CARE HOMES FOR OLDER PEOPLE
Park View (Ilfracombe) Furze Hill Road Ilfracombe Devon EX34 8HQ Lead Inspector
Jo Walsh Key Unannounced Inspection 09:00 6 and 11th July 2006
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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 Park View (Ilfracombe) DS0000022148.V294578.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. Park View (Ilfracombe) DS0000022148.V294578.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Park View (Ilfracombe) Address Furze Hill Road Ilfracombe Devon EX34 8HQ 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) 01271 865657 Mr Andrew S Crowe Mrs Maria Crowe, Mr Geoffrey Crowe Shirley Ann Darling Care Home 22 Category(ies) of Dementia - over 65 years of age (22), Old age, registration, with number not falling within any other category (22) of places Park View (Ilfracombe) DS0000022148.V294578.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. The manager must obtain the Registered Manager’s Award by 2006 The Manager must undertake NVQ 4 in care Date of last inspection 18th October 2005 Brief Description of the Service: Park View is a care home providing personal care and accommodation for 22 service users in the categories of old age (OP) and dementia, over 65 years of age (DE [E]). The home is situated in a residential area of Ilfracombe, adjacent to, and with direct access to, Bicclescombe Park. The Crowe family have run the care home over 20 years and it consists of a two storey building with a large car park situated at the rear of the property. All the private rooms are single and have en-suite facilities. There is a stair lift giving access to all areas of the home. The home has a conservatory, which is sited overlooking the garden at the side of the property and a sun lounge sited to the front of the property. The home has a designated resident smoking area in the reception area at the main front entrance of the building. The range of fee is £274 to £383 per week. The CSCI report is kept in the manager’s office and she will put up a notice in the front lobby to inform people that they are welcome to look at inspection reports if requested. Park View (Ilfracombe) DS0000022148.V294578.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection took place over one day and feedback to the registered manager was given four days later. The inspection took 9 hours and during this time 8 residents were spoken to at length as well as all the staff on duty that day. Time was also spent doing a tour of the building and reviewing some of the home’s key documents. Care plans were looked at in some detail as there have been outstanding requirements relating to these. Residents, relatives and visiting health care professionals were sent surveys prior to the inspection, and feed back was given to the registered manager in respect of these. The home also completed a pre inspection questionnaire, which helped to inform the inspection process. What the service does well: What has improved since the last inspection?
Care plans have been revamped and included more detail in respect of individuals needs and preferred routines. Some of the en suite bathrooms have been refurbished and modernised. Staff have received training in care planning and the protection of vulnerable adults. This will assist them to maintain clear plans of care for each individual and to understand forms of abuse and what they should do if abuse is suspected. Staff have also had training in care of people with dementia, which has helped them to better understand the care needs of the resident group.
Park View (Ilfracombe) DS0000022148.V294578.R01.S.doc Version 5.2 Page 6 What they could do better:
Care plans need to be agreed with individuals and contain risk assessments. This will ensure that residents or their representatives are involved in deciding how the home should provide care and support for an individual. Risk assessments will help to keep residents safe. The home needs to ensure that all residents have a copy of the home’s contract/ statement of terms and conditions, so they know their rights and responsibilities. The home offers limited activities for residents and this needs to be addressed. The home should consult with the residents to see what sorts of activities would meet their needs and preferences. The home needs to reinstate the menu board and ensure that residents are consulted in menu planning. The sun lounge door needs to be fixed as a matter of urgency, as this has been identified as a more suitable fire exit to the side door currently used as the fire exit. In the interim the side fire door exit must remain clear of any obstacles. As this posed a risk to residents and staff an immediate requirement was left and this was followed up during the feedback session to the manager 4 days later. The fire exit is now clear and safe to use. The home needs to consider moving the designated smoking area from the communal entrance hall to a room where the smell does not affect other areas. One comment card form a relative stated that the home smells of cigarette smoke, which is unpleasant, and a health risk to those who don’t smoke. Some furniture in communal areas old and worn and some of the bedrooms are in need of refurbishment in order to make the home a comfortable and homely place to live. Soap dispenser and paper towels should be provided in the staff toilet as this would help prevent the risk of cross infection. Records for service users’ monies need to be more robust to fully protect and safeguard individuals. The home needs to ensure that as part of their quality assurance programme, any results of surveys are collated and results given to residents, their representatives as well as CSCI. Park View (Ilfracombe) DS0000022148.V294578.R01.S.doc Version 5.2 Page 7 The home needs to ensure risk assessments are in place for all individuals in relation to hot water and hot surfaces, where significant risks are identified solutions must be found to minimise risks. The home has regulators fitted on all baths but not all hot taps. Radiators in the bedrooms are all covered but not in communal areas. The home must ensure that all fire checks in the fire logbook are kept up to date. This evidences that the home are taking measures to check fire safety equipment and therefore keep residents safe. 