CARE HOMES FOR OLDER PEOPLE
Cloisters 5 Abbotsford Road Blundellsands Liverpool Merseyside L23 6UX Lead Inspector
Mrs Trish Thomas Unannounced Inspection 20th July 2006 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 Cloisters DS0000005410.V295367.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. Cloisters DS0000005410.V295367.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Cloisters Address 5 Abbotsford Road Blundellsands Liverpool Merseyside L23 6UX 0151 924 3434 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) Mrs Bernadette Neale Mr Stephen John Neale Mrs Hazel Welsh Care Home 20 Category(ies) of Dementia (20) registration, with number of places Cloisters DS0000005410.V295367.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Service users to include up to 20 DE. Date of last inspection 10th January 06 Brief Description of the Service: Cloisters is a permanent care home, registered in the category of dementia for twenty elderly people. The home is owned by Mr. S. and Mrs. B. Neale, and the registered manager is Mrs. Hazel Welsh. The building is a detached Victorian house with a car park at the front and an enclosed and wellmaintained garden at the rear. Cloisters is close to a train station and bus routes and is situated in a quiet residential area. The home has a passenger lift to all levels and there are sixteen single and two double rooms, all with call bells. Bedrooms are located on the ground and upper floors. There are two large lounges and a dining room, which seats twenty people and is also used for activities sessions. The home is staffed throughout the day and night and care staff are trained to NVQ level in direct care. Cloisters DS0000005410.V295367.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The methods used in this un announced inspection were discussion with residents and direct observation, discussion with visitors, staff and the manager. Records compiled in the home relating to care practice, health and safety and staffing were read, a tour of the premises and grounds was carried out and reference was made to the pre-inspection questionnaire, which had been completed by the manager, Mrs. Hazel Welsh, at an earlier date. What the service does well: What has improved since the last inspection?
A number of improvements have been made to the exterior, new steps have been built at the front entrance and the car park has been re-surfaced. A new side gate has been fitted and the garden has been re-landscaped and is in very good order. In addition, the building has a new roof and has been painted.
Cloisters DS0000005410.V295367.R01.S.doc Version 5.2 Page 6 Internally, the kitchen has been tiled, and new curtains and carpets fitted in communal areas and bedrooms. Care plans are reviewed in response to changes in residents’ presenting behaviour and action plans formulated to provide support and minimise risk. Updates in mandatory and service specific training have been ongoing and new staff recruited to fill vacancies following staff resignations. What they could do better:
Records compiled in the home must be written in terms, which respect the residents’ dignity and diversity. Some residents do not have capacity to read or understand their care plans nor to complain if what they read is disrespectful towards them. A minority of staff are writing inappropriate statements about residents and their presenting behaviour, which is both unprofessional and lacking respect for the rights of those in their care. A number of responses from residents and visitors (written and verbal) asked for more outings. The home has a varied activities calendar but there is scope for improvements to residents’ access to the community facilities for shopping, walks and eating out. The adequacy of the amount of meat, which had been cooked for the evening meal, is questionable. One chicken, described as “large” has been cooked and thinly sliced for twenty residents. For people who have dementia and for those who are unable to make an informed decision, it is necessary to monitor food intake and provide meal portions in accordance with the individual’s weight, appetite and preference. It was noted that at least one resident was receiving a food supplement with meals. There is a system in place for managing residents’ prescribed medication. To ensure that an accurate audit trail of drugs is maintained, medication which has been refused or not given, (as observed), must be returned to the pharmacy each month. The home has progressed in appointing new staff following a number of resignations in the past twelve months (mainly for development of career opportunities). Existing staff were covering two vacancies at the time of inspection through working overtime. This is acceptable in the short-term, but is not appropriate as a long-term solution. The day and night vacancies must be recruited as soon as possible. To avoid cross infection/ contamination, improvements will be needed with regards to the rotating of food stocks and the cleanliness of the food store. Cloisters DS0000005410.V295367.R01.S.doc Version 5.2 Page 7 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. Cloisters DS0000005410.V295367.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Cloisters DS0000005410.V295367.R01.S.doc Version 5.2 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 The quality of this outcome was good. This judgement has been made using available evidence, including a visit to the service. All residents admitted to the home have a documented mental health assessment and a general assessment of personal care/health needs prior to admission. EVIDENCE: The care files of two residents were read. Both had on record, professional mental health assessments and assessments for personal care and general health needs. The assessment outcomes placed the residents’ needs within registered category of the home. The home has a standard assessment document, which is used by staff, to assess whether a prospective resident’s needs can be met, within the home’s facilities, training and skills. All admissions to the home are, initially, for a twenty-eight day trial period after which, they are reviewed. Cloisters DS0000005410.V295367.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): 7,8,9,10 The quality of this outcome was adequate. This judgement has been made using available evidence, including a visit to the service. Residents’ health and personal care needs are addressed in individual care plans and they have access to health services and receive their prescribed medication. Staff do not always respect residents’ dignity when they are writing reports. EVIDENCE: Case tracking was carried out for two residents. The care plan of a resident who has lived in the home for a number of years had been reviewed each month and adjusted in accordance with ongoing assessment. For a recently admitted resident, the care plan had been started and the review date had not yet been reached. The outcomes of assessments had been addressed in action plans (Examples with regards to mobility, orientation and continence). Both residents whose plans were tracked, were spoken with individually and their bedrooms were visited. Personal accommodation was comfortable and individualised. Mobility risk assessments were contained on care plans, and there were no difficulties for either resident in accessing their bedrooms with appropriate supervision and support.
