CARE HOMES FOR OLDER PEOPLE
Crossways Care Nursing Home Crossways 17 Overton Road Sutton Surrey SM2 6RH Lead Inspector
Alison Ford Key Unannounced Inspection 30th October 2007 11:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Crossways Care Nursing Home DS0000036868.V353576.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. Crossways Care Nursing Home DS0000036868.V353576.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Crossways Care Nursing Home Address Crossways 17 Overton Road Sutton Surrey SM2 6RH 020 8642 0955 020 8642 0955 crosswaysnursinghome@blueyonder.co.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) Crossway Nursing Home Mrs Alison Churchill Care Home 40 Category(ies) of Dementia - over 65 years of age (0), Old age, registration, with number not falling within any other category (0) of places Crossways Care Nursing Home DS0000036868.V353576.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Intermediate care may be provided for up to six service users. Date of last inspection 9th November 2006 Brief Description of the Service: Crossways Nursing home is owned by Dr and Mrs Koa Hung Yu and is registered with the Commission for Social Care Inspection to provide nursing care for up to thirty-four older people who require care due to conditions associated with old age and dementia. There are also six beds funded by the local authority to provide intermediate care for people who are being assessed as to the level of support that they may need for the future. The Crossways is a large Edwardian three-storey house with a twelve bed roomed annexe which was added in 1998. Since Dr and Mrs Yu took over ownership of the home on 31st January 2003 a great deal of work has been put into the renewal of the fabric of the building to bring it in line with the National Minimum Standards. The home has surrounding gardens and is situated in a quiet residential street close to the centre of Sutton. There is a spacious dining room on the ground floor and two lounges. The kitchen and laundry areas are clean and well equipped. There is ample space for parking vehicles at the front of the property. The home is also close to rail and bus links. A copy of the homes Statement of Purpose can be obtained directly from them and a copy of their latest inspection report can be downloaded from The Commission for Social Care Inspection website. Fees at the time f the inspection range from £595-£825 and any additional charges payable would be discussed prior to admission. Crossways Care Nursing Home DS0000036868.V353576.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This key inspection visit was unannounced and contributes to the inspection process of the home for the year 2007/2008. In compiling the report consideration is also given to information received about the home throughout the year such as comment cards, complaints, and the notification of any incidents. In addition, the Registered Manager had completed an Annual Quality Assurance Assessment which is a document that they are now obliged to return to let us know about their service and how well they consider that they are meeting the needs of those people that they are caring for. During this visit all of those standards considered, by The Commission for Social Care Inspection, to be key to the inspection process have been assessed. A tour of the premises was undertaken and several residents, members of staff and five relatives, who were visiting, were spoken with. A sample of care plans was assessed and various records and documentation, required to be kept by the home as evidence of their commitment to the health and safety of their residents, was seen. Staff files of those who have been employed since the last inspection were also checked, to ensure that appropriate pre - employment checks had been completed and that people who use this service are protected from those who should not be working with vulnerable adults. What the service does well:
The home has recently undergone a period of extensive refurbishment and rebuilding to add a new wing and improve the facilities on offer to the home. This is still ongoing with the exterior and front of the home now almost completed and further work planned to upgrade the rest of the home. The home now provides 36 single bedrooms and 19 of the bedrooms have en -suite facilities. There are also three lounges and one dining room providing ample communal space. A second lift has been added to ensure accessibility. As mentioned previously the home also has a separate intermediate care unit.
