CARE HOMES FOR OLDER PEOPLE
High Trees Residential Care Home 24 Clay Hill Enfield Middlesex EN2 9AA Lead Inspector
Tony Brennan Key Unannounced Inspection 16th January 2007 13:00 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 High Trees Residential Care Home DS0000010570.V323301.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. High Trees Residential Care Home DS0000010570.V323301.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service High Trees Residential Care Home Address 24 Clay Hill Enfield Middlesex EN2 9AA 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) 020 8363 2238 Khemchand Prakash Hurril Deborah Olive Hurril Care Home 12 Category(ies) of Old age, not falling within any other category registration, with number (12) of places High Trees Residential Care Home DS0000010570.V323301.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 27th October 2005 Brief Description of the Service: High Trees is a registered care home, which provides care for 12 older people of mixed gender. Mr Khemchand Hurril owns the home. The home is situated in a residential area in Enfield and is easily accessible by public transport. The premises are constructed of two floors with the lounge and dining areas on the ground floor. There are five bedrooms on the ground floor and five bedrooms upstairs. Two bedrooms are shared. There is a very attractive large conservatory at the rear of the property, which leads onto a well-maintained garden and patio. The fees are £380 a week. This report is available through the internet. Copies may also be obtained from the provider of this service. High Trees Residential Care Home DS0000010570.V323301.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This key unannounced inspection was undertaken as part of the annual inspection programme. The inspection took place over one day. The registered manager, Deborah Hurril and Mr Khemchand Hurril, assisted the inspector. The inspector received comments from the service users and professionals who live, or are connected with High Trees. The inspector spoke with four service users and two staff. The inspector observed care practice and staff interaction with service users. The inspector toured the building and examined a number of records relating to the care, health and safety and management of the home. The inspector would like to thank the registered provider and staff who assisted him by answering questions about the running of the home. The inspector would also like to thank people who live at the home and their representatives for commenting on the service. What the service does well:
A relative commented, “staff were welcoming and answered all our questions”. The people living at the home confirmed that they had visited the home prior to admission. People had their needs assessed before coming to live at High Trees. The initial assessment carried out by the home and care management identified all their physical, health and cultural needs. Detailed care plans were available showing how people living at the home wished to be supported. One of the people living at High Trees felt that, “staff are good and very helpful when I need it”. The needs of the service users case tracked had been reviewed. People living at High Trees commented that they receive medical care when they need it. There were records of medical support provided from dentists, chiropodists and opticians. The inspector found that the medication policy was complete and contains all the necessary guidance to ensure that a safe system for the management of medication was in place. The inspector examined the medication records for medicines received, administered and returned, and found these were complete. Comment cards received from people living at High Trees confirmed that activities were provided. The inspector observed a game of bingo taking place on the day of the inspection. Two people who live at the home were also seen playing dominos. The inspector spoke to them and they confirmed that they enjoyed this. People living at the home spoken to confirmed that the food was good and that choices were offered to them. The inspector spoke with the cook who had recently started working at the home. She explained that the menu was being reviewed to improve the range of meals on offer.
