CARE HOME MIXED CATEGORY MAJORITY OLDER PEOPLE
Hesslewood Care Centre Ferriby Road Hessle East Yorkshire HU13 OJB Lead Inspector
Mrs Rosalind Sanderson Key Unannounced Inspection 22nd September 2006 09:45 X10029.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 Hesslewood Care Centre DS0000000936.V312656.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 and Care Homes for Adults 18 – 65*. 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. Hesslewood Care Centre DS0000000936.V312656.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Hesslewood Care Centre Address Ferriby Road Hessle East Yorkshire HU13 OJB 01482 648543 01482 640990 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) the.willows@ashbourne.co.uk Exceler Healthcare Services Limited Mrs Anne M Devaney Care Home 86 Category(ies) of Dementia - over 65 years of age (64), Old age, registration, with number not falling within any other category (64), of places Physical disability (22) Hesslewood Care Centre DS0000000936.V312656.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 17th January 2006 Brief Description of the Service: Southern Cross Healthcare took over the running and management of Hesslewood Care Centre in July 2006. Hesslewood Care centre is a large Victorian House with a modern purpose built extension. It is situated approximately a mile from the town of Hessle and close to the City of Hull. The original house is now a unit for younger physically disabled people whilst the large modern extension is the home for older people some of whom may require nursing care. The home is managed as three separate units and each has their own staff compliment. Accommodation is provided on two floors and both parts of the building are served by passenger lifts. The home stands in extensive, pleasantly landscaped grounds overlooking the Humber Estuary and the Humber Bridge. Prospective service users and their families are provided with information about the home in the form of a ‘Service Users guide’ with additional information provided in the home’s ‘Statement of Purpose’. Service users and their families are invited to visit the home and spend time there before deciding to make the move to live at Hesslewood. The fees charged at 22/9/06 were from £400 - £650 per week. Additional charges are made for hairdressing (from £4.50), chiropody (£10.00) and personal newspapers and toiletries. Hesslewood Care Centre DS0000000936.V312656.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The key inspection has used information from different sources to provide evidence. These sources include: • • • Reviewing information that has been received about the home since the last inspection. Information provided by the registered person on a pre inspection questionnaire. Comment cards returned from 5 service users and 8 relatives. 5 care managers responded to the surveys and one was spoken with during the site visit. One GP also provided their comments. Seventeen surveys were sent out to service users to complete. The manager has agreed that in the future a key worker responsibility will be to assist service users to complete the questionnaires if they wish or advise their advocates that they may need assistance. A visit to the home carried out by one inspector. • A site visit was carried out and lasted for six hours. Nine service users, six relatives, seven staff and a visiting care manager were spoken with. Records relating to service users, staff and the management activities of the home were inspected. During the visit care practices were observed, where appropriate, and time was also spent watching the general activity within the home. This enabled the inspector to gain an insight of what life is like at Hesslewood Care Centre for the people that live there. The Manager was available to assist throughout the day. What the service does well:
Service users enjoy living at Hesslewood. They are listened to and their opinions are valued. Accommodation is comfortable and pleasant and service users are encouraged to personalise their rooms. The standard of care at the home is very good and service users and their families are all involved in the care. Comments received include, ‘I was unable to attend the review of my ……care but the staff informed me of the outcome immediately and provided me with written records’. Another said, ‘Absolutely first class standard of care is given by dedicated staff. We cannot praise them enough’. Comments received from service users included, ‘I am very happy here, I have all that I need and wish for’ and ‘the standard of nursing attention is very good’. ‘This is a lovely place, the staff are excellent and always there to sort things out for you’.