Cloisters DS0000005410.V295367.R01.S.doc Version 5.2 Page 11 All residents are registered with G.P.s and have access to health and paramedical services, all such referrals being on record in the individual’s care file. There was evidence in care plans of ongoing attention to residents’ wellbeing and comfort in the home through exercise programmes and planned rest periods. Residents are assessed with dementia and their supervision needs had been addressed in accordance with risk assessment, through hourly/half-hourly checks throughout the night, particularly where risk of wandering and disorientation had been identified. The home has a procedure for managing residents’ prescribed medication, which is secured in a locked trolley. Medication Administration Records were satisfactorily maintained, and staff who administer prescribed medication have received the relevant training. There is a system whereby medication is supplied at twenty-eight day periods from the pharmacy and un-used medication is returned each month. Some un-blistered medication observed, was dated February 06 and May 06. To ensure that an accurate audit of medication is maintained, un-used medication must be included with each month’s “returns”. Three visitors commented on care. Comments include, “… is settled, secure and well looked after.” “No problems……….is well looked after.” Relative’s questionnaires state, “We are very pleased with the progress …..is showing…… is settled and happy.” Residents appeared relaxed and well cared for and staff were treating them respectfully during the inspection. Respect for residents’ dignity must also be observed by staff, when compiling daily reports. The written content of some reports was lacking in respect for residents’ dignity and diversity, particularly with regards descriptions of the presenting behaviours of people who have dementia. Reference was made to quality assurance questionnaires, in response to the question, “Are your views and opinions respected?” The reply given by a resident was, “Not always.” (The manager, Mrs. Welsh, arranges meetings with residents and their representatives to discuss the outcomes of questionnaires when negative responses are discussed and addressed). Cloisters DS0000005410.V295367.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): 12,13,14,15. The quality of this outcome was adequate. This judgement has been made using available evidence, including a visit to the service. There are limitations to residents’ freedom, presented by their dementia and the required levels of supervision and security necessary to meet their needs. The lifestyle experienced in the home appears to meet residents’ expectations and preferences other than where stated, regarding outings. The home provides residents with a varied menu but the adequacy of meat portions per resident for dinner, is in question. EVIDENCE: Reference was made to the home’s activities calendar, which is posted in the hallway. The calendar records a wide range in home and community based activities including drawing, dominoes, poetry reading, news reading, skittles, exercise, local churches, library, civic hall shows, key park, promenade. Three visitors who were spoken with, said they would like their relatives to get out more often. One said “Maybe more outings could be arranged. I realize there could be transport difficulties, but……..could afford to pay for her outings.” A resident said, “This is a lazy time, I would like to do more.” Some responses on quality assurance questionnaires were, “I would like to go out more instead of always staying in.” “Would like to go on more days out, more books to read.”