High Trees Residential Care Home DS0000010570.V323301.R01.S.doc Version 5.2 Page 6 The pre-inspection questionnaire and the homes complaints record showed that there had no complaints since the last inspection. Comment cards received from people who live at the home confirmed they knew how to make a complaint. A person who lives at High Trees felt that they were safe at the home. There have had no adult protection meetings since the last inspection. Bedrooms were personalised. The registered manager explained that people living at the home were encouraged to bring furniture and other items into the home. A person who lives at the home said, “I brought all the things I wanted when I moved in”. The inspector spoke with staff and examined training records that confirmed that they had received the required statutory training. A person who lives at the home said, “the manager talks to us about what we need”. The inspector observed the registered manager working with people who live at the home. The registered manager listened and responded to their needs. People living at High Trees confirmed that they had been asked about how the home could do things better. All the necessary systems and procedures were in place to ensure the safety of those who live and work at the home. What has improved since the last inspection? What they could do better:
Three areas for improvement were identified at this inspection. The inspector saw that the hallway is in need of redecoration. The inspector recommended that this be included in this year’s redecoration plan. This will ensure that the home provides a suitable environment for people who live at the home. 25 of the total staff group have a National Vocational Qualification. The inspector explained to the registered manager that 50 of staff should achieve this qualification to ensure that they were able to meet all the needs of people living at the home. One member of staff only had one reference and no CRB check. The registered person agreed to ensure that all checks on newly
High Trees Residential Care Home DS0000010570.V323301.R01.S.doc Version 5.2 Page 7 appointed staff are carried out prior to them commencing work at the home. This will ensure the safety of people who live at the home. 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. High Trees Residential Care Home DS0000010570.V323301.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection High Trees Residential Care Home DS0000010570.V323301.R01.S.doc Version 5.2 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users needs are assessed prior to admission to the home to ensure they receive the care and support they need. EVIDENCE: Comment cards from service users and relatives confirmed that they had been given information about the service prior to admission. One relative commented, “staff were welcoming and answered all our questions”. The three service users case tracked confirmed that they had visited the home prior to admission. The three service users case tracked all had initial assessments of their needs. The initial assessment carried out by the home and care management identified all their physical, health and cultural needs. A service user case tracked said, “staff were good and understand my needs”. The service user
High Trees Residential Care Home DS0000010570.V323301.R01.S.doc Version 5.2 Page 10 had been diagnosed with Parkinson’s. The initial assessment identified the support the service user needed. The inspector spoke with the key worker for this service user who was able to explain their needs. The key worker understood the support that the service user wanted. Cultural and religious needs of the three service users were identified in the initial assessment process. Two of the service users case tracked attended a local church. One of the service users explained, “the home has arranged for me to have visitors from the church and helped me to attend my church on Sundays”. The service users case tracked had care plans that reflected the needs identified in their initial assessments. The registered manager has started to introduce a more comprehensive initial assessment. This will ensure the needs of service users are identified in greater detail. The inspector found that the new initial assessment had been used to assess the needs of one of the service users case tracked. The inspector found that this provided more information on the needs of this service user. High Trees Residential Care Home DS0000010570.V323301.R01.S.doc Version 5.2 Page 11 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7 8 9 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users personal, social and medical care needs are fully planned for. Service users are fully protected by safe procedures for handling medication. Service users right to privacy is supported. EVIDENCE: At the last inspection one service user recently admitted to the home had been found not to have a care plan. The registered manager explained that all service users now had a care plan that detailed their needs. The inspector found that the three service users case tracked all had detailed care plans. One of the service users case tracked felt that, “staff are good and very helpful when I need it”. The needs of the service users case tracked had been reviewed. One of the service users case tracked had been diagnosed with Parkinson’s disease. The home had ensured that a referral to the relevant consultant had been made. A review had been carried out of this service user’s medical needs.
High Trees Residential Care Home DS0000010570.V323301.R01.S.doc Version 5.2 Page 12 The three service users case tracked all had care plans that identified how to meet their needs. This included their religious and cultural needs. There was guidance on how these should be met. Two of the service users case tracked attended church regularly. The inspector spoke with these service users who confirmed that they were supported to practice their faith in the way they wished. Service users case tracked had records of medical support. Service users spoken to commented that they receive medical care when they need it. Service users case tracked had records of medical support provided from dentists, chiropodists and opticians. Falls risk assessments are now in place. The inspector found that the three service users case tracked had all been assessed and a falls prevention plan had been put in place. Accident records showed that one service user case tracked had had two falls. The risk assessment had been reviewed and action to prevent further falls was recorded in the falls prevention plan. The care plan and daily notes for one service user showed that they were at risk of developing pressure sores. The registered manager explained that the district nurses provided support to this service user. The inspector found on the tour of the home that the service user had the necessary equipment in place. The inspector found that the medication policy was complete and contains all the necessary guidance to ensure that a safe system for the management of service users medication was in place. The inspector examined the medication records for medicines received, administered and returned, and found these were complete. The General Practitioner had been consulted to ensure that medication was appropriate to the health needs of the service users. Staff spoken to confirmed that they had received training in how to administer medication safely. The inspector found there was a list of the names of those staff that are trained to administer medication. Certificates were available to confirm that staff had received the required medication training. High Trees Residential Care Home DS0000010570.V323301.