CARE HOMES FOR OLDER PEOPLE
Potton House Nursing Home Potton Road Biggleswade Bedfordshire SG18 OEL Lead Inspector
Mrs Louise Trainor Unannounced Inspection 19th April 2007 09:30 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 Potton House Nursing Home DS0000017688.V334041.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. Potton House Nursing Home DS0000017688.V334041.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Potton House Nursing Home Address Potton Road Biggleswade Bedfordshire SG18 OEL 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) 01767 314782 01767 314862 Health & Care Services (NW) Limited Patricia Sandra Pearson Care Home 24 Category(ies) of Dementia - over 65 years of age (24), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (24) Potton House Nursing Home DS0000017688.V334041.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. The home can accommodate a maximum of 24 service users. The home can continue to accommodate the identified service user who is aged under 65 years. The home cannot admit any other service users aged under 65 years. Date of last inspection 11th May 2006 Brief Description of the Service: Potton House is a purpose built care home with nursing situated in the grounds of Biggleswade Hospital on the outskirts of Biggleswade, a rural village, in mid Bedfordshire. Biggleswade has good road access and there is a limited bus service with the nearest train station in Sandy. Potton House provides places for up to twenty-four older adults with mental health care needs. The home is single story with accommodation separated into three wings. Each wing has eight bedrooms and its own living areas. There is also some additional communal space. The home has a large fenced garden and there is ample parking area at the front. All the beds at Potton House are block purchased by the Primary Care Trust. Potton House Nursing Home DS0000017688.V334041.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was the first inspection for this home this year and Regulatory Inspector Louise Trainor carried it out on the 19th of April 2007 between the hours of 09:30 and 16:00 hours. The manager was present throughout the day to assist and support. During the inspection a full tour of the building took place. The care of three service users picked at random by the inspector, was tracked. This involved assessing the care documentation against the care provided to them, and seeking their views on the care they receive which was done through informal interviewing and observations. The inspector also had the opportunity to talk to visitors to the home. In addition three care staff were interviewed and three other staffs personal files were inspected. Care practices were observed on and off throughout the day, particularly across lunch- time. Other documentation and issues inspected and discussed during this visit included; training and supervision records for staff. Service User’s financial records, medication administration records, complaints, and the introduction of new person centred care- planning documentation. The inspector would like to thank everyone involved for their support and assistance throughout the day. What the service does well:
Care plans were clearly written and reviewed on a regular basis so that service users changing needs were met with continuity of care. All service user files contained numerous detailed care plans that had been generated from risk assessments. They had clear instructions for daily care and had all been reviewed and updated on a monthly basis. Wishes in the event of death were identified in this documentation. Daily reports were also reflective of the care plans. There is a complaints policy in place, which is summarised in the Service User Guide, and is on display in the reception area to ensure easy access to all services, staff and relatives.
Potton House Nursing Home DS0000017688.V334041.R01.S.doc Version 5.2 Page 6 There have been no formal complaints since the last inspection. The home operates an open visiting policy, and there were several visitors spending time with their loved ones throughout the day. The majority of the staff had attended POVA training, and staff that were interviewed were able to discuss what behaviours would constitute abuse and what they would do if abuse was suspected. The home appeared clean and well maintained. Communal lounges provide sufficient space for service users to relax comfortably and the smaller lounges provide more private areas for service users to go with their visitors if they prefer. The manager closely monitors the training of the staff and the training record indicates that all staff are up to date with the mandatory training such as moving and handling, and an induction programme is listed on the training statistics record. What has improved since the last inspection? What they could do better:
The communication skills of some staff were very poor which resulted in some care being carried out in silence with no explanations to these service users, most of who have dementia, as to what or why things were happening. Two carers were also observed to ‘drag lift’ a service user into a more upright position in his chair for dinner, despite the fact that he was sitting on a hoist sling. This is an unacceptable lift. Some service users are encouraged to make choices in this home however the majority of service users suffer with dementia and the choices for these people were either non existent or very restricted.
