CARE HOMES FOR OLDER PEOPLE
Dovehaven 22 Albert Road Southport Merseyside PR9 0LG Lead Inspector
. Daniel Hamilton Unannounced Inspection 18th January 2006 09:30 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 Dovehaven DS0000005399.V278941.R01.S.doc Version 5.1 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. Dovehaven DS0000005399.V278941.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Dovehaven Address 22 Albert Road Southport Merseyside PR9 0LG 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) 01704 548880 Mr Mark J Gilbert Mrs Wendy J Gilbert Miss Laura Smith Care Home 42 Category(ies) of Old age, not falling within any other category registration, with number (32), Physical disability over 65 years of age of places (10) Dovehaven DS0000005399.V278941.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Service users to include up to 32 OP and up to 10 PD(E) Date of last inspection 4th July 2005 Brief Description of the Service: Dovehaven is a residential care home for older people providing 42 registered places, 32 of which are registered for older people and 10 for older people with a physical disability. The home is situated close to Southport town centre and all its amenities and is within easy reach of shops, parks and public transport. The home has 36 bedrooms, 6 of which are double rooms however these are currently used for single occupancy. The communal areas consist of a dining room and a large lounge to the front of the building with a conservatory attached. A smaller lounge is available for residents who wish to smoke. Toileting and bathing facilities are located throughout. The home has three levels with a passenger lift serving the main floors and chair lifts to the mezzanine floors giving residents access to all parts of the building. A call bell system is fitted in all areas of the home. Dovehaven DS0000005399.V278941.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place over 9 hours. It was an unannounced visit and conducted as part of the regulatory requirement for care homes to be inspected at least twice a year. There had been no cause for any visits to the home since the last routine inspection in July 2005. A partial tour of the premises took place and observations were made. A selection of care, staff and service records were also viewed. The owner, manager, deputy manager, two staff members, eight of the 33 residents and two relatives were spoken with during the visit and their views obtained of the home. Comment cards were also left in the home to enable residents and others to comment on the service provided. What the service does well: What has improved since the last inspection?
Medication administration records had been correctly completed to record the administration of medication and risk assessments had been completed for residents who self-administered their medication.
Dovehaven DS0000005399.V278941.R01.S.doc Version 5.1 Page 6 A nutritional risk assessment had been developed for residents who experienced difficulties with their dietary intake and a new application form had been introduced, to provide space for applicants to record their full employment history. Arrangements had been made to test the home’s fire alarm system on a weekly basis and a record had been established, to ensure staff received fire instruction training at appropriate intervals. All the external windows (except for 5 on the gable wall) had been replaced and three bedrooms had been redecorated. One bedroom had been refurbished. What they could do better:
Despite a requirement at the last inspection, care plans viewed did not clearly identify the needs of residents or provide sufficient information of the action required by staff. Furthermore, some care plans had not been signed by residents or their representatives and some risk assessments had not been kept under regular review. Care planning processes must be improved so that the welfare of the residents is safeguarded. Medication was being secondary dispensed for one resident and the date and quantity of medication entering the home had not consistently been recorded on Medication Administration Records. This practice is not safe and must stop. Furthermore, the home should obtain a copy of guidance issued by the Royal Pharmaceutical Society of Great Britain, to use as a reference tool to ensure best practice. Although the home maintained a record of complaints received, there was limited information on the action taken in response to the complaint and the outcome. This information must be recorded in the complaints register. Staff employed since the last visit had commenced employment in the home before a Protection of Vulnerable Adult (POVA) check had been completed, despite a requirement at the last inspection. Staff must be recruited correctly, so that the people living in the home are protected. Up-to-date training records were not in place for all staff members. Furthermore, some staff had not completed all the necessary training, to ensure safe working practices and competency in their role. All staff must complete safe working practice and refresher training and 50 of the care staff should be trained to National Vocational Qualification (NVQ) level 2 or equivalent. Furthermore, the manager should complete an award equivalent to the Registered Manager’s Award. In order to improve consultation processes, the results of quality assurance questionnaires should be collated and published for the benefit of current and prospective residents, their representatives and other interested parties.
