CARE HOMES FOR OLDER PEOPLE
Lyndhurst Lyndhurst 67 Byfleet Road New Haw Weybridge Surrey KT15 3JZ Lead Inspector
Christine Bowman Unannounced Inspection 19th December 2005 12:00 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 Lyndhurst DS0000013707.V262381.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. Lyndhurst DS0000013707.V262381.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Lyndhurst Address Lyndhurst 67 Byfleet Road New Haw Weybridge Surrey KT15 3JZ 01932 842730 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) Mr Aboo Bakar Seeparsand Mrs Zehra Bibi Seeparsand Mr Aboo Bakar Seeparsand Care Home 16 Category(ies) of Dementia - over 65 years of age (10), Old age, registration, with number not falling within any other category (16), of places Physical disability over 65 years of age (3) Lyndhurst DS0000013707.V262381.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. The age/age range of the persons to be accommodated will be: 65 YEARS AND OVER One named individual DE(E) Dementia - 0ver 65 to be added to the registration for the duration of their stay at the home. 21st June 2005 Date of last inspection Brief Description of the Service: Lyndhurst is a large detached house in a residential road within walking distance of local shops and New Haw and Byfleet railway station. The building is Tudor style with car parking facilities to the front of the house and an enclosed mature garden to the rear. The home provides care for sixteen older people, ten of whom may also be diagnosed with dementia and three with physical disabilities. Bedroom accommodation is single with the exception of one double bedroom. Nine of the bedrooms have en-suite facilities. There is a large combined lounge and dining area and a conservatory overlooking the garden. The kitchen has been modernised and there is a separate utility room. Lyndhurst DS0000013707.V262381.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection was the second for the year April 2005 to March 2006 and was undertaken by two inspectors commencing at 12.00pm and ending at 17.30pm. Evidence was sought to check on the progress of the requirements made at the previous inspection, and to complete the second inspection. The manager and two members of staff were interviewed and some of the residents gave their views of the home. The living areas, decorated for Christmas were bright and cheerful and the residents were smiling and interacting with the staff. Samples of resident’s care plans and staff personnel files were viewed, supervision, appraisal and training records were requested but not seen because the manager stated he could not find them. A partial tour of the premises was undertaken. What the service does well: What has improved since the last inspection?
There had been few significant improvements since the last inspection and there was little evidence to prove that requirements made at the previous inspection had been complied with. Failure to comply with requirements will result in legal action being taken against the proprietors. Resident’s prescribed medications sampled had clear instructions from the pharmacist and were not prescribed ‘as directed’. Staff files of foreign nationals sampled, contained the correct documentation allowing them to work in this country. Lyndhurst DS0000013707.V262381.R01.S.doc Version 5.1 Page 6 What they could do better:
The information available to residents before they decide if Lyndhurst will be the right care home for them, which is available in the form of a ‘Service User’s Guide’ and the ‘Statement of Purpose’, needs to be clear about how the special needs of those residents with dementia, who are in the majority, will be catered for. Those prospective residents who are more independent also need to know how the home will provide for them. Considering that eleven of the residents in the home have a diagnosis of dementia, the current training is insufficient to ensure the staff team have a depth of knowledge sufficient to fulfil the resident’s needs. Recording on care plans needs to be more consistent, the residents’ psychological health needs monitored and appropriate care provided. The care plan must cover all identified needs as assessed. Care plans of residents inspected showed significant shortfalls in the ability to see the continued need for fall risk assessments and to consider preventative measures when risks were identified. There were shortfalls in following up identified needs with a care plan and to ensure that the staff were appropriately trained to deal with resident’s specific needs. The policy for dealing with medication needs to be reviewed so that it contains more specific detail relevant to the home to instruct the staff and ensure the safety of the residents. Resident’s wishes with respect to death and dying must be recorded to inform the staff so that they are in no doubt should an emergency arise. The complaints policy must allow for the complainant to contact the Surrey CSCI local office at any time throughout the process. Lyndhurst needs to develop it’s own policy on responding to Safeguarding Adults issues in order to inform staff. Recruitment practises need to be reviewed, and all checks carried out before new staff work with the residents, in order that they are protected. Newly appointed staff should have received the mandatory training before carrying out tasks for the residents. A strategy for the attainment of the NVQ training needs of the staff should be devised. In order to comply with the current guidance, the registered manager needs to attain a qualification in management as has been discussed with him on a number of occasions. Cardboard boxes were stored on the first floor landing and close to resident’s bedrooms causing a fire risk. Resident’s call bells were not all in working order putting them at risk.