Potton House Nursing Home DS0000017688.V334041.R01.S.doc Version 5.2 Page 7 There is a four weekly menu in place, however unfortunately it appeared that if people using this service were unable to communicate verbally, they were not given a choice. Activities during the day appeared very limited, particularly for those service users that could not communicate verbally. The homes recruitment policy is closely adhered to so that service users are protected, however the poor communication skills of some staff may compromise the care delivered. There was no dementia training included on the present training record, and some care practices observed indicated that some of the staff on duty had very little idea of how to interact with the people who live in this home that suffer with dementia type illnesses. So although there are sufficient numbers of staff on duty in this home, the competencies surrounding dementia care are somewhat limited. Staff, service users and their representatives have confidence in the management of this home, however evidence indicates that the manager must be more proactive in order to eradicate the poor care practices witnessed during the inspection. 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. Potton House Nursing Home DS0000017688.V334041.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 Potton House Nursing Home DS0000017688.V334041.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, 3, 4, 5, 6 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There is a Statement of Purpose and Service User Guide in place, however these require reviewing so that service users and their representatives receive accurate information about the service so that informed choices can be made about the appropriateness of the home. EVIDENCE: The Statement of Purpose is still awaiting review. Therefore information for service users about this home is insufficient and out of date. Three service user files were picked at random by the inspector to be examined in more depth. Documentation was thorough in them all, however only one of the three contained a pre admission assessment. The most recent admission had come from another home owned by the same company. There was no evidence that this home had carried out their own assessment prior to
Potton House Nursing Home DS0000017688.V334041.R01.S.doc Version 5.2 Page 10 admission. This was discussed with the manager who stated that all prospective admissions are now assessed by a qualified nurse prior to admission and this had been an exception. Potton House Nursing Home DS0000017688.V334041.R01.S.doc Version 5.2 Page 11 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10, 11 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Care plans were clearly written and reviewed on a regular basis so that service users changing needs were met with continuity of care. However the approach to care delivery from some staff did not always appear respectful or dignified. EVIDENCE: The manager discussed recent training that she has done in preparation for the imminent introduction of new care plan documentation which is more service user friendly and will clearly evidence the involvement from service users and their families in all aspects of their care. However all service user files contained numerous detailed care plans that had been generated from risk assessments. They had clear instructions for daily care and had all been reviewed and updated on a monthly basis. Wishes in the event of death were identified in this documentation. Potton House Nursing Home DS0000017688.V334041.R01.S.doc Version 5.2 Page 12 One service user file contained care plans relating to; Dignity around incontinence, religion, personal hygiene, diet and nutrition, verbal aggression, concentration, inappropriate sexual behaviour and a recently written one for an incident where the service user had required stitches. These had all been written in correlation with risk assessments and were all being updated on a regular basis. Daily reports were also reflective of the care plans. Another service user’s care plans included one for pressure area care. The appropriate pressure relieving equipment was in place and the home receives supporting visits from the ‘tissue viability nurse’. Entries in this service users file from the ‘tissue viability nurse’ indicated that the wound was healing well. Care observations throughout this visit revealed a wide spectrum of care delivery standards. Some were of an excellent standard, however communication skills of some staff were very poor which resulted in poor outcomes for some service users, and some care being carried out in silence with no explanations to these service users, most of who have dementia, as to what or why things were happening. One carer was observed to feed a female service user her dinner in silence except for saying her name twice. This was totally unacceptable. This lady clearly needed a lot of encouragement to eat, and the carer was unable to provide that. The carer was then observed to hold a ‘feeder beaker’ of liquid to this service users mouth, barely giving her time to take a breath. Two carers were also observed to ‘drag lift’ a service user into a more upright position in his chair for dinner, despite the fact that he was sitting on a hoist sling. This is an unacceptable lift and again this care was carried out with very limited communication. These issues were addressed with the manager immediately. Medication Administration Charts were inspected. All service users had photographic identification and any allergies clearly documented on the sheets. Signature and omission codes had been recorded correctly, although it was difficult to distinguish the E s from the F s that made reconciliation with stocks difficult. The returns and disposal book was appropriately completed. The controlled drugs book was examined and all stocks and signatures corresponded correctly. The medication Policy had been reviewed as required in the last inspection report. Potton House Nursing Home DS0000017688.V334041.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Some service users are encouraged to make choices in this home however the majority of service users suffer with dementia and the choices for these people were either non existent or very restricted. EVIDENCE: There is a four weekly menu in place, however on the day of the inspection the inspector observed the midday meal being served. The two dishes available were; Spanish omelette or chicken pie, both served with vegetables or baked beans and mash. Unfortunately it appeared that if people using this service were unable to communicate verbally, they were not given a choice. Bowls containing liquidised food were removed from the hot trolley and given to staff, who then commenced feeding the individual service users. One or two staff communicated very well whilst delivering this service, however others were seen doing it in silence, so that service users were not even made aware of what they were eating. Food supplement drinks were being given to some service users, liquid thickeners were being used appropriately and seconds were being offered to some service users.