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12 13 14 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users need to be provided with varied activities to meet their needs. Service users are supported to maintain contact with relatives and other representatives of their choice. Service users are able to make choices about how they live in the home. The menu needs to reflect the preference of service users and offer a balanced diet. EVIDENCE: Comment cards received from service users confirmed that activities were provided. The inspector observed service users enjoying a game of bingo. Two service users were also seen playing dominos. The inspector spoke with the two service users who confirmed that they enjoyed doing this. The inspector observed that staff spent time talking to service users. Staff took time to engage and hold meaningful conversations with service users. One of the service users case tracked said, “they try to keep us entertained”. Another service user spoken to confirmed that she received a daily paper and that staff discussed current events with her. Two service users case tracked enjoy going to church. The inspector spoke with these service users who explained that
High Trees Residential Care Home DS0000010570.V323301.R01.S.doc Version 5.2 Page 14 they are supported to attend the church. This need was recorded in their care plan. A service user said, “my friends from the church visit regularly. I choose when they come and visit”. Service users confirmed that they saw their General Practitioner in private. Service users personal preferences as to how they wished to live in the home are recorded in their care plans. The inspector observed staff assisting service users and observed that time was taken to discuss how they wanted things to be done. Service users spoken to confirmed that the food was good and that choices were offered to them. The inspector spoke with the cook who had recently started working at the home. She explained that the menu was being reviewed to improve the range of meals on offer. Service users spoken to confirmed that they had been asked about possible meal choices. The inspector observed that hot and cold drinks were offered to service users regularly throughout the day. The inspector found that service users were supported by staff to enjoy their meal. Staff ensured that service users had all the food and drink they wished. Service users enjoyed their meal in a relaxed atmosphere. The inspector observed that staff went to each service user at suppertime to ask them what they wanted to eat. A range of options was offered. High Trees Residential Care Home DS0000010570.V323301.R01.S.doc Version 5.2 Page 15 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are confident that their complaints will be listened to, taken seriously and acted upon. Service users are protected from abuse. EVIDENCE: The pre-inspection questionnaire and the home’s complaints record showed that there had been no complaints since the last inspection. Comment cards received from service users confirmed they knew how to make a complaint. A service user said that they felt confident in making concerns known to staff. The complaints policy explained how to make a complaint and how it would be dealt with. A service user spoken to felt that they were safe at the home. There have been no adult protection meetings since the last inspection. There were comprehensive policies on handling abuse and protection. Staff spoken to were clear about the signs of abuse and how suspected abuse should be handled. The inspector found that the training records showed that staff had received training on POVA. High Trees Residential Care Home DS0000010570.V323301.R01.S.doc Version 5.2 Page 16 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users live in a home that provided a safe and accessible environment. The home is clean and hygienic. EVIDENCE: The inspector toured the building and found that service users bedrooms were personalised. The registered manager explained that service users were encouraged to bring furniture and other items into the home. A service user case tracked said, “I brought all the things I wanted when I moved in”. The inspector saw that records of maintenance were being maintained. The home has been adapted to meet the needs of service users. There are raised toilet seats and accessible baths. Records showed that regular maintenance checks of the chair lift had been carried out. High Trees Residential Care Home DS0000010570.V323301.R01.S.doc Version 5.2 Page 17 The registered persons explained that a number of improvements had been made to the home’s environment since the last inspection. These included the purchase of an industrial dishwasher for the kitchen. This will ensure that service user safety is maintained. A new worktop has been fitted in the kitchen. The flooring in the down stairs toilet has been replaced. Two bedrooms are in the process of being redecorated. The registered persons explained that their plan is to redecorate the sitting room and a further three bedrooms. The inspector saw that the hallway is in need of redecoration. The inspector recommended that this be included in this year’s redecoration plan. The inspector saw that the home was appropriately lit. The inspector saw that the home was clean. The inspector found that all bathrooms and toilets had liquid soap and paper towels in them. Staff spoken to understood how to prevent cross infection when assisting service users with personal care tasks. High Trees Residential Care Home DS0000010570.V323301.R01.S.doc Version 5.2 Page 18 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27 28 29 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Sufficient staff are available at all times to meet service users needs. Staff have all the skills to meet all the assessed needs of service users. Service users are not protected by the home’s recruitment practices. EVIDENCE: The inspector spoke with service users and staff who felt that sufficient staff were available at all times. The staff explained that currently there is one service user who needs a high level of care. The registered manager said that the staffing level would be kept under review to reflect the changing needs of service users. The rota showed that a consistent staffing level is maintained to meet the needs of service users. The inspector spoke with staff and examined training records that confirmed that they had received the required statutory training. This included first aid. A service user commented, “staff understand how to help me”. Staff spoken to were able to explain the needs of the service users case tracked. Training records showed that staff had been on training on infection control, health and safety and Protection of Vulnerable Adults training. The registered manager explained that further training was planned. This will include dementia care and care planning.