Lyndhurst DS0000013707.V262381.R01.S.doc Version 5.1 Page 7 The accident book was in keeping with the data protection act, but the individual sheets had not been detached and stored securely. The staff induction and training was not compliant with statutory requirements in terms of content and timescales. The home’s record keeping practises do not facilitate the assessment of individual competencies and skill/knowledge base. The staff supervision, appraisal records and individual training profiles were not available to be inspected because the manager could not find them, although he confirmed that supervision meetings were held with the staff. The organisation of record keeping was chaotic and the office extremely untidy. This resulted in much time being taken looking for documents, which could not be found. The registered provider is also the registered manager and in day-to-day control of the home, but failing to meet many of the standards. The annual accounts of the home, certified by an accountant, which the manager had been required to send to the CSCI local office had not been sent and were not available. 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. Lyndhurst DS0000013707.V262381.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 Lyndhurst DS0000013707.V262381.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): 1&4 More information is required for prospective residents to enable them to make a decision about the ability of the home to meet their needs. More knowledge and in depth training is required to ensure the assessed specialist needs of the residents are met. EVIDENCE: The majority of residents living at Lyndhurst have dementia and this fact is not made clear in the statement of purpose. There is also no indication about how those special needs would be met or how the needs of more independent residents will be met. There was no evidence of dementia training, but the manager stated that the staff had undergone a two-hour training course on dementia in 2004. The providers were urged to research more in depth training courses specific to dementia care, which are known to operate locally. Lyndhurst DS0000013707.V262381.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): 7,8,9&11 Assessed needs and risk assessments do not always lead to appropriate care plans and interventions therefore resident’s care needs are not always fulfilled. These shortfalls have the potential to place the residents at risk. A local policy to instruct the staff on medical procedures is not in place to protect the staff and residents. Plans were not in place for residents in the event of death and dying and the details of their wishes in this respect were not recorded to ensure they were acknowledged. EVIDENCE: From a sample of resident’s files observations confirmed that all areas of need and risk were not fully addressed in the care plans. A resident diagnosed with diabetes had significant fluctuations in the recordings of blood sugar levels. Care notes had not been recorded in chronological order of interventions in response to this. Care plans were not considered adequate to identify what action was to be taken should the resident have a hypoglycaemic attack and there was no evidence that all staff had received appropriate training regarding diabetes. Although the proprietors stated that the diabetes nurse was involved there was no evidence to support this claim. A resident who had recently had a serious fall in her en-suite did not have a risk assessment in place for time
Lyndhurst DS0000013707.V262381.R01.S.doc Version 5.1 Page 11 spent alone in her room and preventative measures had not been considered. Risk assessments for falls should generate care plans for the prevention of falls and should be regularly reviewed and updated. Medication was not fully inspected on this occasion but the progress on fulfilling the requirements of the previous inspection was checked. A local policy to instruct the staff on the home’s medical procedures had not been completed. Random samples of medications supplied to residents by the pharmacist were labelled with appropriate instructions from the pharmacist for administration. Although the new assessment tool purchased by the home has a section for the details of the resident’s wishes with respect to death and dying, none were recorded leaving those dealing with these issues unsure of how to proceed. Lyndhurst DS0000013707.V262381.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): These standards were not inspected on this occasion. EVIDENCE: Lyndhurst DS0000013707.V262381.R01.S.doc Version 5.1 Page 13 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&18 The revised complaints procedure could not be located making the availability to prospective complainants unlikely. There had been no progress on producing a Safeguarding Adults procedure to ensure a proper response to any suspicion or allegation of abuse. EVIDENCE: The manager stated that the complaints policy had been revised to include the twenty eight day response time and that the procedure made the complainant aware that the CSCI local Surrey office could be contacted at any time. A copy of the revised complaints procedure could not be located at the time of the inspection. The manager also confirmed that the local Safeguarding Adults Procedure, which was a requirement of the previous inspection had been written but it could not be located at the time of the inspection. Lyndhurst DS0000013707.V262381.R01.S.doc Version 5.1 Page 14 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): These standards were not inspected on this occasion. EVIDENCE: Lyndhurst DS0000013707.V262381.R01.S.doc Version 5.1 Page 15 