Crossways Care Nursing Home DS0000036868.V353576.R01.S.doc Version 5.2 Page 6 The newly refurbished areas are presented to an extremely high standard and exceed the minimum standards. They are light and airy and tastefully decorated. Six of them are designated for people who need intermediate care. There is also a small kitchen so that occupational therapy assessments can be undertaken to assess people’s ability to manage if they were to go home. The staff in the home are currently undertaking extended training in palliative care in line with The Gold Standard Framework, a community based initiative to provide the best possible care for those people who are nearing the end of their lives, and these rooms will provide a quiet and peaceful area for them and their families. Any potential residents would have an in-depth assessment, undertaken by a senior staff member, to ensure that the home would be suitable for them and that the care that would be needed could be provided. An individual care plan would then be devised so that everyone was aware of the interventions that were required and the way that the resident preferred to be supported. These are reviewed regularly so that any changes are identified. Residents consider that their healthcare needs are being met in the home and all of those who were able to express an opinion and their relatives were unanimous in their praise of the home and the staff who care for them. They agreed that the “they had wonderful care” “the home was always clean and tidy”, “ the laundry was always well done” and “the food was very good “ especially the chips “! Staff turnover in the home is very low and this allows staff to develop a close relationship with those that they are caring for. Many of the care staff are nurses who qualified overseas and bring with them a high level of expertise. There are very low levels of complaints: the complaints book had no new entries and The Commission for Social Care Inspection has not received any directly. Both residents and their relatives all agreed that any concerns would be dealt with quickly by the homes owner or the manager and her staff. The home has recently been awarded The Investors in People Award. Crossways Care Nursing Home DS0000036868.V353576.R01.S.doc Version 5.2 Page 7 What has improved since the last inspection? What they could do better:
Very few concerns were raised following this inspection visit and it is considered that the people who use this service receive good care, which suits their needs and expectations. All of those who come to live in this home have an assessment carried out first, by a senior nurse, so that they are certain that any healthcare needs will be met. This assessment looks at medical and nursing requirements however, little reference is made to their social preferences. People that were spoken with consider that their healthcare needs are being met although it was noted that a limited range of organised activities are provided. At the time of the preadmission assessment the manager makes sure that potential residents and their families are made aware of this however there must be some evidence that these issues have been discussed. Also consideration of past interests and achievements will allow staff to plan activities, which they may find appealing. All of the residents have an individual care plan which sets out the care and support that they need. However there is no indication that they or their families have been involved in the discussion about how they would like this care to be delivered, in a way which suits them. There must be some indication that they have been kept informed about the plan and given the opportunity to influence this.
Crossways Care Nursing Home DS0000036868.V353576.R01.S.doc Version 5.2 Page 8 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. Crossways Care Nursing Home DS0000036868.V353576.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 Crossways Care Nursing Home DS0000036868.V353576.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): Standards 1,3,6 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The people who use this service are able to access information that will help them decide if the home will suit them although some of this needs to be updated in line with current legislation. An assessment is always completed to ensure that residents healthcare needs can be met at the home. A separate intermediate care unit is now in place in the home to provide shortterm care for those who require an assessment regarding future support that will be needed for them. Crossways Care Nursing Home DS0000036868.V353576.R01.S.doc Version 5.2 Page 11 EVIDENCE: Crossways has a Statement of Purpose and Service User Guide in place, which are in the process of being updated to reflect the improvements and increase in facilities. They will also need to include information about fees in line with current legislation. A copy of the homes most recent inspection report would be available in the home on request. Any potential resident would be visited by a senior member of the nursing staff so that they could confirm that the home would be able to meet their healthcare needs. Care plans that were assessed showed that physical needs had all been fully considered although there was limited information available about resident’s social needs and preferences. Gaining this information would help to ensure that the daily life within the home would suit people when they were deciding if they would like living in the home and also help staff to plan activities that might interest them. Each of the residents has a personal contract, specifying the terms and conditions of their occupancy that included periods of notice, fees charged, and the cost of ‘extras’ not covered by the basic cost of the placement. There is a dedicated intermediate care unit of six beds, which has been registered with the Commission for Social Care Inspection and it is considered that this unit exceeds the required standard. It includes six bedrooms with en-suite facilities as well as a kitchen/diner and seating area. Bedrooms are very well appointed and attractively presented and specialist services are provided to enable people to be assisted to reestablish community living. Crossways Care Nursing Home DS0000036868.V353576.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): Standards 7,8,9,10,11 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. People who use this service consider that their healthcare needs are being met in a way, which suits them. They have individual care plans, which are regularly updated to ensure that any changing needs are met. Medication policies and procedures are in place to ensure their protection. EVIDENCE: A sample of five care plans was inspected. These indicated that residents’ individual healthcare needs were identified, action was taken to meet these and they were reviewed regularly. It was noted that medical needs and interventions were well documented but there was limited information about resident’s social history and achievements. It was recommended that more emphasis on these aspects of their lives would help the staff understand more about the people that they were caring for and also to help identify activities that would suit their needs.