Potton House Nursing Home DS0000017688.V334041.R01.S.doc Version 5.2 Page 14 One member of staff confirmed that this is the usual procedure, She said. “Food is pureed and served in a bowl, if you can’t talk there is no choice really”. Activities during the day appeared very limited, particularly for those service users that could not communicate verbally. At 10:30 hours their were nine service users sitting in the lounge area, all but two were sleeping, and there was one member of staff present assisting someone with their breakfast. The television was on and there was a radio also on in the background. None of the service users were engaging with either of these. The activity programme for the day of the inspection identified; personal grooming – hand massage, radio, relaxation, music and crafts for the days activities. But there was little evidence of any of these, providing meaningful stimulation for the majority of service users during this visit. The home operates an open visiting policy, and there were several visitors spending time with their loved ones throughout the day. One relative said. “By enlarge the care has been outstanding here, the home has a touch of country friendliness and I see fresh food being delivered. The main problem seems to be with communication and sometimes the form of address is not considered, and they talk to them like children.” Potton House Nursing Home DS0000017688.V334041.R01.S.doc Version 5.2 Page 15 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is a complaints policy in place so that service users and their relatives are confident that their concerns will be listened to, taken seriously and acted upon in a timely way. EVIDENCE: There is a complaints policy in place, which is summarised in the Service User Guide, and is on display in the reception area to ensure easy access to all services, staff and relatives. There have been no formal complaints since the last inspection, and one relative indicated that the manager always addresses any concerns immediately, he told the inspector. “The manager is outstanding, if I raise a concern it is acted upon immediately. If you ask a question the staff will rush around to sort it out for you”. The majority of the staff had attended POVA training, and staff interviewed were able to discuss what behaviours would constitute abuse and what they would do if abuse was suspected. Potton House Nursing Home DS0000017688.V334041.R01.S.doc Version 5.2 Page 16 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 23, 24, 25, 26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. This home provides a clean, comfortable and homely environment for the people who live here, however some areas are still being used for inappropriate storage of equipment. EVIDENCE: The home appeared clean and well maintained. Communal lounges provide sufficient space for service users to relax comfortably and the smaller lounges provide more private areas for service users to go with their visitors if they prefer. Individual rooms are identified by a name and/ or a photograph on the door and decorated to individuals’ tastes. Some are furnished with personal assets that reflect the personal history of the people who live in them, however some appeared very bare.
Potton House Nursing Home DS0000017688.V334041.R01.S.doc Version 5.2 Page 17 The garden is well tended, and provides a safe area for service users to wander in the warmer weather. Bathrooms are plentiful however some are still being used as storage space. One bathroom had a hoist, a commode and a double linen skip in it, leaving very little room for manoeuvring if it were to be used. Another of the baths was found to have a blocked plughole and had been left with dirty water in it. This was reported to the manager and the problem resolved immediately. There appeared to be no shortage of moving and handling equipment around the home although the inspector did not witness this being used during this inspection. Hydraulic hospital beds are now in place in all bedrooms. Potton House Nursing Home DS0000017688.V334041.R01.S.doc Version 5.2 Page 18 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The homes recruitment policy is closely adhered to so that service users are protected, however the poor communication skills of some staff may compromise the care delivered. EVIDENCE: Three staff files were inspected, the recruitment procedure had been followed and all appropriate documentation was present. This included: fully completed application forms, interview notes, photographic identification, passports, birth and marriage certificates, contracts of employment, signed and dated, appropriate references, Enhanced Criminal Record Bureau (CRB) checks, POVA first checks and evidence of permission to work for overseas staff. Although the recruitment procedure is being followed it is still of some concern to the inspector, that staff that have a very poor command of the English language are being deemed suitable to deliver effective care to this specialist client group without more specific training. The manager closely monitors the training of the staff and the training record indicates that all staff are up to date with the mandatory training such as moving and handling, and an induction programme is listed on the training statistics record. However evidence seen by the inspector during this visit, did
