CARE HOMES FOR OLDER PEOPLE
Connie Lewcock Resource Centre West Denton Road Lemington Newcastle upon Tyne Tyne & Wear NE15 7LQ Lead Inspector
Elaine Malloy Key Unannounced Inspection 26th October 2006 09:20 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 Connie Lewcock Resource Centre DS0000032762.V302768.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. Connie Lewcock Resource Centre DS0000032762.V302768.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Connie Lewcock Resource Centre Address West Denton Road Lemington Newcastle upon Tyne Tyne & Wear NE15 7LQ 0191 264 3439 0191 267 1169 pamela.vickers@newcastle.gov.uk 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) Newcastle upon Tyne Social Services Care Home 24 Category(ies) of Dementia - over 65 years of age (3), Old age, registration, with number not falling within any other category (21) of places Connie Lewcock Resource Centre DS0000032762.V302768.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Up to 3 beds can be flexibly used to accommodate service users aged 55 to 64 years old, or service users over pensionable age. 28th February 2006 Date of last inspection Brief Description of the Service: Connie Lewcock Resource Centre is a registered care home for older people, including people with dementia. 3 beds can be used to accommodate people aged 55 to 64 years old. It is operated by Newcastle City Council Social Services. The centre is located at Lemington in Newcastle upon Tyne. It provides short stays for community rehabilitation, respite care and emergencies. A range of health and social care professionals supplement the staff team. Accommodation is provided at ground floor level. The centre is separated into units with their own lounge and kitchen/dining areas. All service users have single bedrooms, and 2 rooms have en-suite facilities. A guide to the centre’s services and inspection reports are readily available at the centre. The current weekly fee for respite care is £63.25. Fees for service users admitted for emergency stay are dependent upon an assessment of their finances. Service users admitted for community rehabilitation stays do not pay fees for the first six weeks. Fees after six weeks are dependent upon financial assessment. Connie Lewcock Resource Centre DS0000032762.V302768.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced key inspection. It was carried out by one inspector over 1 day and took 7 hours. A manager of the service completed a questionnaire with information about the centre. This was returned to the Commission before the inspection. Key standards were inspected through discussion with a Team Leader, staff and service users, examining the centre’s records and touring the building. Surveys were made available to service users and their relatives/visitors to get feedback on the service. Areas that needed improvement from the previous inspection were also checked. What the service does well:
The centre supports older people to continue to live in their own homes by giving them short breaks. It has a rehabilitation service that helps the majority of service users with health care needs to return home. Service users described receiving a good service. They said they get the care and support they need and that staff are kind and attentive. Service users have their privacy and dignity respected during personal care. Service users are involved in how their care needs are assessed and planned, and encouraged to make choices and decisions. Medical professionals are based at the centre and give support to meet health care needs. Service users maintain contact with relatives, friends and the local community. A good choice of meals is offered and service users said they enjoy the food. There is a complaints policy that service users can use if they are unhappy about the service. Staff receive training on protecting service users from abuse and procedures are in place. Service users have their personal finances safeguarded. The centre provides comfortable and clean accommodation and promotes service user health and safety. There are good staffing levels to meet service user needs. Training is provided to staff on aspects of caring for older people, including gaining care qualifications. An experienced manager has been managing the centre for the last six months. Connie Lewcock Resource Centre DS0000032762.V302768.R01.S.doc Version 5.2 Page 6 The centre sets standards for the quality of the service and has a plan for how this is monitored. What has improved since the last inspection? 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. Connie Lewcock Resource Centre DS0000032762.V302768.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 Connie Lewcock Resource Centre DS0000032762.V302768.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. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users care needs are properly assessed. The centre’s community rehabilitation service assists service users to return to their own homes. EVIDENCE: ‘Baseline assessments’ are completed for each new service user and updated if they return for further stays. Care Managers assessments and assessments from medical professionals are also obtained. Information from the assessments that identifies care needs is used to record individual care plans. Each service user who completed a survey said they had received enough information about the centre before admission. Connie Lewcock Resource Centre DS0000032762.V302768.R01.S.doc Version 5.2 Page 9 Service users who stay at the centre for community rehabilitation are provided with intermediate care. A team of health and social care professionals supplement the staff team. An example was seen of an individual’s management plan. This included details of rehabilitation meetings, referral for physiotherapy and to moving and handling co-ordinators, and liaising with their GP and consultants. Service user stays are tailored to their needs and there is a planned discharge process. In the past six months there had been 52 community rehabilitation service users. Following their stays 28 service users had returned to their own homes, 9 moved into care homes, 10 went into hospital, and 5 people were still at the centre. Connie Lewcock Resource Centre DS0000032762.V302768.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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Each service user has plans for how their care needs will be met. Service users health care needs are fully assessed and appropriately met. Service users are being protected by improved medication procedures. Service users have their privacy and dignity respected. EVIDENCE: A sample of service user care records was examined. Each person had a good range of care plans that showed how their health, personal and social care needs are to be met. The plans were generally well recorded. Advice was given to make interventions in mental health plans more specific. Care plans are evaluated during or at the end of stays. Staff had recently been instructed to make sure that evaluations are properly detailed.