Cloisters DS0000005410.V295367.R01.S.doc Version 5.2 Page 13 Residents’ family contact details are included in their admission details and visitors said the manager is a good communicator and they are kept informed of their relatives’ progress. Three visitors said that they are always made welcome and given privacy when they call in. One visitor said she comes at various times on different days and the welcome and staffing levels are always satisfactory. A quality questionnaire states, “Visitors are always welcome and the home is always clean. The care seems to be excellent.” All residents have been assessed with dementia and present varying levels of memory loss and confusion. There was evidence of representation from residents’ family members in the care planning process and those who have no family, have access to an advocacy service whose contact details are contained in the home’s brochure. Residents’ religious affiliations are recorded on their care plans and they are supported in following their beliefs through contact with religious ministers from local churches. To widen the level of consultation with residents and their representatives, annual meetings with them are arranged by the manager, Mrs. Welsh, to discuss the outcomes of quality assurance questionnaires and remedial action if necessary. The home has a well-presented dining room with space and seating for twenty residents. There is a four weekly rotating menu stating breakfast, lunch and dinner on offer. For breakfast the menu offers “assorted cereals” in addition to toast and a cooked breakfast on request. Only two types of cereal were observed in the food store. One chicken, described by the cook as, “large,” had been cooked and sliced into thin pieces for twenty residents, to be served at the evening meal. In commenting on the portion size of meat, available to each resident, the manager said that they are served large portions of vegetables and the meat portion per person is adequate. Some residents are diabetic and there were no detailed records of their diets. In a quality questionnaire, which was read, a resident had requested more salads. The meat freezer was not well ordered and must be organized in a way which rotates the food to be served, according to date. Cloisters DS0000005410.V295367.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, 18 The home has a complaints procedure, which is accessible to residents and their representatives on admission and there are systems to protect residents from abuse. EVIDENCE: The quality of this outcome was good. This judgement has been made using available evidence, including a visit to the service. The home has a complaints procedure, which is provided to residents and their representatives on admission to the home. The procedure states contacts (including the Commission for Social Care Inspection) and timescales and a record of complaints is maintained in the home. This record was read and confirmed that there have been no complaints about this service in the last twelve months. The home has adult protection and “whistle-blowing” policies. The preinspection questionnaire states that staff have received “Elder Abuse” training during the past twelve months and that Introduction to “whistle-blowing” and Protection of Vulnerable Adults has been scheduled for staff. Cloisters DS0000005410.V295367.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): 19,26 The quality of this outcome was adequate. This judgement has been made using available evidence, including a visit to the service. The home is comfortable, well maintained and in good order. Attention to infection control in the food stores was lacking. EVIDENCE: The exterior of the building is very well presented and welcoming and there is an ongoing maintenance programme. In recent months, the car park has been re-surfaced, the roof replaced, and new steps built to the front door. The exterior has been painted and a new side gate fitted. The gardens front and rear are very attractive and well maintained. New carpets and curtains have been fitted in communal areas and in the bedrooms. The kitchen walls have been newly tiled. The rear garden is secure with level access from the back door and there was seating placed outside for residents although it was very hot and sunny, and most preferred to remain inside where fans and cold drinks had been provided. The communal areas are cosy and welcoming providing a
Cloisters DS0000005410.V295367.R01.S.doc Version 5.2 Page 16 choice of two lounges and an airy dining room, which is also used at times for social activities. The majority of bedrooms are on upper floors and the home has a passenger lift for the more frail residents’ use. The home was generally clean and well ordered. The laundry is well organised and equipment was in working order, the same applied to the kitchen. The kitchen stores required cleaning, particularly the floors, in corners and around the cold stores and on the surfaces. The home employs two cooks (who alternate their duties to give seven day cover), and domestic staff and there was one domestic on duty during the inspection. Toilets and bathrooms were clean, as were the residents’ bedrooms which were visited. Cloisters DS0000005410.V295367.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): 27,28,29,30 The quality of this outcome was adequate. This judgement has been made using available evidence, including a visit to the service. Staffing levels in the home are maintained and there are good training opportunities for staff with over 50 having NVQ qualifications. Staff vacancies are covered by existing staff, which is satisfactory as a short-term measure until such time as new staff are appointed. EVIDENCE: Reference was made to staff rosters, which record the staff and hours worked in the home on each shift. The rosters were difficult to follow, as the designation of each staff member was not given, (that is Senior Care, Care Assistant, Domestic, Cook, Night Care Assistant). Reference was made to the pre-inspection questionnaire, which gives the following information. During the past 12 months, the following training has been carried out in Cloisters, First Aid, Wellbeing in the Elderly, Dementia Care, Food Hygiene, Infection Control. In-house video training has been carried out as follows : fire safety, health & safety, abuse in the care home, death and dying, first aid, medication, policies and procedures. 65 of staff have NVQ 2 qualifications. Reference was made to two staff files which were well organised and held in a locked cabinet when not in use. The home has a satisfactory recruitment procedure, which includes advertising the post, taking up two references, POVA and CRB clearances and interviewing job candidates. Staff who are appointed, are issued with contracts of employment and job descriptions. The preinspection questionnaire states that six staff have left since the last inspection.