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): 28,29&30 Sufficient numbers of staff are available to meet the needs of the residents, but the NVQ training targets for 2005 have not been achieved. The practise of the recruitment of staff continues to show shortfalls leaving the residents at risk. Inadequate recording makes the assessment of staff competencies difficult. EVIDENCE: The manager stated that the nurses, who had been trained abroad, had attained qualifications, which were at least the equivalent of NVQ levels 2 or 3 and that the agency had confirmed this. There was, however no record of this verification. Random samples of staff personnel files confirmed the need to revise the home’s recruitment application form to include a full employment history section. This information was not being routinely sought making the relevance of referees and the relationship to the applicant unclear and gaps in employment impossible to probe. Personnel records did not provide a record of the date on which the post had commenced, and in one case when a member of staff had a break in service, it was not possible to ascertain when she had left and resumed work. Application forms were also found to be incomplete. Terms and conditions of service were not all signed and there was no job specification. A record of Criminal Record Bureau disclosures was not maintained. A reference was missing on one file, although the manager stated that it existed, references were not verified. Evidence was found of staff taking up post prior to CRB disclosures being received and the most recently
Lyndhurst DS0000013707.V262381.R01.S.doc Version 5.1 Page 16 recruited member of staff had taken up post on the basis of a disclosure obtained by a former employer. The provider had not made application for a CRB check on behalf of the home and there was no evidence of POVA checks being applied for. There were no individual training and development assessments and profiles of the staff. Induction and foundation booklets had not been completed because the scope of learning, although it included all the required knowledge base was too broad there was no evidence of it being completed. The providers were not compliant with statutory requirements for staff induction and training both in terms of content and timescales. The manager stated that he had signed up with an agency, which offers distance learning mandatory training over six to twelve weeks and that the food hygiene training had been completed on December 7th 2005. He also stated that manual handling training had taken place on November 15th 2005 and health and safety on 22nd November 2005. There was no evidence to confirm this. Lyndhurst DS0000013707.V262381.R01.S.doc Version 5.1 Page 17 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): 31,34,35,36,37&38 The manager/provider could not verify that he had secured an appropriate course of management training and he is not ensuring that The National Minimum Standards for Care Homes for Older People are being met in a number of areas. Supervision, appraisal and mandatory training are not recorded for individual staff members leaving no method of verifying this activity to ensure the staff are supported and trained adequately. The best interests of residents are not served by a disorganised system of filing and an extremely untidy office. A number of shortfalls in attending to the health, safety and welfare of the residents places them at risk. EVIDENCE: The manager stated that he had made application for inclusion on a National Vocational Qualification course at level 4 in management, but had no evidence of acceptance. He had a list of potential managers with appropriate qualifications, provided by an agency, but had not taken the matter further.
Lyndhurst DS0000013707.V262381.R01.S.doc Version 5.1 Page 18 The manager does not receive supervision and a suggestion was put forward that a consultant could provide this service. There was no evidence to show that the manager had complied with the requirements made at the previous inspection. Although he stated that without exception the necessary work had been completed, a fruitless search through disorganised files in an extremely untidy office did not produce the required evidence and much valuable time was wasted. (Please see comments under the appropriate sections of the report). A copy of the home’s financial and business plans to be sent to the CSCI local office was a requirement made following an inspection in November 2004, and although documents had been received, the appropriate annual accounts certified by an accountant as stated in Regulation 25 of The Care Homes Regulations 2001, have not been received to verify the financial viability of the home. The manager stated that no residents were able to control their own money and relatives on their behalf managed it. He went on to state that invoices were sent to relatives when residents made requests to purchase items. A resident interviewed later stated she had no relatives. In circumstances such as this, the manager is requested to clarify how the resident’s finances are handled and recorded, and send this information in writing to the CSCI local office. The staff supervision and appraisal records were requested but were not seen because the manager could not find them, although he confirmed these meetings had taken place. The registered manager must arrange a timetable to ensure that all staff receive the mandatory supervision and appraisal and send a copy to the CSCI local Surrey office. This standard was not fully inspected on this occasion, but evidence was sought to check that a requirement of the previous inspection had been