Connie Lewcock Resource Centre DS0000032762.V302768.R01.S.doc Version 5.2 Page 11 Day and night reports needed some improvement to correspond to care plans and provide information to help record evaluations. There is a system for reviewing service users care and services. Reviews are held weekly for those receiving rehabilitation, within 5 working days for emergency admissions, and 6 monthly for respite service users. Medical history and physical and mental health needs are identified within the baseline assessment. Moving and handling, risk of falls, continence and nutritional needs were addressed in care plans. Service users keep their own GP during their stay where possible and there are arrangements with a local GP practice. The District Nursing Service was visiting daily at present. The community rehabilitation team consists of a Geriatrician, Physiotherapists, Occupational Therapist, and Dietician. They carry out assessments and provide input to meet service users health needs. Each person who completed a survey said they always received the medical support they needed. Service users spoken with confirmed they were receiving plenty of medical attention. Self-administration of medication is risk assessed. From the last inspection there was an outstanding requirement to rectify deficits to medication recording. The centre had notified the Commission of 5 medication errors since the last inspection. 3 of these involved centre staff and 2 errors were by nurses. Audits of medication records had been introduced and medication training and competency assessments were being updated. The current medication records were examined. There was significant improvement and overall the requirement was now met. Privacy and dignity issues are discussed at service user meetings and positive comments were recorded. Each service user has a single bedroom. Personal care and medical examination/treatment is carried out in the privacy of bedrooms. The Team Leader said that service users would be routinely offered keys to their bedroom. Service users can make or receive calls on a pay telephone or portable telephone. Service users are asked how they want to be addressed and whether they prefer male or female staff to attend to them. Systems are in place to make sure service user clothing is returned to them from the laundry. Connie Lewcock Resource Centre DS0000032762.V302768.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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. An improved range of social activities was being offered to service users. Service users are supported to maintain contact with relatives, friends and the local community. Service users are involved in making choices and decisions in daily living. Service users are offered a nutritious and varied diet and said they enjoy the food. Connie Lewcock Resource Centre DS0000032762.V302768.R01.S.doc Version 5.2 Page 13 EVIDENCE: At the previous inspection there was an outstanding requirement to provide a varied programme of social activities and maintain daily records. A programme of activities is drawn up as a result of activities requested by service users at their weekly unit meetings. Daily audits of the activities diary were being carried out. This had identified that staff should be offering alternatives when service users decline activities. Improvement has been made to the range of activities provided. Recent activities included quiz, bingo, reminiscence, pamper day, dominoes, board games and sing-a-long. There had been outings to Corbridge, Whitley Bay and Burnopfield. Day care provision at the centre is now provided by the Alzheimer’s Society. Previously service users at the centre used to take part in entertainment provided in the day centre and have use of their transport. The Team Leader said alternative arrangements for trips and entertainment would now be made. Each person who completed a survey said activities were always or usually arranged that they could take part in. A service user commented, “But cannot always take part, so staff arrange another activity that I can take part in”. There is an open visiting policy and service users can choose who they wish to see. Visitors are received in the service user’s bedroom or communal areas. Contact with family, friends and the community is encouraged. Relatives are invited to reviews and planning meetings. Support is provided to service users who wish to visit places of worship and clergy visit individuals. The centre has a mobile library service. Service users make use of local amenities such as the pub and West Denton Centre. There are seasonal visits from school children. Relatives/visitors who completed surveys said they are welcome in the home at any time and can visit in private. Each said they are kept informed of important matters and consulted about their relative’s/friend’s care. Service users can deposit cash for personal spending and valuables in the centre’s safe or keep them in the locked drawer in their bedroom. Information on advocacy services is available. Personal possessions can be brought in and inventory lists are recorded. Service users are involved throughout the process of completing assessments and agreeing, commenting on and signing their care plans. A daily report on a service user verified she had participated in completing her care records. One service user spoken with confirmed that she had been fully involved in making decisions as to her future discharge and change of accommodation. The centre has a cycle of menus that offer a variety and choice of meals. Menus are displayed for service user information and preference sheets are completed each day to show which meals are chosen and any alternatives