Cloisters DS0000005410.V295367.R01.S.doc Version 5.2 Page 18 A number of staff have recently been appointed and there were two staff vacancies (in the process of being recruited), one night staff and thirty hours care on days. Mrs. Walsh said the vacancies were currently being covered by existing staff overtime. Cloisters DS0000005410.V295367.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): 31,33,35,38 The quality of this outcome was good. This judgement has been made using available evidence, including a visit to the service. The manager is qualified and competent to manage the home and there are systems in place to consult with residents and protect their safety and best interests. EVIDENCE: The manager, Mrs. Welsh, has a management qualification and has many years experience in managing the home. A visitor said she is a good communicator and keeps the family informed of their relative’s progress. Mrs. Welsh said that the post of assistant manager is to be established and has been advertised for recruitment. Mrs. Welsh displays knowledge of the residents and their aspirations and needs. Residents appeared relaxed in her company as she served afternoon tea in the dining room. The office and records are well organised and the information requested was easily accessible.
Cloisters DS0000005410.V295367.R01.S.doc Version 5.2 Page 20 The home has a quality assurance system and the latest questionnaires completed by residents and their representatives were read. A meeting is arranged annually by the manager to discuss the outcomes of quality assurance questionnaires with interested parties and any remedial action, which may be required to address negative responses. The manager states in the pre-inspection questionnaire, that the home has no involvement in residents’ personal finances. In instances where small amounts of money are held for residents’ expenses on a day-to-day basis, records are maintained, with double signatures to all transactions. The current scale of charges is stated as, single room £450.00, en suite £465.00 weekly. Extra charges are made for magazines, cigarettes, hospital escort, alcohol, private chiropody, dry cleaning (as stated in the pre-inspection questionnaire). Staff on duty confirmed that they receive formal supervision (one-to-ones) every eight weeks and they find this helpful and supportive. Training plans and certificates were held in staff files. Reference was made to Health & Safety certificates. The fire book and fire risk assessment were read, and these were satisfactorily maintained. Cloisters DS0000005410.V295367.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 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 2 STAFFING Standard No Score 27 2 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 X 3 Cloisters DS0000005410.V295367.R01.S.doc Version 5.2 Page 22 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 OP10 Regulation 12(4) (a) Requirement The registered person must ensure, by training and instructing staff, that reports are written in language, which respects the residents’ dignity and diversity. The registered person must ensure that all unused medication is returned to the pharmacist each month. The registered person must ensure that there is a system in place for dating and rotating the food in store prior to use. Timescale for action 07/09/06 2. OP9 13 (2) 29/08/06 3. OP15 13 (3) 29/08/06 4. OP15 16 (i) 5. OP15 16 (i) The registered person must 29/08/06 ensure that the home’s menu is a true representation of the choices on offer (regarding cereals). The registered person must 29/08/06 ensure that adequate portions of meat are provided to residents in accordance with individual nutritional assessments/weight monitoring, appetite and preferences.
DS0000005410.V295367.R01.S.doc Version 5.2 Page 23 Cloisters 6. OP26 13 (3) 7. OP27 18 (1) (a) The registered person must arrange for the food stores (flooring and surfaces) to be maintained to the highest standards of hygiene. The registered person must take action to recruit vacant care posts. 29/08/06 29/09/06 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 OP12 Good Practice Recommendations The registered person should arrange for ongoing consultation with residents and their families about community-based activities, and days out should arranged for residents in accordance with their stated preferences. The registered person should arrange for diabetic diets to be recorded for individual residents. The registered person should arranged for staff job roles to be included on the roster for ease of reference. 2. 3. OP15 OP27 Cloisters DS0000005410.V295367.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Knowsley Local Office 2nd Floor, South Wing Burlington House Crosby Road North Liverpool L22 0LG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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