easily accessible to residents and has unrestricted opening, this could put residents at risk, and the manager said this would be addressed. The home has moving and handling aids which includes two full body hoists and one standing hoist and there are assisted baths and grab rails in the bathrooms. The lack of wheelchairs with footrests results in residents having to wait until an appropriate wheelchair is free. There were some odours noticeable in the communal areas of the home although the standard of general cleanliness was satisfactory. The requirements made at by the fire authority have now been addressed, but the door of one resident’s room was wedged open. The home has a ‘closed door’ policy and the manager should make arrangements to ensure this residents safety if the resident wishes for the door to remain open. The manager gave assurances that this would be addressed. Clemsfold House DS0000014459.V353978.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 People who use the service experience good quality outcomes in this area. Staff are employed in sufficient numbers and undertake a range of training to assist them to meet the needs of the residents in the home. The recruitment system is generally robust and safeguards the residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home provides sufficient staff for the number of residents in the home throughout the seven days of the week, however deployment of staff at weekends to ensure that the staff are visible to both residents and visitors should be considered. Care staff are supported by house keeping, catering and administrative staff. Many of the staff are from overseas, often with a health care professional qualification in their own country, they had a good command of the English language and said that they enjoyed the care roles that they are in at the present time. Clemsfold House DS0000014459.V353978.R01.S.doc Version 5.2 Page 22 Staff undergo a thorough induction programme on commencement of employment and 44 of staff have attained their National Vocational Qualification level 2 or 3 in care, with housekeeping staff also undertaking National Vocational Qualification training relevant to their role. Mandatory health and safety training takes place and staff are encouraged to participate in other relevant to the care of the residents admitted to the home. Four personnel files (20 ) were examined which showed that the recruitment system is generally robust, but there were discrepancies in the quantity of written references received in one personnel file. The manager gave assurances that this would be addressed. Clemsfold House DS0000014459.V353978.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,35,36,37,38. People who use the service experience good quality outcomes in this area Systems are in place to facilitate residents and their relatives to express their views about the services offered by the home. The management of the home generally ensures that the health and safety of residents, staff and visitors is maintained. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager has the experience and qualifications required to enable her to run the service in a manner that meets the needs and expectations of the
Clemsfold House DS0000014459.V353978.R01.S.doc Version 5.2 Page 24 residents. There is a friendly and relaxed atmosphere and there was evidence that the manager and staff were aware of individual circumstances and needs of the residents. The Annual Quality Assurance Assessment required by the CSCI accurately identified the current status of the home. Residents and relatives receive questionnaires on an annual basis to enable them to make known their opinions and views of the services offered by the home, this opportunity is also offered to relatives at the monthly meetings held by the home. The monthly visits required by the provider (Regulation 26 visits) are undertaken and reports were available in the home, during these visits both residents and staff are spoken with. Staff also receive formal supervision on a bi-monthly basis and staff meetings are held quarterly. The manager or administrator do not act as appointee or hold any money for any of the residents, any money given to residents for spending on outings or other items is included in the monthly invoice sent to the representatives. Records of services received by residents such as chiropody or hairdressing were seen. The manager informed the CSCI in the Annual Quality Assurance Assessment that the servicing of all utilities and equipment used in the home has taken place. A representative from the fire authority has visited the home recently and a fire risk assessment is in place. Clemsfold House DS0000014459.V353978.R01.S.doc Version 5.2 Page 25 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 2 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 2 3 3 2 x 3 3 2 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 x 3 3 3 3 Clemsfold House DS0000014459.V353978.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? NO 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 Reg 5 Requirement Timescale for action 31/12/07 2 OP19 Reg 13.4 3 OP26 Reg 23 2(d) That service users are provided with a service user guide which gives the information on all aspects of living in the home, including making a complaint, in a format which is suitable for the needs of the service users in the home. That maintenance to the external 10/12/07 part of the building and the maintenance of wheelchairs is undertaken in a regular and timely manner to safeguard the residents. That action is taken to ensure 10/12/07 that the home is free from offensive odour. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Clemsfold House DS0000014459.V353978.R01.S.doc Version 5.2 Page 27 Clemsfold House DS0000014459.V353978.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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