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. Park View (Ilfracombe) DS0000022148.V294578.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 Park View (Ilfracombe) DS0000022148.V294578.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2,3 “Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service.” Residents’ needs are assessed prior to them moving in, to ensure that these needs can be met. The home needs to ensure that all residents have a copy of the home’s contract/statement of terms and conditions, so they know their rights and responsibilities. EVIDENCE: Information was viewed for the two newest residents. One person had moved from another home and the manager had been to visit them prior to them moving and detailed all the individual’s basic care needs. The second person had recently moved from another area, so staff were unable to visit prior to them moving to Parkview. The manager had got some of the information from the existing home and was due to speak with the person and their family on the day of the inspection to go through the
Park View (Ilfracombe) DS0000022148.V294578.R01.S.doc Version 5.2 Page 10 assessment details and work out a plan of care. The manager gave assurances that this would be in place within the next day or so. The residents’ files did not contain details or evidence of the home’s contract or statement of terms and conditions. The manager stated that they do not routinely give local authority funded residents terms and conditions. Park View (Ilfracombe) DS0000022148.V294578.R01.S.doc Version 5.2 Page 11 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 & 10 “Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service.” Individuals’ health and personal care are met, although plans of care need to include more detail to ensure it is provided in a consistent and safe way. Residents are protected by a robust medication procedure. Respect, dignity and privacy are upheld. EVIDENCE: The home has had a number of outstanding requirements relating to their care plans for some time now. The manager has worked hard to try and meet these requirements. She and the staff team have had some external training on care planning and the plans have now been updated. The format is easier to read and includes information about what are the individuals preferred routines. A total of four care plans were looked at in some detail. Whilst the plans set out how staff are to assist individual with their personal and health care needs, they still need to ensure that risks are identified and actions put in place to
Park View (Ilfracombe) DS0000022148.V294578.R01.S.doc Version 5.2 Page 12 minimise risks. One plan looked at identified in the care notes that this individual had a very poor appetite. There was no risk assessment or action plan about how staff would ensure that this individual was encouraged or monitored to ensure they were eating and drinking enough. Staff spoken to knew the difficulties and could say what they did to encourage this individual, but in order to have a consistent approach, this needs to be detailed as part of their care plan. More detail is also needed where individuals are incontinent. Plans state whether pads are used and if assistance is needed. Information should also include how often staff should check on the individual and whether they should be encouraged to use the toilet at regular intervals. None of the plans have yet been agreed with the individual or their representative. The manager stated that she has discussed plans with individuals to ensure she has got a good social history and their likes and dislikes, but that she has not formally documented that plans have been agreed with the individual. Plans and daily records detail health care needs, appointments and visits from district nurses and GPs. One resident did raise the fact that they thought that the home should provide transport to health care appointments. When this was discussed with the manager she clarified that where possible they do provide transport, but on one occasion they were unable to so provided a taxi, which the home paid for. Residents spoken to felt that their personal and health care needs were met and also confirmed that staff treated them respectfully. Surveys from residents also confirmed this view. Staff were observed throughout the day providing care in a kind and respectful manner. One resident was quite distressed and staff made time to sit and talk to them and encourage them to try and eat something. The medication system was viewed and lunchtime medications were observed being given out. The home has appropriate facilities for the safe storage of medications and records were seen to be well maintained. The manager confirmed that only staff that have received medication training from the pharmacist were able to administer the medications. Park View (Ilfracombe) DS0000022148.V294578.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 “Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service.” The home provides limited activities and this does not ensure they are meeting individuals social and recreational needs. The home provides a good balanced diet. EVIDENCE: Residents spoken to and surveys returned indicated that there were very few organised activities on offer for residents. The only regular activity was a prayer service once a week. Other activities such as games were done on a more adhoc basis. The home was unable to demonstrate that they had consulted with residents to find out what activities they would like. This could be something they pursue as part of their quality assurance programme. Residents spoken to confirmed they are able to have visitors when they wished, had access to a phone and could choose where to see any visitors. One visiting friend of a resident confirmed that they were always made welcome and could pop in whenever they wished. Residents confirmed they are able to choose where they spend their days and got up and went to bed when they chose. Staff were able to give examples of
