CARE HOMES FOR OLDER PEOPLE
Marley Court Nursing & Residential Home Bolton Road Heath Charnock Chorley Lancashire PR7 4AZ Lead Inspector
Mrs Susan Hargreaves Unannounced Inspection 10:10 16th July 2007 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 Marley Court Nursing & Residential Home DS0000025550.V339412.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. Marley Court Nursing & Residential Home DS0000025550.V339412.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Marley Court Nursing & Residential Home Address Bolton Road Heath Charnock Chorley Lancashire PR7 4AZ 01257 226700 01257 234407 marleycourtnh@aol.com 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) Marley Court Nursing Home Limited Mrs Janet Gilchrist Marshall Care Home 49 Category(ies) of Old age, not falling within any other category registration, with number (49) of places Marley Court Nursing & Residential Home DS0000025550.V339412.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. The home is registered for a maximum of 49 service users in the category of OP (Old age, not falling within any other category). The service should employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. Staffing must be provided to meet the dependency needs of the service users at all times and will comply with any guidelines that may be issued through the Commission for Social Care Inspection regarding staffing levels in care homes. 18th September 2006 Date of last inspection Brief Description of the Service: Marley Court is a purpose built home, which is registered to provide both personal and nursing care for older people. The accommodation at Marley Court is offered on two floors, the first floor being accessed by stairs or passenger lift. There are a range of single rooms some with en suite facilities and double or companion rooms, some of which also have en suite facilities. There are two lounge/dining rooms, one on each floor and a range of toilet and bathing facilities throughout, there is also a fully equipped laundry. There is a large patio area at the front, furnished with hardwood garden furniture and set around a central fountain. This area, along with the side gardens is fully accessible to residents, regardless of mobility. As Marley Court is situated on the main A6 road from Chorley to Adlington it is well provided by public transport. The current fees charged at Marley Court are £399.50 to £483.00 per week. Additional charges are payable for hairdressing, newspapers, chiropody and toiletries. A statement of purpose and service user guide was available to prospective residents and their relatives on request. Marley Court Nursing & Residential Home DS0000025550.V339412.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. A key unannounced inspection, which included a visit to the home, was conducted at Marley on the 16th July 2007. No additional visits have been made since the last inspection. Two completed surveys were received from the relatives of residents, one from a GP and one from a social worker. At the time of this inspection 43 residents were living at the home. A tour of the premises took place and staff files and care records were inspected. Members of staff on duty, residents and visitors were spoken to. Discussions also took place with the manager regarding issues raised during the inspection. What the service does well: What has improved since the last inspection?
A statement of purpose has been written and is available on request. Although agency staff is frequently used to cover any shortfall in staffing levels the manager does ensure enough care workers are duty to meet the needs of the residents. Induction training for new care workers meets the ‘Skills for Care’ standards. To ensure staff are familiar with the procedure to follow in the event of a fire regular fire drills are held.
Marley Court Nursing & Residential Home DS0000025550.V339412.R01.S.doc Version 5.2 Page 6 The testing of small electrical appliances has been carried out within the last year. What they could do better:
Urgent action must be taken to improve care planning in order to provide person centred care for all residents. Care plans must clearly identify and address the individual needs of each resident. This includes the safe use of bed rails, short-term memory problems and social needs. Wound care records must contain detailed information about the care and condition of the wound. A falls risk assessment must be carried out for each resident. Care plans must also be reviewed monthly and up dated when the needs of the resident change. It is also important to involve the resident or their relatives in these reviews. It is essential to ensure medication is managed safely. A record of all medication received into the home must be kept. Hand written instructions on the medication administration records should be signed and witnessed. Written instructions should be in place stating when medication prescribed ‘when required’ should be given to individual residents. The amount of medication remaining from a previous prescription should be ‘carried forward’ onto the next medication administration record. Urgent action must be taken to ensure residents are protected from abuse. All members of staff must be given training in safeguarding vulnerable adults. The procedure for safeguarding vulnerable adults must be amended to clearly state the action to take if allegations of abuse are made. It is of concern that a requirement made at the last inspection for the carpet on the stairs and corridors to be cleaned has not been met. Action must be taken to ensure these carpets are thoroughly cleaned or replaced. Failure to address the requirement made at five previous inspections about recruitment practices is of serious concern. Two written references must be obtained before any new employees start working at the home. It is essential for the manager to have support and supervision from the responsible person. This must involve making an unannounced visit to the home every month and writing a brief report for the manager about the standard of care and conduct of the home. A requirement made at the last inspection about this issue has not been addressed. It is important to ensure that all members of staff receive the training necessary in order to promote the health and safety of residents. All members of staff must have training in fire safety. Marley Court Nursing & Residential Home DS0000025550.V339412.R01.S.doc Version 5.2 Page 7 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. Marley Court Nursing & Residential Home DS0000025550.V339412.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 Marley Court Nursing & Residential Home DS0000025550.V339412.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): 1 and 3. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A thorough admissions procedure ensured sufficient information was obtained in order to identify the needs of each resident. EVIDENCE: A statement of purpose and service user guide was available. These provided information about the care and facilities provided at the home. The individual records of four residents were inspected. Each contained a detailed pre-admission assessment. The manager or a senior member of staff visited prospective residents in hospital or their own home prior to admission. These assessments provided important information for the care plans. Prospective residents or their relatives received confirmation in writing that their needs could be met at the home. Standard 6 is not applicable to this service.
