CARE HOMES FOR OLDER PEOPLE
LYNGATE 236 Wigan Road Bolton Lancs BL3 5QE Lead Inspector
Sue Evans Unannounced 23rd May 2005 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 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. LYNGATE F56 F06 S59303 Lyngate V215521 230505 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Lyngate Address 236 Wigan Road Bolton BL3 5QE Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01204 62150 Lyngate Health Care Limited Mrs Ann Marie Else CRH PC Care Home Only 41 Category(ies) of OP Old age registration, with number of places LYNGATE F56 F06 S59303 Lyngate V215521 230505 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: The Home is registered for a maximum of 41 service-users to include: Up to 41 service-users in the category of OP (Older People) The service should employ a suitably qualified and experienced Manager who is registered with the Commission for Social Care Inspection. Date of last inspection 14th December 2004 Brief Description of the Service: Lyngate is a privately owned care home providing care and accommodation for up to 41 older people. The home is situated in a residential area of Bolton approximately 1 mile from the town centre. There are bus routes, shops, a bank, and other community facilities close by. The home is on three floors and it has 29 single bedrooms and 6 doubles. Twenty four of the rooms are en-suite. There are four lounge/dining rooms and an activities lounge. Three of the lounges have kitchenettes where residents and visitors can make drinks. There is a garden at the front of the home and a car park at the back. The home is fitted with suitable adaptations and equipment such as a passenger lift, assisted baths and showers, portable hoists, and grab rails. In addition to care staff, the home employs an activities co-ordinator, cooks, kitchen assistants, domestic staff, and a maintenance worker. LYNGATE F56 F06 S59303 Lyngate V215521 230505 Stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out by 2 inspectors over 1 day for a period of 6½ hours each. More than half of this time was spent watching what went on in the home, talking at length to 7 residents and more briefly with others, talking to a visiting District Nurse, and interviewing 4 staff members. The inspectors also looked round most of the building, examined some key records, and interviewed the manager and owner. One inspector ate lunch with the residents. What the service does well: What has improved since the last inspection?
In order to keep up the home’s good environmental standards, the owner has made some improvements to one of the bathrooms and two of the toilets. Staff members have started a 12 week training course on infection control to increase their understanding of how to promote good hygiene and control the spread of infection. New staff members are now completing more thorough induction training to help them to understand their responsibilities in providing appropriate care for residents.
LYNGATE F56 F06 S59303 Lyngate V215521 230505 Stage 4.doc Version 1.30 Page 6 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.
LYNGATE F56 F06 S59303 Lyngate V215521 230505 Stage 4.doc Version 1.30 Page 7 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 Standards Statutory Requirements Identified During the Inspection LYNGATE F56 F06 S59303 Lyngate V215521 230505 Stage 4.doc Version 1.30 Page 8 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 standard(s) 1 The Statement of Purpose and Service Users’ Guide contained useful information about the home. However, some additions are needed to the Service Users’ Guide so that prospective residents have enough information to help them decide whether they would like to live in the home. EVIDENCE: The home had a Statement of Purpose and Service Users’ Guide that contained useful information about the home including its aims and objectives and the facilities it provided. Since the last inspection, the owner had amended the Statement of Purpose and it now contained the necessary information. However, the Service Users’ Guide still needed a few additions in order to provide prospective residents with full information about what to expect from the home. LYNGATE F56 F06 S59303 Lyngate V215521 230505 Stage 4.doc Version 1.30 Page 9 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 standard(s) 7, 8 and 10 Care plans were poor and did not accurately reflect the needs of the residents. Health care needs were not being fully met, placing residents at risk. Discreet care practices in the home mean that most residents feel that they are treated with respect and that their privacy is upheld. EVIDENCE: Four residents were asked about the things staff supported them with. Staff members were also asked to describe the needs of those residents. However, the care plans and risk assessments for those residents had not been reviewed for several months and none of them accurately described the resident’s current needs. They lacked crucial information, for example that one resident had a penicillin allergy, and that another was prone to grazing his knees because of crawling along the floor. Emotional needs were not addressed. For example, a person was described as “depressed” but there was no guidance to show how staff should respond to the person. A lot of the information recorded, for example moving and handling guidance, was vague. An instruction to “give assistance” does not give clear enough information. One resident was being cared for totally in bed, and given pureed food yet her care plan described her as being able to get around with the aid of a zimmer, and
LYNGATE F56 F06 S59303 Lyngate V215521 230505 Stage 4.doc Version 1.30 Page 10 eat a normal diet. The care plan did not include details of her current medical needs. Residents’ records need re-organising so that up to date, accurate information about residents’ needs can be easily found. Care plans and risk assessments need to be reviewed every month (with the involvement of the resident or their representative where possible) and updated if necessary. They must reflect current needs, and provide staff members with clear guidance on how needs will be met. Residents’ health care needs were not being satisfactorily met. Weights had not been recorded since December 2004. The resident who was cared for in bed was “turned” regularly to ease pressure and try to make her comfortable. However, staff members gave differing information about how often this should be done. Turning charts and food and drink charts for this resident were not fully completed. Some recordings had been made on scraps of paper. It was therefore not possible to monitor whether this person’s health and nutritional needs were being met. Staff members demonstrated an understanding of