Dovehaven DS0000005399.V278941.R01.S.doc Version 5.1 Page 7 Likewise, the home should consult residents and explore the possibility of introducing resident’s meetings on a regular basis. Written records were available for money handled on behalf of residents however some receipts had not been obtained for all expenditure. Furthermore, residents had not signed to confirm they had received their cash. Receipts must be obtained for all money handled and residents should sign for money received, to protect the interests of the residents and the registered provider. In order to ensure the health and safety of residents and staff, an up-to-date gas safety certificate must be obtained. 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. Dovehaven DS0000005399.V278941.R01.S.doc Version 5.1 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 Dovehaven DS0000005399.V278941.R01.S.doc Version 5.1 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): Not applicable. EVIDENCE: None of the above standards were inspected during the inspection. Standard 3 was measured at the last inspection and was met. Standard 6 is not applicable to Dovehaven. Dovehaven DS0000005399.V278941.R01.S.doc Version 5.1 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 and 9 Care plans did not provide sufficient detail of the care to be provided to residents and some medication practice was poor. These shortfalls have the potential to place residents at risk. EVIDENCE: Four files were viewed. Three files were for residents who had moved into the home since the last inspection and one file was for a resident who had lived in the home for approximately ten years. Each file contained a plan of care, however some of the care plans did not satisfactorily address the needs of residents or the support required by staff. For example, one care plan identified a residents needs as “All Care” and the action required by staff detailed “Care Team – Personal Hygiene.” Care plans had not been signed by residents or their representatives. Similar issues were noted at the last inspection. Care plans had been kept under monthly review. Supporting documentation including: risk assessments, lifestyle profiles, medical appointment records and diary sheets were also in place. Since the last visit, the manager had introduced a nutritional risk assessment for residents who had difficulty with their dietary intake. Some risk assessments viewed had not been kept under regular review.
Dovehaven DS0000005399.V278941.R01.S.doc Version 5.1 Page 11 A medication policy was in place, to provide guidance to staff. The deputy manager reported that staff responsible for administering medication had completed in-house training and additional training from the home’s pharmacist. The deputy manager checked the competency of all staff prior to staff being authorised to administer medication. Records were maintained to confirm this. A record of staff authorised to administer medication together with sample signatures was in place. Likewise, a system had been established, to verify the identity of residents prior to administering medication. Consent declaration forms and risk assessments had been completed for residents who selfadministered medication. The home used a monitored dosage system. Medication Administration Records viewed had been completed to record the administration of medication however, the quantity and date that medication had been received into the home had not always been recorded. Furthermore, medication had been dispensed into a Dosett Pill Organiser for one resident. This practice is not safe and is known as secondary dispensing. Suitable records were in place to account for medication returned to the pharmacist and to account for the administration of controlled drugs. Dovehaven DS0000005399.V278941.R01.S.doc Version 5.1 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 Daily life and activities within the home were flexible and varied to meet the expectations, preferred routines and needs of residents. EVIDENCE: An activities programme had been developed, a copy of which was displayed on the home’s notice board for residents to view. The programme showed a range of planned activities was provided for the people living in the home. The activities included: Hairdressing on a Monday; a Trip to a choice of destinations in the home’s mini bus a Tuesday afternoon; Bingo on a Wednesday afternoon; Musical Movement and Physical Exercises with a Physiotherapist on a Thursday afternoon and an additional Bingo session on a Saturday afternoon. The manager reported that the programme was occasionally changed to include musical entertainers and to ensure the programme reflected the recreational interests and preferences of the people living in the home. Overall, residents interviewed during the visit were satisfied with the range and frequency of the activities provided and were able to confirm that activities were organised on a regular basis. Comments included: “I went to Albert Dock last week”; “We have bingo twice a week, a trip out and we are supported to do our shopping if we need help” and “I am happy with the range provided”. Dovehaven DS0000005399.V278941.R01.S.doc Version 5.1 Page 13 Likewise, some residents reported that they preferred not to participate in activities and that their wishes were respected by the home. For example one resident said; “I am a solitary person and prefer my own company to activities.” Likewise, another resident stated; “I’m not one for activities. There are enough for me.” Residents spoken with were able to describe how they were supported to maintain contact with local church representatives, in accordance with their individual religious beliefs / preferences. Dovehaven DS0000005399.V278941.R01.S.doc Version 5.1 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 The home had a complaints system in operation, however some records lacked key information on the outcome of complaints. EVIDENCE: The home had a complaints policy in place and a record of all complaints received was maintained. The complaints record book showed that four complaints / concerns had been received since the last visit. Although the details of the complaints had been recorded, the action taken in response to one complaint was not clear, as there was insufficient detail in the records. The Commission for Social Care Inspection had received no complaints about the home in the last six months. Residents spoken with during the visit had no complaints about the home or the service provided and were confident to approach the management team with any concerns. Feedback from three residents included: “Laura [Manager] and Carol [Deputy Manager] are always there to listen. They are not remote people”; “I’ve no complaints. I’m sure if I asked them they would help me” and “I could never complain about this place. I wouldn’t have lived here as long as I have if it wasn’t up to the mark.” Dovehaven DS0000005399.V278941.R01.S.doc Version 5.1 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 The home was suitable for the needs of the people living in the home and was accessible, well maintained and safe. EVIDENCE: The manager and the home’s handyman continued to undertake a health and safety risk assessment every 4 to 6 weeks, in order to monitor the condition of the home. Staff maintained a record of jobs requiring attention by the home’s handyman. A maintenance plan was not in place as the home received ongoing investment and maintenance as required. Since the last visit, the boundary wall had been repaired following an accident and all the windows (except for 5 on the gable wall) had been replaced. Furthermore, three rooms had been redecorated and one resident reported that his room had recently been refurbished with a new carpet and bedroom furniture. Areas viewed during the visit were well-maintained and free from obvious hazards. The fabric, fittings and decoration were in good condition and the external grounds were well maintained. One resident said; “They look after the environment and it’s always clean. Cleaners are on every day.”