Connie Lewcock Resource Centre DS0000032762.V302768.R01.S.doc Version 5.2 Page 14 requested. Positive comments from service users about food were recorded in the minutes of unit meetings. Service users can choose where and when they wish to eat. Nutritional needs are assessed and care planned and there is regular monitoring of weights. A Dietician was giving training to staff next month. Catering staff are informed of individual’s dietary needs and feedback from service user meetings. Feeding aids such as plate guards and adapted cutlery are provided by the Occupational Therapist. Specialist diets are catered for. Staff help service users by cutting up food and prompting them to eat independently. Each person who completed a survey said they always or usually liked the meals. One service user commented, “I enjoy all the food which I receive and second helpings are usually available if required”. Connie Lewcock Resource Centre DS0000032762.V302768.R01.S.doc Version 5.2 Page 15 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users understand how to make a complaint and any complaints received are taken seriously and investigated. There are procedures to safeguard service users from abuse and staff are given training. EVIDENCE: The centre’s complaints policy is included in the Service User Guide. A copy is provided in each bedroom. Complaints leaflets are also available. A new Social Services procedure was recently introduced. Four complaints were received in the period since the last inspection. Three of these had been investigated and the complainants were sent written responses detailing the action taken. One complaint was still under investigation. Thank you cards and letters are maintained. Each person who completed a survey indicated they would know who to speak to if they were unhappy or wished to make a complaint. Connie Lewcock Resource Centre DS0000032762.V302768.R01.S.doc Version 5.2 Page 16 There are policies and procedures on prevention of abuse, protecting vulnerable adults and ‘whistle blowing’ (informing on bad practice). The majority of staff have had training on safeguarding adults and the remainder were booked to attend training in December 2006. There had been no allegations of abuse since the last inspection. Training for staff on challenging behaviour and caring for people with dementia was planned. Connie Lewcock Resource Centre DS0000032762.V302768.R01.S.doc Version 5.2 Page 17 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 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users stay in a hygienic and comfortable environment and improvements were being made to the building. EVIDENCE: Redecoration of corridors was taking place at the time of the inspection, and new carpets were to be fitted upon completion. There were also plans to redecorate some bedrooms and lounges and provide new carpets. All parts of the building seen were clean and suitably decorated and furnished. Some rooms were being converted for alternative use, including creating a double bedroom to accommodate couples. Each person who completed a survey said the centre is always fresh and clean. Connie Lewcock Resource Centre DS0000032762.V302768.R01.S.doc Version 5.2 Page 18 The centre has procedures on control of infection. New staff receive training on infection control during induction. Consideration is being given to providing this training for other staff. Disposable gloves and aprons are provided for staff use. Suitable hand-washing facilities are provided. The laundry and sluice are located away from kitchen and dining areas. The Manager is the link person for meetings on infection control that are ran by the local Communicable Diseases Unit. Connie Lewcock Resource Centre DS0000032762.V302768.R01.S.doc Version 5.2 Page 19 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 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Good staffing levels are provided to meet the needs of individual service users. The centre meets the standard for the number of staff who have completed care qualifications. The staff recruitment process protects service users. Staff receive training relevant to the needs of older people. EVIDENCE: The centre continues to operate good care and ancillary staffing levels. There is a minimum of 4 carers on duty across the waking day and 2 carers at night. The Manager and Team Leader’s hours are additional to these levels. All care staff are aged over 18 and staff left in charge of the centre are over 21 years of age. Connie Lewcock Resource Centre DS0000032762.V302768.R01.S.doc Version 5.2 Page 20 Each service user who completed a survey said that they always received the care and support they needed. They said staff listen and act on what they say, and are always or usually available when they need them. Service users commented, “ Sometimes the staff seem to forget!” “I am impressed with the care received