Hesslewood Care Centre DS0000000936.V312656.R01.S.doc Version 5.2 Page 6 Staff are well trained and nursing and care staff are encouraged to undertake training to assist them to care for the service users. A care manager commented, ‘I have always found the staff and management very helpful and my clients are well cared for and happy’ The manager is very experienced, approachable and well liked by service users, their relatives and staff at the home. 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. Hesslewood Care Centre DS0000000936.V312656.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home Health and Personal Care Daily Life and Social Activities Complaints and Protection Environment Staffing Management and Administration Scoring of Outcomes Statutory Requirements Identified During the Inspection Older People (Standards 1–6) (Standards 7-11) (Standards 12-15) (Standards 16-18) (Standards 19-26) (Standards 27-30) (Standards 31-38) Adults 18 – 65 (Standards 1–5) (Standards 6, 9, 16 and 18–21) (Standards 7, 15 and 17) (Standards 22–23) (Standards 24–30) (Standards 31–35) (Standards 8, 10 and 37–43) Hesslewood Care Centre DS0000000936.V312656.R01.S.doc Version 5.2 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 (Older People) and Standards 1 – 5 (Adults 18 – 65) are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. (YA NMS 1) Each service user has a written contract/ statement of terms and conditions with the home. Each Service User has an individual contract or statement of terms and conditions with the home. (YA NMS 5) No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Prospective Service Users’ individual aspirations and needs are assessed. (YA NMS 2) Service users and their representatives know that the home they enter will meet their needs. Prospective Service Users know that the home they choose will meet their needs and aspirations. (YA NMS 3) Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Prospective service users have an opportunity to “test drive” the home. (YA NMS 4) Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. 6. The Commission considers Standards 3 and 6 (Older People) and Standard 2 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3, (6 is not applicable.) Standard 2 (adults 18-65) Quality in this outcome area is good. Service users can be confident that their assessed needs will be met at Hesslewood. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The records showed that all people expressing a wish to use this service are visited at home or in hospital in order that their health and social needs may be assessed. The assessments include all health care needs, activities of daily
Hesslewood Care Centre DS0000000936.V312656.R01.S.doc Version 5.2 Page 9 living, and social and recreational needs of each service user. This assessment is carried out with the co-operation and agreement of the service users and/or their relatives. The assessments were signed by service users to show that the assessment was correct. Hesslewood Care Centre DS0000000936.V312656.R01.S.doc Version 5.2 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 (Older People) and Standards 6, 9, 16, 18 –21 (Adults 18-65) are: 7. The service user’s health, personal and social care needs are set out in an individual plan of care. Service Users know their assessed and changing needs and personal goals are reflected in their individual plan. (YA NMS 6) Also Service Users are supported to take risks as part of an independent lifestyle. (YA NMS 9) Service users’ health care needs are fully met. Service Users physical and emotional health needs are met. (YA NMS 19) 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, retain, administer and control their own medication where appropriate and are protected by the home’s policies and procedures for dealing with medicine. (YA NMS 20) Service users feel they are treated with respect and their right to privacy is upheld. Service Users rights are respected and responsibilities recognised in their daily lives. (YA NMS 16) Also Service Users receive personal support in the way they prefer and require. (YA NMS 18) Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The ageing, illness and death of a Service User are handled with respect and as the individual would wish. (YA NMS 21) 8. 9. 10. 11. The Commission considers standards 7, 8, 9 and 10 (Older People) and Standards 6, 9, 16, 18, 19 and 20 (Adults 18-65) are the key standards to be inspected at least once during a 12 month period JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 (Older people) and 6,9,16,18,19,&20 (Adults 18-65) Quality in this outcome area is good. Service users care is well planned and delivered in a way that ensures all assessed needs are met in a way that promotes the privacy and dignity of service users. This judgement has been made using available evidence including a visit to this service. EVIDENCE:
Hesslewood Care Centre DS0000000936.V312656.R01.S.doc Version 5.2 Page 11 The new care plan records looked at gave good information about the service users physical, personal care and health care needs. There was information about the social likes and dislikes of all service users. The qualified nurses and the care staff record on a daily basis the care and treatments delivered to the service user. The plans ensure that staff are fully informed of all needs of all service users. There is evidence that service users and their relatives are involved and contribute to the plans. This ensures that service users receive the care they require in a way in which they choose to do so and that promotes their dignity, respect and privacy. One relative said, ‘I was unable to attend the review but the staff informed me of the outcome immediately and provided me with written records’. Another said, ‘Absolutely first class standard of care is given by dedicated staff. We cannot praise them enough’ Comments received from service users included, ‘I am very happy here, I have all that I need and wish for’ and ‘the standard of nursing attention is very good’ ‘This is a lovely place, the staff are excellent and always there to sort things out for you’ A care manager commented, ‘I have always found the staff and management very helpful and my clients are well cared for and happy’ Records of all treatments and interventions were recorded consistently on the evaluation sheet. All medications are now handled and administrated correctly and regular audits ensure that any problems are quickly identified and addressed. Hesslewood Care Centre DS0000000936.V312656.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 (Older People) and Standards 7, 11– 15 and 17 (Adults 18-65) are: 12. 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 have opportunities for personal development. (YA NMS 11) Also Service Users are able to take part in age, peer and culturally appropriate activities. (YA NMS 12). Also Service users engage in appropriate leisure activities. (YA NMS 14) Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service Users are part of the local community. (YA NMS 13) Also Service Users have appropriate personal, family and sexual relationships. (YA NMS 15) Service users are helped to exercise choice and control over their lives. Service Users make decisions about their lives with assistance as needed. (YA NMS 7) Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. Service Users are offered a healthy diet and enjoy their meals and mealtimes. (YA NMS 17) 13. 14. 