Marley Court Nursing & Residential Home DS0000025550.V339412.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Deficiencies in care planning and medication procedures means residents do not always receive person centred care. EVIDENCE: The individual care plans of four residents were inspected. These plans did not identify and address all the care needs of each resident. One resident identified as having short-term memory problems did not have a care plan in place to address this issue. A healthcare problem had been identified for another resident but a care plan was not in place to address this. The care plan for one resident indicated that bed rails had been in use for two weeks before a risk assessment had been carried out. Moreover, the risk assessment identified the need for bed rails but did not identify the risk factors associated with their use. A care plan was not in place for the safe use of bed rails.
Marley Court Nursing & Residential Home DS0000025550.V339412.R01.S.doc Version 5.2 Page 11 A falls risk assessment had not been carried out for one resident. The falls risk assessment for another resident did not clearly identify the risk factors associated with falling. Care plans about social interests and hobbies were generic and did not clearly identify the social needs of individual residents. One of these care plans merely stated ‘maintain social interests and hobbies’. Wound care records for one resident did not include detailed information about the wound, the dressings to be used and the frequency of dressing changes or of the condition of the wound. The manager explained that on the previous day it was decided this wound no longer required a dressing. However, the care plan had not been updated with this important information. Not all risk assessments and care plans were reviewed monthly. There was no evidence to suggest in three of the care records inspected of any recent involvement of the resident or their relatives in care planning. A written report about the care given to individual residents was completed during each shift. Residents were registered with a GP and had access to other healthcare professionals. Medication was stored correctly in a locked trolley and cupboards inside a locked utility room. The temperature of this room was checked and recorded daily. Records relating to the management of medication were in place. However, a record of some of the medication received into the home was not kept. Hand written instructions on one of the medication administration records was not signed or witnessed. Written instructions stating, when medication prescribed ‘when required’ should be given to individual residents was not available. The manager was also advised to write the amount of medication remaining from the previous prescription on the current medication administration record. Controlled drugs were appropriately stored and a stock check was satisfactory. Personal care was carried out in the privacy of the resident’s own room or the bathroom. Two members of staff explained how they promoted privacy and dignity for all residents. One resident said, “The staff are very good.” A visitor said, “The staff are excellent.” Marley Court Nursing & Residential Home DS0000025550.V339412.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Resident’s decisions were respected and they were supported by care workers to have a fulfilling lifestyle. EVIDENCE: On arrival at the home a group of residents were enjoying a game of dominoes in the dining room. A member of staff was responsible for organising leisure activities on three days each week. These included, quizzes, crosswords, sing alongs, dominoes and bowls. One resident said there had been a ‘Body Shop’ party the previous week. Another resident said someone came from St Paul’s Church every fortnight and gave communion. Visitors were welcomed into the home at anytime and offered refreshments. The relative of on resident regularly stayed for tea. Residents were encouraged to make decisions about their lifestyle and daily routine. Two residents said they could choose when to get up and go to bed. One resident said, “You can do as you like within reason.” Residents had personalised their rooms with photographs, ornaments etc.