Dovehaven DS0000005399.V278941.R01.S.doc Version 5.1 Page 16 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 and 30 Sufficient numbers of staff were deployed to meet the needs of the people living in the home. Recruitment practice was not robust and did not provide appropriate protection for the people living in the home. Some staff had not completed all the necessary training, to ensure competency in their role. EVIDENCE: Examination of the staffing rota and direct observation confirmed that the staffing levels had not changed since the last visit. The home continued to be staffed with three care assistants and the manager or a senior carer during the day, with two waking night staff and an additional member of staff providing a sleep-in service throughout the night. The manager was allocated one day each week, to undertake administrative duties. At the time of the visit, the capacity of staff was not recorded on the rota. However, the manager was able to show that the home employed a good skill mix of staff, to ensure the various needs of residents were met. Residents interviewed spoke highly of the care provided and confirmed that there were sufficient staff on duty to meet their needs. Comments from four residents included: “There is always someone to help you if you need it”; “Generally, there are enough staff on duty in my opinion”; “The staff are marvellous. I was helped this afternoon with a personal matter and was treated with such sensitivity” and “The carers are very good and treat me well. They understand my needs and respect me.” Four care staff had commenced employment at the home since the last visit. Overall, records required under the Care Home Regulations were in place,
Dovehaven DS0000005399.V278941.R01.S.doc Version 5.1 Page 17 however there were no photographs on file for any of the new staff. Furthermore, recruitment records showed that all four staff had commenced employment at the home before the results of a Protection of Vulnerable Adults (POVA) check had been received. Since the last visit, the home had introduced a new application form, which provided space for job applicants to record their full employment history. The manager reported that the home employed 16 care staff. Records showed that 2 staff had completed a National Vocational Qualification (NVQ) at level 2 or above (12.5 ), however certificates were available for only 1 staff member (6.25 ). One member of staff was currently studying the award and three care staff had been nominated for the training. Examination of staff files and training records and discussion with staff confirmed that new staff completed a ‘Staff Induction to Work and Workplace’ and ‘Induction to Care Standards’ training. At the time of the visit, it was not possible to accurately assess the learning needs of staff or to determine training completed, as the home did not have training matrix in place and training records had not been set up for all members of staff. Discussion with staff confirmed that some staff required safe practice and refresher training. The manager was able to provide documentary evidence that a training provider had been commissioned to supply a range of training to the home. A letter was viewed confirming that a number of places had been reserved for some staff to complete Safe Working Practice training during February 2006. Dovehaven DS0000005399.V278941.R01.S.doc Version 5.1 Page 18 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 and 38 Some administration / records within the home require further attention, to ensure the welfare of residents and the interests of the Provider are safeguarded. EVIDENCE: The manager (Miss Laura Smith) was registered with the Commission for Social Care Inspection and had managed the home since 1997. Prior to her appointment, she had gained approximately 5 years experience as the deputy manager of the home. The manager had completed: the National Vocational Qualification (NVQ) level 4 in Management, the City and Guilds 325/3 Advanced Management for Care and the D32/D33 assessor’s award. At the time of the visit, the manager had not yet registered to complete the care element of the award. Likewise, the manager required refresher training for Safe Working Practice topics. Residents and staff spoken with during the visit complimented the manager and her staff team. For example, one resident said; “Laura [Manager] is well