High Trees Residential Care Home DS0000010570.V323301.R01.S.doc Version 5.2 Page 19 The number of staff with the National Vocational Qualification has increased to eight. Two staff are currently working on the level three National Vocational Qualification. However, this only constitutes 25 of the total staff group with a National Vocational Qualification. The inspector explained to the registered manager that 50 of staff should achieve this qualification to ensure that they were able to meet all the needs of service users. The inspector examined files of staff who had recently started work at the home. These two files were found to be complete. The third newly appointed member of staff only had one reference and no CRB check. The registered person agreed to ensure that all checks on newly appointed staff are carried out prior to them commencing work at the home. This will ensure the safety of service users. High Trees Residential Care Home DS0000010570.V323301.R01.S.doc Version 5.2 Page 20 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31 33 35 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The registered manager does have the necessary qualifications to manage the home effectively and in the best interests of service users. Service users are consulted about the quality of the service provided and encouraged to make suggestions for improvement. Service users financial interests are protected by the home’s procedures. Service users and staff are protected by the home’s health and safety procedures. EVIDENCE: A service user said, “the manager talks to us about what we need”. The inspector observed the registered manager working with staff and service users. The registered manager listened and responded to their needs. The registered manager demonstrated to the inspector that she understood the
High Trees Residential Care Home DS0000010570.V323301.R01.S.doc Version 5.2 Page 21 needs of service users. The registered manager has a nursing background and has completed the Registered Managers Award. The inspector spoke with staff who confirmed that the registered manager provided support to them to meet the needs of service users. Service users spoken to confirmed that they had been asked about how the home could do things better. The home has a system in place to consult with service users and other stakeholders about the quality of the service provided. The registered manager explained that a survey of service users and other stakeholders has been carried out recently. The registered manager explained that the area for improvement identified by service users was the quality of the food provided. The registered manager explained that a new cook has been employed. The cook will review the menu with service users to ensure that food is provided that meets with their preferences and is of a consistent quality. Service users spoken to and comment cards received by the inspector confirmed that the quality of the food provided has improved. The home has an effective complaints system for service users and their representatives to raise issues. The registered manager explained that the home has the necessary procedures to manage service users finances securely. The home does hold money for one service user. The inspector checked the monies held for this service user and found that they corresponded to the record of money spent by this service user. Receipts were available for all purchases made on behalf of this service user. Their families or social service departments manage other service users finances. Fire drills were taking place and the fire alarms are tested regularly. The system had been regularly checked and any maintenance needed had been carried out. The fire risk assessment includes an assessment of all the potential fire risks in the home. The inspector questioned staff on the fire safety procedures and found that they understood fire safety issues. All health and safety policies were available. Certificates for gas, legionella and electrical testing were in date. COSHH guidance was in place and chemicals were stored safely. The inspector discussed health and safety issues with staff and they demonstrated their understanding. The home has an effective system for monitoring accidents. The inspector found that the temperature of cooked food, fridges and freezer are recorded. High Trees Residential Care Home DS0000010570.V323301.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 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 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 High Trees Residential Care Home DS0000010570.V323301.R01.S.doc Version 5.2 Page 23 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP29 Regulation 19(1)(b) Requirement The registered persons must ensure that staff have two references and a CRB check before starting to work at the home. Timescale for action 10/02/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2 Refer to Standard OP19 OP28 Good Practice Recommendations The registered persons should ensure that the redecoration of the hallway is included in the redecoration and maintenance plan for the home. The registered persons should ensure that 50 of staff achieve NVQ at level 2 in care. High Trees Residential Care Home DS0000010570.V323301.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Southgate Area Office Solar House, 1st Floor 282 Chase Road Southgate London N14 6HA 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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