carried out. Surrey Fire & Safety Ltd had been contracted by the home over a number of years to service the home’s fire detection system. It was under new management on 07/01/05 when an inspection carried out identified heat detectors of a specific type, were recommended to be upgraded. The providers questioned the integrity of the report and they stated that another company had been sought to carry out a second inspection which found only some of the heat detectors were in need of replacement and that this work was planned in January 2006. No evidence was produced to support this information however. Cardboard boxes were stored on the landing at the top of the stairs and close to resident’s bedrooms, the proprietor was asked to remove them immediately because they posed a fire risk. Lyndhurst DS0000013707.V262381.R01.S.doc Version 5.1 Page 19 Call bells were tested and some were not in working order consequently putting residents at risk in their rooms. The accident book was checked and, although it was in keeping with The Data Protection Act 1998, the perforated forms had not been detached and securely stored. Lyndhurst DS0000013707.V262381.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 1 X X 1 X X HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 X 10 X 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 1 17 X 18 1 X X X X X X X X STAFFING Standard No Score 27 X 28 1 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X X 1 1 1 1 1 Lyndhurst DS0000013707.V262381.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 OP1 Regulation 4 Requirement Timescale for action 10/01/06 2 OP4 12(1)(a) 3 OP8 14(1)(2) 15(1)(2) 4 OP9 14 The Registered Manager must ensure that the statement of purpose and the service users guide are expanded to include more information about the resident groups catered for and how this home achieves this. This was a requirement of the previous inspection. The Registered Manager must be 17/12/05 able to demonstrate the home’s ability to meet the assessed needs (including specialist needs) of the residents The Registered Manager must 10/01/06 ensure that the recording on care plans is consistent, covers all areas of need and identifies action taken when problems are identified. This was a requirement of the previous inspection. The Registered Manager must 10/01/06 revise the medication policy to include details relevant to the home. This was a requirement of the previous inspection. Lyndhurst DS0000013707.V262381.R01.S.doc Version 5.1 Page 22 5 OP11 15(1) 6 OP16 22 7 OP18 13 (6) 8 OP28 18(1)(a) 9 OP29 19,(Sched ule 2) 10 OP30 18(1)(a) 11 OP31 10 (3) The Registered Manager must ensure that the resident’s wishes with respect to death and dying are recorded. The Registered Manager must revise the complaints procedure to be less prescriptive and to inform complainants that the Surrey CSCI local office can be contacted at any time. This was a requirement of the previous inspection. The Registered Manager must develop a policy for the protection of vulnerable adults for the home based on The Surrey Multi Agency Guidance. This was a requirement of the previous inspection. The Registered Manager must ensure that a strategy for the attainment of NVQ training is developed. The Registered Manager must ensure that all necessary recruitment checks are carried out on staff before commencing employment. This was a requirement of the previous inspection. The Registered Manager must ensure that newly recruited staff receive the mandatory induction and foundation training in line with The Skills for Care programme, in a timely fashion and that this information is recorded in an individual training and development log. The Registered Manager must enrol on a relevant course to obtain a management qualification or recruit a manager. This was a requirement of the previous inspection.
DS0000013707.V262381.R01.S.doc 10/01/05 10/01/06 10/01/06 10/01/06 10/01/06 10/01/06 10/01/06 Lyndhurst Version 5.1 Page 23 12 OP34 25(2)(a)( 3)(a –c) 16(2)(l) Schedule 4 18 (2)(a) 13 OP35 14 OP36 15 OP37 17 16 OP38 23 (4)(a) 17 OP38 13(4)(c) 18 19 OP38 OP38 17(1)(b) 12(1)(a) The Registered Manager must send a copy of the annual accounts for the home as certified by an accountant. The Registered Manager must demonstrate how the finances of those residents without relatives are handled and recorded. The Registered Manager must ensure that staff receive regular formal supervision at least six times a year. This was a requirement of the previous inspection. The Registered Manager must ensure that records and filing systems are orderly and that the office is tidy. The Registered Manager must ensure that the fire appliances identified by the inspection carried out on 07/01/05 are renewed. The Registered Manager must ensure that health and safety of residents is adhered to with respect to the storage of inflammable materials. The Registered Manager must ensure the accident records are stored securely. The Registered Manager must ensure resident’s call bells are in working order. 17/12/05 10/01/06 10/01/06 19/12/05 10/01/06 19/12/05 19/12/05 19/12/05 Lyndhurst DS0000013707.V262381.R01.S.doc Version 5.1 Page 24 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. Refer to Standard OP18 Good Practice Recommendations The policy for the protection of vulnerable adults referred to in the service users guide as the abuse policy needs to be changed. Lyndhurst DS0000013707.V262381.R01.S.doc Version 5.1 Page 25 Commission for Social Care Inspection Surrey Area Office The Wharf Abbey Mill Business Park Eashing Surrey GU7 2QN National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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