Marley Court Nursing & Residential Home DS0000025550.V339412.R01.S.doc Version 5.2 Page 13 All the residents asked said the meals were good. A member of staff from the kitchen was observed asking residents to choose what they wanted for lunch. Lunchtime was unhurried allowing residents time to chat and enjoy their meal. Marley Court Nursing & Residential Home DS0000025550.V339412.R01.S.doc Version 5.2 Page 14 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Complaints were taken seriously and investigated. Staff had not been given the training necessary to ensure that residents were protected from abuse. EVIDENCE: A copy of the complaints procedure was included in the resident’s files and displayed in the home. The manager also said the complaints procedure was explained to residents on admission. The previous manager has investigated three complaints made to the Commission since the last inspection. Policies and procedures about the safeguarding of vulnerable adults were in place. However, the procedure needed amending to clearly state the action to be taken if allegations of abuse are made. This issue was discussed with three care workers. Although they said they would report any concerns immediately they had not received any training in safeguarding vulnerable adults. The manager was aware of this problem and has made enquiries about appropriate training. Marley Court Nursing & Residential Home DS0000025550.V339412.R01.S.doc Version 5.2 Page 15 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The premises were well maintained and provided a comfortable and ‘homely’ environment for the residents. EVIDENCE: At the time of the inspection the home was clean, tidy, free from offensive odour and well maintained. However, the carpets on the stairs and corridors were stained and needed cleaning. One relative commented in the survey that her mother’s room was kept clean and tidy. The grounds and gardens were well kept and accessible to all residents. Laundry facilities were appropriate for the size of the home. An infection control policy was in place. Marley Court Nursing & Residential Home DS0000025550.V339412.R01.S.doc Version 5.2 Page 16 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 17,28,29 and 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Members of staff were encouraged to acquire the skills and knowledge necessary in order to meet the needs of the residents. Recruitment procedures did not fully protect residents. EVIDENCE: Examination of the duty rota confirmed that a sufficient number of staff were on duty for all shifts to ensure the needs of the residents were met. The manager was in the process of recruiting care workers and until a full complement of staff was in place agency care workers were employed to meet any shortfalls in staffing levels. One member of staff explained that since the new manager had been appointed staff were not taking as much time off. One resident said she didn’t have to wait very long when she ‘buzzed’ for assistance. It was evident from discussion with members of staff and the manager that training was encouraged. This included induction training for new employees, moving and handling, basic food hygiene, fire safety and first aid. Eight care workers had an NVQ level 2 and three had NVQ level 3. In addition to this a further three members of staff were working towards NVQ level 2 and five towards level 3. Four registered nurses had been enrolled to start NVQ level 4 in health and social care in September.
Marley Court Nursing & Residential Home DS0000025550.V339412.R01.S.doc Version 5.2 Page 17 The files of four members of staff appointed since the last inspection were examined. Three of these files indicated that all the required pre-employment checks to ensure protection of the residents had been completed prior to appointment. However, only one written reference had been obtained for the other employee. This reference was from a neighbour who was also a friend. The manager was advised not to accept references from relatives or close friends. Marley Court Nursing & Residential Home DS0000025550.V339412.R01.S.doc Version 5.2 Page 18 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,37 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a competent manager. The views of residents are considered when decisions about the care and facilities provided at the home are made. EVIDENCE: The manager is an experienced nurse and has an NVQ level 4 in management, the NVQ registered manager’s award and the NVQ assessor’s award. She maintains an up to date knowledge of current practice by using the Internet. Members of staff said the manager was easy to talk to, firm but fair and making improvements in the home. These included obtaining new commodes and new slings for the hoist and dealing promptly with resident’s problems. The home has achieved the nationally accredited Investors in People award. Satisfaction questionnaires were given out to residents and their relatives in