Park View (Ilfracombe) DS0000022148.V294578.R01.S.doc Version 5.2 Page 14 how they enable individuals to make decisions and choices, in what they wear encouraging independence in personal care. The lunchtime meal was sampled with residents. The offers a three course lunch, which was served in a relaxed atmosphere. Residents are given a choice for the evening meal a three or four options. Some residents stated that the menu was repetitive. This was fed back to the manager who said that they do try to vary the menu and take into consideration individual likes and dislikes, but when any changes are made residents complain that they want the same things they always have. It was suggested that the home do a formal survey to residents to ask what they would like to see included in the menu choices. The home should also reinstate the menu board so residents are aware of what the daily meals on offer are. Park View (Ilfracombe) DS0000022148.V294578.R01.S.doc Version 5.2 Page 15 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): “Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service.” Arrangements for protecting residents from abuse are satisfactory. Most residents feel that their concerns will be listened to and acted upon. EVIDENCE: Most residents spoken to were aware whom they could talk to if they had any concerns or complaints. One resident did say they had raised a concern but did not get a satisfactory response. This issue was discussed with the manager who gave assurances that the issue raised had been dealt with and the individual had been spoken to. It was suggested for future reference that any actions taken should be recorded. This should include who gave feed back to the individual concerned and whether they were happy with the outcome. Most staff have now completed a POVA training session and those spoken to were aware of what they should do if they suspected any form of abuse. Park View (Ilfracombe) DS0000022148.V294578.R01.S.doc Version 5.2 Page 16 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,26 “Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service.” Improvements are needed to ensure the home is safe and well maintained. EVIDENCE: The registered providers are slowly updating the rooms and furnishings to improve the environment for residents. Several areas of concern were noted during this inspection. The sliding door out of the sunroom was very difficult to open and the handle needs replacing. This is supposed to be the fire exit so needs to be easy to open in emergency. There is another exit door off the sun lounge, which is also indicated as a fire exit, but the pathway to get to this door was obstructed by furniture. An immediate requirement was left to ensure that all fire exits were made clear, safe and easy to use. When the inspector returned to give feedback the fire exits had been made clear, but the sliding door had not yet been fixed. Park View (Ilfracombe) DS0000022148.V294578.R01.S.doc Version 5.2 Page 17 Some of the furniture in the communal lounge is grubby around the armrests and needs to be cleaned or replaced. The home’s smoking area for residents in currently in the main entrance hall, which means that people entering the building have to pass through this area. It was also noted that smoke had wafted up to the upstairs corridors near to people’s bedrooms. The home needs to consider relocating the smoking area so the smell is more contained. The home does have a small lounge area at one end of the building, which could be used for a smoking room. All bedrooms have en suite facilities but the home does not currently have a communal assisted bathroom. The manager stated that they have been given a parker bath and need to look at where they can best situate it. They are considering using the current manager’s office for a communal bathroom. This would enable residents who need support to get in and out of the bath to do so more safely. The home currently uses portable battery operated bath chairs in individuals’ bathrooms. This is not ideal if the individual needs two carers for support to get in and out of the bath safely. The sun lounge is in need of redecoration as are some of the residents’ bedrooms. The staff toilet needs to have a soap dispenser and paper towel to help prevent the risk of cross infection. Apart form the smell of the cigarette smoke in the entrance hall, the home smelled fresh and was cleaned to a reasonable standard. It was noted that some of the side tables in the main lounge needed cleaning, but this may have been due to spills from the morning drinks. Park View (Ilfracombe) DS0000022148.V294578.R01.S.doc Version 5.2 Page 18 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30. “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 robust recruitment procedure, which ensures that residents are protected from risk. The number and skill mix of the staff meets resident needs. EVIDENCE: The staff rota evidences that there are sufficient staff on duty per shift to meet the needs of the current resident group. Staff spoken to confirmed that they are able to meet all individuals needs with the level of staffing and all staff working on the day of the inspection was spoken to. Staff confirmed that they are given training in key areas such as moving and handling, first aid, fire training and food hygiene. Most have or are completing NVQ 2 training and more recently have undertaken training in care planning and a dementia awareness training session. Not all staff had training in infection control. The staff files of the two newest members of staff were viewed. Both had two references, CRB checks and copies of the individuals’ proof of identification. Park View (Ilfracombe) DS0000022148.V294578.R01.S.doc Version 5.2 Page 19 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): 31,33,35,38 “Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service.” The manager is experienced but not yet qualified to run the home. Records for service users’ monies need to be more robust to fully protect and safeguard individuals. Further improvements are needed to ensure that the safety and welfare of service users and residents are protected. EVIDENCE: The manager has almost completed her registered manager’s award and has in addition to this and on the advice of from the previous inspection also undertaken training in care planning and will now extend this to include risk assessments.