pressure sore prevention and knew what signs to look for. They said they would report any concerns to a senior staff member. However, the District Nurse gave an example of an instance where a resident had not been referred to them quickly enough. An accident that the inspectors were told about was not recorded in the accident book. There was no evidence to show that accident recordings were analysed by the home and used to help complete risk assessments. Some accidents had been recorded in an “incident book”. The home was asked to record all accidents in the accident book. There were mixed views about the standard of care in the home. For example, one resident said, “Staff are great. They look after me very well”. Another person said, “Staff who have been here a long time are good but some don’t know what they’re doing”. Staff members gave examples of how privacy and dignity were promoted in the home, for instance when helping residents with personal care. Residents said that staff members were polite and usually knocked on their bedroom doors before entering. During the inspection, staff members spoke with residents in a pleasant way. Staff members understood about confidentiality procedures. They said they did not talk about one resident in front of another, or discuss residents’ business outside the home. LYNGATE F56 F06 S59303 Lyngate V215521 230505 Stage 4.doc Version 1.30 Page 11 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 standard(s) 12 and 15 Residents have choice about their daily routines, spending their time doing whatever they prefer. The activities co-ordinator offers individual and group activities to add some interest and variety to residents’ lives. Although residents were satisfied with the food, there was no choice of dishes, and pureed food was prepared in an unappealing way. EVIDENCE: The inspection commenced at 9.30 a.m. At that time, some of the 33 residents were still in bed having a lie in. Staff members and residents said that people could choose what time they got up. The residents who were spoken with said that they did as they chose throughout the day and that they could choose whether to stay in their rooms or use one of the lounges. The home had an activities co-ordinator who had talked with residents to find out about their interests. She offered both individual and group activities, and kept records to show what people had been doing. Residents talked about some of the activities provided. These included dominoes and quizzes. During the inspection, a birthday party was held. Some residents followed their own individual interests such as reading, crosswords, and watching television. The residents who were spoken with said that they were reasonably satisfied with the activities provided.
LYNGATE F56 F06 S59303 Lyngate V215521 230505 Stage 4.doc Version 1.30 Page 12 The menu for the current week was looked at. It did not offer residents a choice of dishes. The manager said that fish, or a cheese or steak pie, was usually available for anyone who did not want what was on the planned lunchtime menu. She said that the cook asked residents in the mornings what they would like for lunch. An alternative dish was provided on the day of the inspection but residents said that they did not usually get a choice. Records indicated that no meal choices had been offered since December 2004. The residents who were spoken with said that they were reasonably satisfied with the meals even though there was no choice. One inspector ate lunch with the residents in one of the ground floor dining rooms. The meal was satisfactory. However, two residents complained about the length of time they had been sitting at the table waiting for their meal. Only one staff member was assigned to serving lunches, and helping residents, who dined on the other two floors. She alternated between the two. This resulted in a fairly long time span between residents finishing their main course and being served a sweet. Residents said that this was usual. Staff members assisted residents in a sensitive way. However, at least 5 people needed assistance with their meals. Current staffing levels meant that some people had to wait until others had finished, before being given their meal. At the time of the last inspection a requirement was made in respect of pureed meals. The home had been asked to puree each element of the meal separately to preserve its flavour and appearance. This had not been addressed. LYNGATE F56 F06 S59303 Lyngate V215521 230505 Stage 4.doc Version 1.30 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 standard(s) 16 The home has a written complaints procedure but not all residents feel that their concerns would be properly dealt with. EVIDENCE: Residents said that they would speak to the manager or a staff member if they were unhappy about anything. However, three of the residents did not particularly feel confident that it would be worthwhile complaining. One said, “There’s no point complaining because nothing will be done”. At the time of the last inspection, the home was asked to make some amendments to its complaints procedure to make it clear that complainants had the right to complain directly to the CSCI if they wished. These changes had not been made. The complaints book showed that the home had received one complaint since the last inspection. Records showed that the complaint had been looked into and that it had been upheld. However, there was no record to show that the complainant had been advised of the outcome. The home was advised to record even small things in the book and to write to the complainant about the outcome of the investigation and the action being taken. This would contribute towards reviewing and improving the service, and help to assure residents and relatives that their concerns were being listened to and acted upon. LYNGATE F56 F06 S59303 Lyngate V215521 230505 Stage 4.doc Version 1.30 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 standard(s) 19, 20, 21, 22, 23, 24 and 26 Residents were satisfied with their environment. The ongoing redecoration and refurbishment of the home, the employment of maintenance and domestic staff, and the attention given to health and safety, have resulted in a safe, clean, comfortable, well-maintained environment for residents. EVIDENCE: A partial tour of the building was undertaken. Areas looked at were the lounge/dining rooms, the activities room, some bathrooms and toilets, and some bedrooms. The home is on three floors and it has 29 single bedrooms and 6 doubles. Twenty four of the bedrooms are en-suite. The home was comfortable and well maintained. The home employs a maintenance worker, and there is an ongoing programme of redecoration and refurbishment to ensure that satisfactory standards are maintained.