Marley Court Nursing & Residential Home DS0000025550.V339412.R01.S.doc Version 5.2 Page 19 May 2007. A meeting with residents and their relatives was planned for 13 August 2007. An annual development plan to help monitor the quality of the service and further improve outcomes for residents was not available. Records of transactions involving resident’s money were seen to up to date. There is no evidence to suggest that the responsible individual has been making unannounced visits to the home every month in accordance with regulation 26. The responsible individual is required to complete a brief report for the manager about the standard of care at the home. It is also good practice to supply the Commission with a copy of this report. Policies and procedures for safe working practices were available. Fire alarms and emergency lighting were tested regularly. Fire drills also took place regularly. However, the manager was advised to keep a staff attendance record at fire drills to ensure all members of staff received this training. A member of staff who had been working at the home for several months said she had not received training in fire safety. Records of the routine servicing of equipment were seen. These included gas safety and electrical installation certificates and evidence that the testing of small electrical appliances had taken place in September 2006. Records maintained in the kitchen included fridge, freezer and food temperatures. Although these were recorded regularly the manager was advised to ensure they were recorded daily. Marley Court Nursing & Residential Home DS0000025550.V339412.R01.S.doc Version 5.2 Page 20 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 4 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 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 2 X 3 X 2 2 Marley Court Nursing & Residential Home DS0000025550.V339412.R01.S.doc Version 5.2 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 OP7 Standard Regulation 15(1) Requirement Timescale for action 31/08/07 2 OP7 13(4)(c) 3 OP7 15(2)(a) (b)(c)(d) To ensure the care needs of all residents are met. Care plans must accurately identify and address the care needs of each resident. This includes the safe use of bed rails, short-term memory problems, healthcare and social needs. 31/08/07 To promote the safety of residents a risk assessment for the use of bed rails must be carried before they are used. All residents must have a falls risk assessment. These risk assessments must clearly identify the risk factors associated with the use of bed rails and falls. Timescale of 27/10/06 not met. 31/08/07 To ensure staff have the information necessary in order to meet the needs of all residents care plans and risk assessments must be reviewed monthly and up dated when the needs of the resident change. Residents or their relatives must be involved in these reviews. Timescale of 27/10/06 not met.
DS0000025550.V339412.R01.S.doc Version 5.2 Marley Court Nursing & Residential Home Page 22 4 OP8 17(1)(a) Schedule 3(n) 5 OP9 6 OP18 24(1) 13(6) To ensure residents receive effective wound care detailed records must be kept of the wound, the dressings to be used and the frequency of dressing changes and the condition of the wound. Timescale of 6/10/06 not met. To ensure medication is managed safely a record of all medication received into the home must be kept. To ensure all residents are protected from abuse All members of staff must have training in safeguarding vulnerable adults. Timescale of 31/08/06 and 27/10/06 not met The procedure for safeguarding vulnerable adults must be amended to clearly state the action to take if allegations of abuse are made. In order to provide a pleasant and homely environment for the residents the carpet on the stairs and corridors must be cleaned or replaced. Timescale of 27/10/06 not met. 31/08/07 31/08/07 30/11/07 7 OP18 13(6) 31/08/07 8 OP19 23(2)(d) 30/11/07 9 OP29 19(1)(b) Schedule 2 10 OP37 17(2) Schedule 4 (5) In order to safeguard residents 03/08/07 from abuse two written references and a POVA/CRB check must be obtained before new employees start working at the home. Timescale of 31/3/05, 30/12/05, 02/03/06, 13/07/06 and 18/09/06. To ensure the manager receives 31/08/07 proper support and supervision the registered person must make an unannounced visit to the home every month and provide a report for the manager under
DS0000025550.V339412.R01.S.doc Version 5.2 Page 23 Marley Court Nursing & Residential Home regulation 26. A copy of this report should be supplied to the commission. Timescale of 27/10/06 not met. 11 OP38 23(4)(d) To ensure all members of staff understand how to promote the health and safety of residents training in fire safety must be provided. 30/11/07 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 OP9 2 OP9 3 OP9 4 5 OP38 OP33 Refer to Standard Good Practice Recommendations Hand written instructions on the medication administration records should be signed and witnessed. Written instructions should be in place for individual residents stating when medication prescribed when required should be given. The amount of medication remaining from a previous prescription should be ‘carried forward’ onto the next medication administration record. An annual development plan to help monitor the quality of the service and further improve outcomes for residents should be developed. To ensure all members of staff regularly attend fire drills an attendance record should be kept. Marley Court Nursing & Residential Home DS0000025550.V339412.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Lancashire Area Office Unit 1 Tustin Court Portway Preston PR2 2YQ 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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