Crossways Care Nursing Home DS0000036868.V353576.R01.S.doc Version 5.2 Page 13 The nursing staff at the home make a daily record of significant events and activities for each service users however it was recommended that care staff, who are delivering a high proportion of personal care, should also be given the opportunity to contribute to these. There must also be some evidence to show that residents or their representatives had been given the opportunity to discuss the content of care plans and that they have been made aware of the support that is being given. During the inspection, staff were observed to be treating residents in a pleasant, friendly manner and those that were spoken with displayed a good understanding of the needs of the people that they were caring for. Medication storage and administration procedures were all in order and according to current legislation. The staff in the home are currently undertaking training to help them care for those at the end of their lives in accordance with The Gold Standards Framework. This will include advance care planning for all residents so that all staff are aware of their wishes in the event of them becoming unwell or their death and will help to avoid unwanted hospital admissions. Crossways Care Nursing Home DS0000036868.V353576.R01.S.doc Version 5.2 Page 14 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): Standards12, 13,14,15 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. People who use this service consider that it meets their needs. There are some opportunities to engage in organised activities and there is an open visitors policy to ensure family links are maintained. They enjoy the meals that are served which are nutritionally well balanced and based on their food and drink preferences. EVIDENCE: The home has a limited activity programme in place although this is explained to any potential resident and their families prior to admission. There is an intention to expand the range of activities although resident that were spoken with were quite happy with those that were offered. Staff were observed to have time to sit and chat with them and visitors are always made very welcome. The homeowner confirmed that all residents have the choice of a birthday tea in order to celebrate their special day.
Crossways Care Nursing Home DS0000036868.V353576.R01.S.doc Version 5.2 Page 15 Residents are offered three meals a day as well as morning and afternoon tea and a wide variety of well balanced, nutritional food is available. Residents can also have seasonal choices such as salads. Any dietary needs are recorded in the residents care plan and they are weighed on a regular basis however, the home must also keep a detailed record of all food consumed in sufficient detail to provide evidence that they are having a satisfactory diet. It is considered that this standard is exceeded by virtue of the fact that the cook at the home is happy to cater for individual tastes and has prepared dishes such as curry for small groups of residents. Menus are on a board in the sitting rooms and alternative dishes are always available. Wine and Sherry is available to resident’s, daily, if their health and medication permits. Crossways Care Nursing Home DS0000036868.V353576.R01.S.doc Version 5.2 Page 16 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): Standards 16,18 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. People who use this service have access to a complaints policy and procedure, which ensures that any concerns will be dealt with in an appropriate and timely manner. There are policies and procedures in place to ensure that they are kept safe from those people who are considered unsuitable to be working with vulnerable adults EVIDENCE: Crossways has a complaints procedure, which outlines how a complaint is dealt with and timescales for action. The complaints procedure is included in the Service Users Guide. The home keeps a record book of any comments or complaints made about the service. There had not been any entries made since the last visit. The home has in place procedures for responding to suspicion or evidence of abuse, including whistle blowing, and passing on concerns to the Commission for Social Care Inspection The London Borough of Sutton’s adult protection procedures were available in the office on request. The manager assured the inspector that any allegations or incidents of abuse would be reported to the appropriate authorities, including the Commission, and appropriate records maintained, including any action taken.