15. The Commission considers standards 12, 13, 14 and 15 (Older People) and Standards 12, 13, 15 and 17 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 (Older people) and 12,13,15 &17 (Adults 18-65) Quality in this outcome area is excellent. Service users enjoy the lifestyle that they experience at Hesslewood and are encouraged and assisted to make choices and decisions. This judgement has been made using available evidence including a visit to this service. Hesslewood Care Centre DS0000000936.V312656.R01.S.doc Version 5.2 Page 13 EVIDENCE: Service users are able to look after their own finances where they wish and are able. If the manager takes care of personal allowances the service users can have access to this at any time. All monies held are kept individually. There are details in the home about advocacy services and on admission service users are asked if they would like contact with advocacy service. Service users room were all individual and personalised. On the younger disabled unit some rooms are set out as ‘bed-sits’ to promote and encourage independence. One service user commented that they were appreciative of the fact that they could bring their own furniture and that they loved their bedroom. Another said, ‘I like the fact that we may have a fridge in our room if we wish. I keep snacks in there for visitors and myself’ All service users have their nutritional needs assessed and a service user dietary preference sheet is provided to the cook in respect of each service user so that the cook is aware of all needs. On the day of the visit a group of service users were going to a local pub for lunch. A recent dinner party had been a great success. The cook had provided a restaurant style meal and the staff had acted as waiters. Relatives had also attended and the service users had enjoyed this so much that another one is being planned for the autumn. Comments received about the daily food provided were extremely complimentary Special diets such as vegetarian and diabetic diets are catered for. The kitchens are clean and well stocked. Assistance was given to service users needing this in an appropriate way that promotes dignity. Hesslewood Care Centre DS0000000936.V312656.R01.S.doc Version 5.2 Page 14 Complaints and Protection
The intended outcomes for Standards 16 – 18 (Older People) and Standards 22 – 23 (Adults 18-65) 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 feel their views are listened to and acted on. (YA NMS 22) Service users’ legal rights are protected. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Service users are protected from abuse. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) The Commission considers standards 16 and 18 (Older People) and Standards 22 and 23 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16&18 (Older people) and 22,23 (adults 18-65) Quality in this outcome area is good. Service users are protected and can feel confident that they will be listened to and any complaints acted upon. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There is a complaints procedure in place that is available to all service users and visitors to the home. The adult abuse policy reflects the recommendations in the Department of Health ‘No Secrets’ document. The manager holds a copy of the local authority multi agency policy that clearly states reporting procedures should an allegation of abuse occur. Staff receive training during their induction in relation to protection of vulnerable adults and there are regular updates available for care assistants and trained staff. Trained nurses and carers spoken with were very clear about the types of abuse that could occur and what actions they should take if a disclosure is made.
Hesslewood Care Centre DS0000000936.V312656.R01.S.doc Version 5.2 Page 15 Environment
The intended outcomes for Standards 19 – 26 (Older People) and Standards 24 – 30 (Adults 18-65) are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) Service users have access to safe and comfortable indoor and outdoor communal facilities. Shared spaces complement and supplement service users’ individual rooms. (YA NMS 28) Service users have sufficient and suitable lavatories and washing facilities. Service Users toilets and bathrooms provide sufficient privacy and meet their individual needs. (YA NMS 27) Service users have the specialist equipment they require to maximise their independence. (YA NMS 29) Service users’ own rooms suit their needs. Service Users’ own rooms suit their needs and lifestyles. (YA NMS 25) Service users live in safe, comfortable bedrooms with their own possessions around them. Service users’ bedrooms promote their independence. (YA NMS 26) Service users live in safe, comfortable surroundings. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) The home is clean, pleasant and hygienic. The home is clean and hygienic. (YA NMS 30) The Commission considers standards 19 and 26 (Older People) and Standards 24 and 30 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,26 (Older people) & 24,30 (Adults 18-65) Quality in this outcome area is good. Service users live in a home that is safe and secure and offers a clean and hygienic environment. This judgement has been made using available evidence including a visit to this service. Hesslewood Care Centre DS0000000936.V312656.R01.S.doc Version 5.2 Page 16 EVIDENCE: The location and layout of the home meets the individual and collective needs of the service users. The grounds that the home is set in are well maintained. One service user said, ‘I enjoy sitting out in the gardens when the weather permits’ The home is very pleasant and clean. There are no unpleasant odours and there is plenty of natural ventilation. Hand washing facilities are sited around the home and personal protective equipment is provided for all staff and service users. Infection control is paramount to the manager and there are ‘hand washing’ signs in evidence throughout the home. Training has been provided in this area. The organisation is currently starting a comprehensive programme of refurbishment for each part of the home. The laundry is situated away from food preparation areas and the equipment provided ensures that soiled laundry is washed appropriately. Walls and floors in the laundry are readily cleanable. The sluice room on each unit is kept locked to ensure service users do not have access to COSHH materials. There is a sluice disinfector provided in each unit. Hesslewood Care Centre DS0000000936.V312656.R01.S.doc Version 5.2 Page 17 Staffing
The intended outcomes for Standards 27 – 30 (Older People) and Standards 31 – 35 (Adults 18-65) are: 27. 28. 29. Service users needs are met by the numbers and skill mix of staff. Service users are supported by an effective staff team. (YA NMS 33) Service users are in safe hands at all times. Service Users are supported by an effective staff team. (YA NMS 32) Service users are supported and protected by the home’s recruitment policy and practices. Service Users benefit from clarity of staff roles and responsibilities. (YA NMS 31) Also Service Users are supported and protected by the home’s recruitment policy and practices. (YA NMS 34) Staff are trained and competent to do their jobs. Service Users individual and joint needs are met by appropriately trained staff. (YA NMS 35) 30. The Commission considers standards 27, 28, 29 and 30 (Older People) and Standards 32, 34 and 35 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 (older people) and 32,34,35 (Adults 18-65) Quality in this outcome area is good. Service users are cared for by sufficient numbers of staff that safe to do so and are well trained. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The duty rotas provided by the manager show that there are adequate staff on duty on each shift and this was the case on the day of the inspection. Staff rotas show that there is a good skills mix on each shift. There were adequate numbers of staff to assist service users throughout the day. Staff feel well supported. The unit managers hold the Registered Managers Award as well as the general manager. 50 of the car staff have achieved an NVQ qualification in Care at level 2 or above.