LYNGATE F56 F06 S59303 Lyngate V215521 230505 Stage 4.doc Version 1.30 Page 15 The home has four lounge/dining rooms, and an activities room, giving residents some choice about where they spend their time. Three of the lounges have kitchenettes where residents and visitors can make drinks. Outside there is a garden at the front, and a car park at the back. The bedrooms that were looked at were well maintained, decorated and furnished. Residents had brought in some of their own possessions to make their rooms more homely. Residents were pleased with their rooms, and with the general environment. The home was fitted with adaptations and equipment suited to the needs of the residents. These included grab rails, portable hoists, passenger lift, assisted baths and showers, and an assistance call system. The home was warm and clean, and odour free. During the last inspection, some work was required to improve a bathroom and two toilets. The home had dealt with these requirements. LYNGATE F56 F06 S59303 Lyngate V215521 230505 Stage 4.doc Version 1.30 Page 16 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 29 and 30 The numbers of care staff on duty at key times of the day, such as meal times are insufficient to meet the needs of the residents. Failure to carry out all the required pre-employment checks on staff puts residents at risk. Although staff members are provided with some training to equip them with the knowledge and skills that they need to meet the needs of the residents, there are some gaps that need to be addressed. EVIDENCE: The rota showed that, in addition to care staff, the home employed domestic, catering, and maintenance staff. There was also an activities co-ordinator. From Monday to Friday during the daytime there was usually a deputy manager and 4 care assistants on duty. At weekends, there were 5 care assistants. Some care staff and residents were of the opinion that staffing numbers were not enough during the week to provide a satisfactory service. One staff member said, “It’s very difficult to cope with 4 staff on”. Another said it was better at weekends with 5 care staff on duty. A resident said that she was supposed to have help from 2 staff members to help her to move from one place to another but that sometimes one staff member had to manage. The District Nurse also felt there were not enough care staff. She said that staff were “pulled to the limit.”
LYNGATE F56 F06 S59303 Lyngate V215521 230505 Stage 4.doc Version 1.30 Page 17 Residents said that it often took a long time for staff members to answer the call alarm. When the assistance call button in one bedroom was tested by the inspector, it was 15 minutes before a member of staff came to investigate. Other evidence that led inspectors to conclude that staffing levels were insufficient to meet the needs of the current group of residents included the poor standard of record keeping, for example incomplete turning charts and food and drink charts, inadequate mealtime support and supervision, weight checking not regularly done, and care plans and risk assessments not regularly reviewed. The layout of the building, on three floors, adds to the problem. For example, on arrival at the home, and entering the building on the lower ground floor, inspectors saw a partly clothed resident walking along the corridor. They alerted the manager who said that a staff member was actually working on that floor but she was assisting another resident at that time. The owner must keep staffing levels under constant review, to ensure that they are adequate, taking into account the changing numbers and needs of the residents, and the layout of the building. The file for a recently recruited staff member showed that some preemployment checks had been done, for example obtaining 2 written references, a medical declaration, and a photograph. However, the staff member had been allowed to commence employment without a CRB (Criminal Records Bureau) disclosure and POVA (Protection of Vulnerable Adults) register check. This potentially puts residents at risk. The home was required to take immediate action to address this. The home was using induction booklets for new recruits. The manager was asked to include the date that each induction topic was completed. Staff members gave examples of some of the training that they had undertaken. These included NVQ level 2, moving and handling, medication, and adult protection. Since that last inspection, staff members have begun a 12 week course on infection control. Training records were not looked at this time but there are outstanding requirements in respect of first aid and fire awareness training that need to be addressed. The home must also ensure that night staff, who prepare suppers, have received basic food hygiene training. Staff training will be looked at again during the next inspection. LYNGATE F56 F06 S59303 Lyngate V215521 