Crossways Care Nursing Home DS0000036868.V353576.R01.S.doc Version 5.2 Page 17 The home provides staff training on issues of elder abuse and those that were spoken with understood the principles of this. Pre-employment checks ensure that residents are not cared for by those people who are considered unfit to be working with vulnerable adults. Crossways Care Nursing Home DS0000036868.V353576.R01.S.doc Version 5.2 Page 18 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): Standards 19,26 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. People who use this service live in a clean extremely well presented environment, which suits their needs. EVIDENCE: The home is situated in a residential area of south Sutton and is within reasonable walking distance of shops and public transport. On the morning of the unannounced inspection the home was warm, comfortable, bright, well ventilated and free from offensive odours. The home has recently undergone a period of extensive refurbishment and rebuilding to a very high standard to add a new wing and improve the facilities on offer to the home. The home now provides 36 single bedrooms, 19 of the
Crossways Care Nursing Home DS0000036868.V353576.R01.S.doc Version 5.2 Page 19 bedrooms have en-suite facilities. There are also three lounges and one dining room providing ample communal space. A second lift has been added to ensure accessibility. As mentioned previously, the home also has a separate intermediate care unit. The area to the front and exterior of the house is currently being completed. The parts of the home that have been upgraded are considered to exceed the minimum standards in terms of presentation and decor and work is about to begin on other areas including a new hairdressing salon. It is envisaged that once the work is completed this outcome group will be rated as excellent. Crossways Care Nursing Home DS0000036868.V353576.R01.S.doc Version 5.2 Page 20 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): Standards 27,28,29,30 Quality in this outcome area is excellent This judgement has been made using available evidence including a visit to this service. People who use this service are cared for by sufficient numbers of staff with a range of skills and abilities, which enable them to meet their needs. EVIDENCE: The homes duty rotas provide evidence that staffing levels are maintained appropriately and include a sufficient skill mix of qualified nurses and care workers to meet the needs of elderly service users. Many of those employed as care staff are qualified nurses from overseas which provides a highly trained and skilled workforce; others are educated to at least NVQ level 2. Robust recruitment policies and procedures are in place to ensure the protection of those living in the home and staff files provided evidence that appropriate clearance is gained prior to new members of staff starting work. There is a staff training programme in place although it was recommended that a training needs analysis would be useful to show exactly what had been undertaken by various staff members. Crossways Care Nursing Home DS0000036868.V353576.R01.S.doc Version 5.2 Page 21 The home is proud of the fact has just gained The Investors in People Award, designed to improve the care that they deliver. It is considered that this and the high level of qualifications of the care staff exceed the minimum standards. Crossways Care Nursing Home DS0000036868.V353576.R01.S.doc Version 5.2 Page 22 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): Standards31, 33,35,38 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. People who use this service know that it is run in their best interests by a person who is fit to be in charge. Health and safety arrangements are in place to ensure that both residents and staff are protected. Crossways Care Nursing Home DS0000036868.V353576.R01.S.doc Version 5.2 Page 23 EVIDENCE: Alison Churchill is registered with the Commission for Social Care Inspection as the home manager of Crossways. Ms Churchill has been in post four years and is a Registered General Nurse. She has substantial experience in working within a care setting. Mrs Yu, the homeowner is available to support Ms Churchill although there are clear lines of accountability within the home and staff members spoken to were clear about the roles of the management team. Members of the staff team spoken to during the inspection felt supported by the home manager and were happy with the environmental changes to the home. They said that they would be happy to speak to the manager if they had a concern. Every three months a satisfaction survey is distributed to residents and their families to make sure that they are happy with the services provided and the management team are always available to answer any queries. In future the intention is to focus on one area of the service at a time. Small amounts of pocket money only are held on behalf of residents they all have representatives to help them manage their finances. The Annual Quality Assurance Assessment provides details to show that necessary policies and procedures are in place in the home and maintenance and servicing of equipment is undertaken as necessary. Records of accidents in the home, which are few, are kept in individual residents files. It is recommended that copies should be held centrally in order to be able to provide a clear audit trail in future. Crossways Care Nursing Home DS0000036868.V353576.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X X 4 HEALTH AND PERSONAL CARE Standard No Score 7 3 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 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 4 29 3 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 X X 3 X X 3 Crossways Care Nursing Home DS0000036868.V353576.R01.S.doc Version 5.2 Page 25 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 OP3 Regulation 14(1)(a) Requirement The pre-admission assessment must contain information about resident’s social needs and preferences so that there is evidence that there has been consideration as to whether daily life in the home will suit them. There must be evidence that residents and their representatives are being given the opportunity to contribute to their care plans and influence the care and support that is being given. A record of the food actually eaten by the people who use this service must be kept in sufficient detail to show that they are receiving an adequate diet. Timescale for action 30/12/07 2. OP8 14(1)(c) 30/12/07 3. OP15 Schedule 4 30/12/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. Crossways Care Nursing Home DS0000036868.V353576.R01.S.doc Version 5.2 Page 26 No. 1. 2 Refer to Standard OP8 OP8 Good Practice Recommendations It is recommended that care staff be given the opportunity to contribute to care plans and include information about the care and support that they have delivered. It is recommended that there should be more emphasis placed on gaining information regarding residents past lives and achievements so that staff are able to gain a better understanding of the people that they are caring for. It is recommended that a record of accident forms should be kept centrally in order to facilitate an audit trail. 3 OP38 Crossways Care Nursing Home DS0000036868.V353576.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Croydon, Sutton & Kingston Office 8th Floor Grosvenor House 125 High Street Croydon CR0 9XP 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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