Hesslewood Care Centre DS0000000936.V312656.R01.S.doc Version 5.2 Page 18 The unit manager on the Younger Disabled Unit was able to recount recent training courses that staff have attended. These included specific training to meet individual service users needs. She was very clear that she would access training for her staff before admitting any service user with complex needs if this was required. The recruitment records show that all staff recruited to the home undergo robust pre employment checks before they start work. Hesslewood Care Centre DS0000000936.V312656.R01.S.doc Version 5.2 Page 19 Management and Administration
The intended outcomes for Standards 31 – 38 (Older People) and Standards 8, 10, 23, 37 – 43 (Adults 18-65) are: 31. 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 a well run home. (YA NMS 37) Service users benefit from the ethos, leadership and management approach of the home. (YA NMS 38) The home is run in the best interests of service users. Service Users are consulted on and participate in, all aspects of life in the home. (YA NMS 8) Also Service Users are confident their views underpin all selfmonitoring, review and development by the home. (YA NMS 39) Service users are safeguarded by the accounting and financial procedures of the home. Service Users benefit from competent and accountable management of the service. (YA NMS 43) Service users’ financial interests are safeguarded. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Staff are appropriately supervised. Service Users benefit from well supported and supervised staff. (YA NMS 36) Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. Service Users know that information about them is handled appropriately, and that their confidences are kept. (YA NMS 10) Also Service Users rights and best interests are safeguarded by the home’s policies and procedures. (YA NMS 40) and (YA NMS 41) The health, safety and welfare of service users and staff are promoted and protected. The health, safety and welfare of service users and staff are promoted and protected. (YA NMS 42) 32. 33. 34. 35. 36. 37. 38. The Commission considers standards 31, 33, 35 and 38 (Older People) and Standards 37, 39 and 42 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,38 (Older people) and 37,39 & 42 (Adults 18-65) Quality in this outcome area is good. The home is well managed This judgement has been made using available evidence including a visit to this service.
Hesslewood Care Centre DS0000000936.V312656.R01.S.doc Version 5.2 Page 20 EVIDENCE: The registered manager is qualified and has many years experience in care. She operates an ‘open door’ policy and staff feel well supported by her. Service users were observed to freely approach her and chat with her. The manager seeks the views on how the home is performing from service users, their relatives and professionals that visit the home. There is also an audit tool that is used to measure how well the service is performing and this looks at medication, environment and care plans to state a few. Results from these quality assurance tools are used to develop the annual business plan. The home looks after pocket money for a few service users and monies are held individually. Individual accounts can be produced to show how much an individual has and what transactions have taken place. Receipts are kept for all transactions. Health and safety certificates seen were all up to date with the exception of the electrical wiring certificate that had expired in May 2006. This had been arranged and the manager has agreed to forward a copy of the certificate once she has received it. Fire fighting equipment is regularly serviced. Mandatory training is up to date for staff. Hesslewood Care Centre DS0000000936.V312656.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 X 2 X 3 3 4 X 5 X 6 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 ENVIRONMENT Standard No Score 19 3 20 X 21 X 22 X 23 X 24 X 25 X 26 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No Score 31 3 32 X 33 3 34 X 35 3 36 X 37 X 38 2 Hesslewood Care Centre DS0000000936.V312656.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP38 Regulation 13 (4(a)) Requirement The registered person must forward to the Commission evidence that the electrical installations at the home are safe. Timescale for action 27/10/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Hesslewood Care Centre DS0000000936.V312656.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection York Area Office Unit 4 Triune Court Monks Cross York YO32 9GZ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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