Dovehaven DS0000005399.V278941.R01.S.doc Version 5.1 Page 19 respected and is very good to us all.” Likewise, a staff member said; “The manager and deputy manager are very helpful and supportive.” The Registered Provider or an appointed representative visited the home on a daily basis to provide ongoing support to the manager and staff. The home commissioned an external organisation to undertake an annual quality assurance assessment. Furthermore, quality assurance questionnaires were distributed to residents and /or their representatives twice a year by the home. The results of questionnaires had not been collated and summary records had not been produced. There had been no resident’s meetings since January 2004, however the manager met with residents informally on a dayto-day basis. The lack of residents meetings had been noted by the people living in the home. One resident said; We’ve not had residents meetings recently. We used to have them regularly.” The manager did not act as an appointee for any of the residents. All the residents looked after their financial affairs independently or with support from family members / solicitors. The organisation’s head office was responsible for invoicing and administering fees. The home looked after the personal allowances for some residents. Three records were viewed. One record did not contain receipts for hairdressing and the resident had not signed for money received. The other two financial records were up-to-date and balances checked were correct. Since the last inspection, arrangements had been made to ensure the fire alarm system was tested on a weekly basis. Furthermore, the manager had introduced a record, to ensure night staff received fire instruction refresher training every three months. At the time of the visit, the home did not have an up-to-date Gas Safety Certificate. All other service certificates were checked at the last inspection. Some staff had not completed all safe practice and refresher training as identified in Standard 30. Areas viewed appeared to be well-maintained and free from obvious hazards. Dovehaven DS0000005399.V278941.R01.S.doc Version 5.1 Page 20 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 X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 X 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 X 3 X X X X X X X STAFFING Standard No Score 27 3 28 1 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 2 X X 2 Dovehaven DS0000005399.V278941.R01.S.doc Version 5.1 Page 21 Are there any outstanding requirements from the last inspection? yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15 Requirement Care plans must identify all the health, personal and social care needs of service users and detail the support required by staff to ensure that all the needs of service users are met.[Previous timescale of 4/09/05 not met] Medication must not be secondary dispensed. The date and quantity of all medication entering the home must be recorded on Medication Administration Records. The action that was taken in response to all complaints must be clearly recorded in the complaints record / summary. Staff must only be confirmed in post if full and satisfactory information has been obtained via a POVA check and a CRB has been applied for. [Previous timescale of 04/09/05 not met]. All staff records must be brought up-to-date in accordance with schedule 2 of the Care Home Regulations. [Previous timescale of 04/09/05 not met]. Safe practice training must be
DS0000005399.V278941.R01.S.doc Timescale for action 18/02/06 2 3. OP9 OP9 13 (2) 13 (2) 18/01/06 18/02/06 4. OP16 22 18/02/06 5. OP29 19 18/02/06 6. OP29 19 18/02/06 7. OP30 18 18/04/06
Page 22 Dovehaven Version 5.1 8. OP30 19 9. 10. OP35 OP38 17 (2) Schedule 4 23 (4) completed by all staff and refresher training must be completed periodically. [Previous timescale of 04/10/05 not met]. Each member of staff must have an up-to-date record of all training completed. [Previous timescale of 04/09/05 not met]. Receipts must be obtained for all money handled on behalf of residents. An up-to-date gas safety certificate must be obtained and a copy forwarded to the Commission for Social Care Inspection. 18/03/06 18/02/06 18/03/06 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. 2. 3. Refer to Standard OP7 OP7 OP9 Good Practice Recommendations Care plans should be signed by service users and / or their representatives. Risk assessments should be reviewed on a regular basis and the date of the review recorded. A copy of ‘The Administration and Control of Medicines in Care Homes and Children Services’ (Issued by the Royal Pharmaceutical Society of Great Britain) should be obtained for reference. 50 of the care staff should have a NVQ in Care at level 2 or equivalent. The Manager should complete an award equivalent to the Registered Manager’s Award. A summary of the results of quality assurance questionnaires should be produced and made available to current and prospective residents, their representatives and other interested parties. Residents should be consulted to establish their views about re-introducing Residents’ Meetings. Residents should sign financial transaction record sheets, to confirm they have received their money.
DS0000005399.V278941.R01.S.doc Version 5.1 Page 23 4. 5. 6. OP28 OP31 OP33 7. 8. OP33 OP35 Dovehaven 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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