here compared to (named hospital)”, “I was so glad to come into Connie Lewcock”, “I have found all the staff have been most kind when attending to all my needs”. One lady spoken with described staff as very attentive and said nothing was a bother to them. Another lady who was poorly and spending time in her room said she was pleased to be here and that staff keep checking on her. Relatives/visitors who completed surveys said in their opinion there is always sufficient staff on duty and they are satisfied with the overall care provided. The centre meets the standard of at least 50 of care staff to have achieved National Vocational Qualifications (NVQ) Level 2 in care. No new staff have been recruited externally since the last inspection. The centre has vacancies for a Team Leader, a part time night care officer, and a temporary care officer for days. All staff are recruited following Local Authority procedures and are subject to Criminal Records Bureau (CRB) checks being carried out. New staff are provided with thorough induction training. Records of training and certificates are kept. In the past year training was provided in the following areas: moving and handling (including facilitators), safe handling of medication, first aid, fire prevention, food hygiene, basic awareness of PEG feeding, protection of vulnerable adults, ethnic minorities, Parkinson’s Disease, supervision and appraisal, equality and diversity, Newcastle Manager Programme, Train the Trainer, and customer care. Further training was being planned on falls prevention, foot care, dementia care, mental health, and comments/complaints. Connie Lewcock Resource Centre DS0000032762.V302768.R01.S.doc Version 5.2 Page 21 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, 33, 35, and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. An experienced manager is temporarily managing the centre. The quality of the service is being monitored and managers visit to check on standards. Service user personal finances are protected. The centre complies with health and safety requirements. Connie Lewcock Resource Centre DS0000032762.V302768.R01.S.doc Version 5.2 Page 22 EVIDENCE: Since the last inspection the Registered Manager has left. From May 2006 Mrs Andrea Marshall, the manager of another Local Authority Resource Centre has been managing the centre. She is suitably experienced and qualified. The Commission was awaiting clarification about the permanent management arrangements for both resources. At the previous inspection a requirement was made that the Registered Person, or their representative must visit the centre at least monthly and prepare reports on the conduct of the centre. Copies of reports were to be submitted to the Commission each month. Visits and reports were now being completed monthly. Copies no longer need to be sent to the Commission. A visit had identified lack of individual staff supervision; this was now being scheduled. The previous Recommendation to introduce a development plan with methods of monitoring the quality of service had been done. This includes various audits, staff training and appraisals, questionnaires and meetings with service users, updating comments/complaints and organising entertainment and outings. Service user personal finances were checked. These were suitably recorded with two staff signatures for transactions and service users also sign where possible. Receipts are obtained for any purchases made. A spot check of balances and cash was correct. The centre has a health and safety policy and associated procedures. Identifying risks to individuals is built into the baseline assessment. Examples were seen of care plans that addressed how risks are managed or minimised. Risk assessments for safe working practices are devised. All staff have either received up to date training in safe working practices or were booked to attend courses. The centre has servicing and maintenance agreements for facilities and equipment. At the previous inspection there was an outstanding requirement for all fire safety checks, tests and instructions to be carried out at the required frequencies and recorded. These were now being forward planned and carried out on time. Accident reporting was appropriately recorded and analysis of accidents is carried out to identify any patterns. Connie Lewcock Resource Centre DS0000032762.V302768.R01.S.doc Version 5.2 Page 23 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 3 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 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 2 X 3 X X X X 3 Connie Lewcock Resource Centre DS0000032762.V302768.R01.S.doc Version 5.2 Page 24 NO Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action 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. Refer to Standard OP7 OP12 Good Practice Recommendations Day and night reports should correspond to care plans to aid evaluations of plans. Provision of social activities, outings and entertainment should continue to be improved. Connie Lewcock Resource Centre DS0000032762.V302768.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Cramlington Area Office Northumbria House Manor Walks Cramlington Northumberland NE23 6UR 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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