230505 Stage 4.doc Version 1.30 Page 18 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33 The home has introduced some methods to check out the quality of the service, including asking residents for their views. The home needs to expand on this, and to report on the outcomes so that people will know that their views are being noted and acted upon. EVIDENCE: The owner had almost completed a detailed quality audit on the home. Residents said that the activities co-ordinator had asked them to give their opinions on the home. Staff members said that they could give their opinions during staff meetings or individual support meetings with their supervisor. The home needs to extend its review to include anonymous questionnaires. As well as asking for comments from residents, relatives, and staff members, the home also needs to ask other regular visitors, such as District Nurses, for their views. The outcomes need to be summarised into a report, a copy of which
LYNGATE F56 F06 S59303 Lyngate V215521 230505 Stage 4.doc Version 1.30 Page 19 should be supplied to the CSCI. A copy should also be available to residents, and others, so that they know that their comments are being listened to and acted upon. LYNGATE F56 F06 S59303 Lyngate V215521 230505 Stage 4.doc Version 1.30 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 2 x x x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 x 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 x 15 2
COMPLAINTS AND PROTECTION 3 3 3 3 3 3 x 3 STAFFING Standard No Score 27 2 28 x 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 2 x x x x 2 x x x x x LYNGATE F56 F06 S59303 Lyngate V215521 230505 Stage 4.doc Version 1.30 Page 21 YES 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 1 Regulation 5 Requirement The Service Users Guide needs some minor additions. (Timescale of 31 January 2005 not met) Care plans and risk assessments must be updated and written in a way that clearly reflects the current support needs of each resident. Care plans must be reviewed at least monthly (with the involvement of the resident or their representative where possible) and updated if necessary. (Timescale of 28 February 2005 not met) Residents weights must be checked and recorded at least monthly. Turning charts and fluid charts must be fully completed. All accidents must be recorded in the accident book. Accident records need to be regularly analysed to assist in risk assessing. Elements of pureed meals need to be processed separately to preserve their flavour and appearance. (Timescale of December 2004 Timescale for action 1 August 2005 1 August 2005 2. 7 15 3. 4. 5. 8 8 8 12(1) 12(1) 17 17 30 June 2005 Immediate 30 June 2005 6. 15 16(2)(i) 30 June 2005 LYNGATE F56 F06 S59303 Lyngate V215521 230505 Stage 4.doc Version 1.30 Page 22 not met) 7. 8. 15 16 12(2)(3) 16(2)(i) 22 Menus must include a choice of dishes each day. The complants procedure needs amending in order to make it clear that complainants have the right to complain directly to the CSCI at any stage. Copies of the revised procedure need to be included with the Statement of Purpose and Service Users Guide. (Timescale of 28 February 2005 not met) The registered person needs to make sure that residents, and others, who raise concerns are informed of the outcome of the investigation. The registered person needs to ensure that sufficient care staff members are on duty at key times. Staff rotas must be available in the home. Criminal records checks must be completed in respect of new staff members before they commence employment. The registered person must provide the CSCI with written information, by the date shown in the end column, of the steps taken to arrange the required training in fire awareness and first aid Night staff need to undertake basic food hygiene training. 30 June 2005 1 August 2005 9. 16 22 30 June 2005 10. 27 18(1)(a) 31 August 2005 23 May 2005 23 May 2005 31 July 2005 11. 12. 27 29 17 19 13. 30 18(1)(c) 23(4)(d) 14. 15. 16. 30 30 33 18(1)(c) 18(1)(c) 21, 24 Staff induction records need to include the dates each topic was completed. The home needs to continue with 1 August its quality monitoring exercise 2005 and to produce a written report on the outcome. The report must show how the information
Version 1.30 1 September 2005 31 July 2005 LYNGATE F56 F06 S59303 Lyngate V215521 230505 Stage 4.doc Page 23 gathered will be used to improve the service. The report must be available to residents and to the CSCI. (Timescale of 31 March 2005 not met) 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 Good Practice Recommendations LYNGATE F56 F06 S59303 Lyngate V215521 230505 Stage 4.doc Version 1.30 Page 24 Commission for Social Care Inspection Turton Suite Paragon Business Park Chorley New Road Horwich, Bolton, BL6 6HG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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