Potton House Nursing Home DS0000017688.V334041.R01.S.doc Version 5.2 Page 19 not always support this. During the midday meal the inspector witnessed two male staff assist a service user to change position in his chair. This was done by an underarm draglift, which is totally unacceptable. The manager was made aware of this immediately. Communication skills of some staff were also very poor both in understanding conversation, and making themselves understood to the people they care for. The inspector noticed that there was no dementia training included on the present training record, and some care practices observed indicated that some of the staff on duty had very little idea of how to interact with the people who live in this home that suffer with dementia type illnesses. So although there are sufficient numbers of staff on duty in this home, the competencies surrounding dementia care are somewhat limited. Potton House Nursing Home DS0000017688.V334041.R01.S.doc Version 5.2 Page 20 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36, 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff, service users and their representatives have confidence in the management of this home, however evidence indicates that the manager must be more proactive in order to eradicate the poor care practices witnessed during the inspection. EVIDENCE: This home has an experienced manager that is committed to the people who live in this home, and is keen to promote a higher level of service user involvement. Relatives of people who live here have confidence in her leadership skills, and interviews with staff indicated that they also felt well supported by her, however as evidenced elsewhere in this report, there were several issues of
Potton House Nursing Home DS0000017688.V334041.R01.S.doc Version 5.2 Page 21 poor practice observed by the inspector during this inspection, which when raised with the manager, she appeared unaware of. These included, poor manual handling practices, poor communication skills and the impact they have on the care delivery, and complete lack of choice for those people who were unable to communicate verbally. The staffs’ individual supervision books were seen, and the supervision documented was very minimal. The manager stated that this was an area that required her attention. The records of monies kept by the home for people who live here were viewed. Three individuals’ records were picked at random by the inspector to be examined more closely. All transactions were clearly recorded with a date and signature. Receipts were present for all transactions, and all remaining funds balanced correctly with records. Quality assurance continues to be addressed by the manager who stated she is due to send out questionnaires to service users’ representatives. The results of the questionnaires from last year have now been used to produce a quality improvement plan for this service as was required from the previous inspection in May 2006. Potton House Nursing Home DS0000017688.V334041.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 X 2 2 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 1 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 1 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 2 2 2 3 3 3 STAFFING Standard No Score 27 2 28 2 29 2 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 2 2 X 3 1 X 2 Potton House Nursing Home DS0000017688.V334041.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP1 Regulation 4(1) 5(1)5(2) Requirement Statement of Purpose and the Service Users Guide must be reviewed to reflect the changes in the company’s management structure. These reviewed documents must be available to CSCI. The people who live at this home must be treated with dignity and respect at all times. The people who live in this home must be encouraged and assisted to make personal choices. Service users who are unable to communicate verbally, should be offered a visual choice of meals at mealtime. This requirement is unmet 01/08/06 Bathrooms and toilets must be kept clear of ‘clutter and not used as storage areas. This requirement is unmet 30/06/06 Staff in the home must be appropriately trained so that the specialist needs of the people
DS0000017688.V334041.R01.S.doc Timescale for action 01/08/07 2. 3. OP10 OP14 12(4)(a) 12(2) 31/05/07 31/05/07 4. OP15 16(2) 30/06/07 5. OP21 23(2) 30/06/07 6. OP30 18(1)(a) 01/08/07 Potton House Nursing Home Version 5.2 Page 24 7. OP36 18 8. OP33 24 who live in this home are appropriately met. Staff must be supervised six times a year. This requirement is unmet 01/08/06 The registered persons must ensure that a quality assurance system is ongoing and that improvement plans are implemented. 01/08/07 01/08/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP12 OP15 Good Practice Recommendations Care plans should reflect service users reaction to the activities provided. Different methods of offering service users with dementia a choice of meal should be considered. Potton House Nursing Home DS0000017688.V334041.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Bedfordshire & Luton Area Office Clifton House 4a Goldington Road Bedford MK40 3NF 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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