Park View (Ilfracombe) DS0000022148.V294578.R01.S.doc Version 5.2 Page 20 Staff and residents spoken to stated that the manager is helpful and approachable. Although the home gets residents to complete questionnaire every four months or so, the results of these are not collated and it was suggested that the home focuses on getting residents opinions on some very specific issues such as the activities they would like and menu planning. It was also agreed that part of the homes quality assurance should include an audit of the environment, checking individuals’ rooms and communal areas on a regular basis. The home currently only handles one individual’s finances. The records and amounts held were viewed and found to be inaccurate by four pounds. The home needs to ensure that a robust system of recording is put into place to ensure residents are safeguarded. Most staff has received training in core skills, but this needs to also include infection control. The home has covered all radiators in individuals’ bedrooms but not in communal areas. They must ensure that risk assessments are in place for all individuals in relation to hot surfaces and hot water. Where significant risks are identified, solutions to minimise these risks must be put in place. It was noted that not all weekly checks in the fire logbook had been completed. The home must ensure this record is kept up to date to evidence that they are ensuring residents are kept safe. Park View (Ilfracombe) DS0000022148.V294578.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X 2 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 2 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 2 X X 2 Park View (Ilfracombe) DS0000022148.V294578.R01.S.doc Version 5.2 Page 22 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 OP7 Regulation 15 Requirement Care plans must include risk assessments and be developed and reviewed with the resident and/or their representative. The home must ensure they record all outcomes of any complaints raised, including what feedback was given to the person raising the complaint. The home must ensure that all fire exits are clear and easy to access in an emergency. The home must ensure that the staff toilet has soap dispenser and paper towels. The home must ensure that there is a robust system for recording the handling of residents’ finances. The home must ensure that risk assessments are in place for hot water/surfaces and where significant risks are identified solutions found to minimise these risks. Timescale for action 30/10/06 2. OP16 22 30/08/06 3. 4. 5. OP19 OP26 OP35 23 13 17 30/07/06 30/10/06 30/08/06 6. OP38 13 30/12/06 Park View (Ilfracombe) DS0000022148.V294578.R01.S.doc Version 5.2 Page 23 7. OP38 13 The home must ensure that the fire logbook is kept up to date and all checks are recorded. 30/08/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. Refer to Standard OP2 OP12 OP15 OP19 Good Practice Recommendations The home should ensure that all residents receive a contract or statement of terms and conditions. The home should ensure that they provide regular activities that are suitable to the needs and preferences of the residents. The home should reinstate the menu board and consult with residents in menu planning The home should look at relocating the smoking area from the entrance hall to a room where the smell can be contained and where those residents who do not smoke to not have to effected by it. The home should replace some of the old worn furniture in the communal areas and refurbish the sun lounge area. The manager should ensure she completes her RMA. The home should ensure that the results of any surveys completed are collated and results made available to residents and CSCI. The results should be used to improve the quality of care and support provided. The home should ensure staff receive training in infection control. 5. 6. 7. OP19 OP31 OP33 8. OP38 Park View (Ilfracombe) DS0000022148.V294578.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Exeter Suites 1 & 7 Renslade House Bonhay Road Exeter EX4 3AY National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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